A multipurpose TNM stage ontology for cancer registries

Background

Population-based cancer registries are a critical reference source for the surveillance and control of cancer. Cancer registries work extensively with the internationally recognised TNM classification system used to stage solid tumours, but the system is complex and compounded by the different TNM editions in concurrent use. TNM ontologies exist but the design requirements are different for the needs of the clinical and cancer-registry domains. Two TNM ontologies developed specifically for cancer registries were designed for different purposes and have limitations for serving wider application. A unified ontology is proposed to serve the various cancer registry TNM-related tasks and reduce the multiplication effects of different ontologies serving specific tasks. The ontology is comprehensive of the rules for TNM edition 7 as required by cancer registries and designed on a modular basis to allow extension to other TNM editions.

Results

A unified ontology was developed building on the experience and design of the existing ontologies. It follows a modular approach allowing plug in of components dependent upon any particular TNM edition. A Java front-end was developed to interface with the ontology via the Web Ontology Language application programme interface and enables batch validation or classification of cancer registry records. The programme also allows the means of automated error correction in some instances. Initial tests verified the design concept by correctly inferring TNM stage and successfully handling the TNM-related validation checks on a number of cancer case records, with a performance similar to that of an existing ontology dedicated to the task.

Conclusions

The unified ontology provides a multi-purpose tool for TNM-related tasks in a cancer registry and is scalable for different editions of TNM. It offers a convenient way of quickly checking validity of cancer case stage information and for batch processing of multi-record data via a dedicated front-end programme. The ontology is adaptable to many uses, either as a standalone TNM module or as a component in applications of wider focus. It provides a first step towards a single, unified TNM ontology for cancer registries.

Impact of the first wave of the COVID-19 pandemic on cancer registration and cancer care: a European survey

Background

The coronavirus disease COVID-19 pandemic posed a number of challenges to the oncology community, particularly the diagnosis and care of cancer patients while ensuring safety from the virus for both patients and professionals: minimization of visits to the hospital, cancellation of the screening programmes and the difficulties in the management and operation of cancer registries (CRs) while working remotely. This article describes the effects in the medium term of the first wave of the COVID-19 pandemic on cancer registration in Europe, focusing on changes in cancer detection and treatment, possible reduction of CR resources and difficulties in the access to data sources.

Methods

A questionnaire was distributed in June 2020 to the directors of 108 CRs from 34 countries affiliated to the European Network of Cancer Registries, providing a 37% response rate.

Results

The results of the survey showed that cancer-screening programmes were mostly stopped or slowed down in the majority of regions covered by the respondent CRs. Cancer diagnostics and treatments were severely disrupted. The cancer registration process was also disrupted, due to changes in the work modalities for the personnel, as well as to the difficulties in accessing sources and/or receiving the notifications. In some CRs, staff was allocated to different activities related to controlling the pandemic. Several CRs reported that they were investigating the impact of COVID-19 on cancer care via dedicated studies.

Conclusions

A careful analysis will be necessary for proper interpretation of temporal and geographical variations of the 2020 cancer burden indicators.

The European cancer burden in 2020: Incidence and mortality estimates for 40 countries and 25 major cancers

INTRODUCTION

Europe is an important focus for compiling accurate and up-to-date world cancer statistics owing to its large share of the world's total cancer burden. This article presents incidence and mortality estimates for 25 major cancers across 40 individual countries within European areas and the European Union (EU-27) for the year 2020.

METHODS

The estimated national incidence and mortality rates are based on statistical methodology previously applied and verified using the most recently collected incidence data from 151 population-based cancer registries, mortality data and 2020 population estimates.

RESULTS

Estimates reveal 4 million new cases of cancer (excluding non-melanoma skin cancer) and 1.9 million cancer-related deaths. The most common cancers are: breast in women (530,000 cases), colorectum (520,000), lung (480,000) and prostate (470,000). These four cancers account for half the overall cancer burden in Europe. The most common causes of cancer deaths are: lung (380,000), colorectal (250,000), breast (140,000) and pancreatic (130,000) cancers. In EU-27, the estimated new cancer cases are approximately 1.4 million in males and 1.2 million in females, with over 710,000 estimated cancer deaths in males and 560,000 in females.

CONCLUSION

The 2020 estimates provide a basis for establishing priorities in cancer-control measures across Europe. The long-established role of cancer registries in cancer surveillance and the evaluation of cancer control measures remain fundamental in formulating and adapting national cancer plans and pan-European health policies. Given the estimates are built on recorded data prior to the onset of coronavirus disease 2019 (COVID-19), they do not take into account the impact of the pandemic.

An ontology-based approach for developing a harmonised data-validation tool for European cancer registration

Background

Population-based cancer registries constitute an important information source in cancer epidemiology. Studies collating and comparing data across regional and national boundaries have proved important for deploying and evaluating effective cancer-control strategies. A critical aspect in correctly comparing cancer indicators across regional and national boundaries lies in ensuring a good and harmonised level of data quality, which is a primary motivator for a centralised collection of pseudonymised data. The recent introduction of the European Union’s general data-protection regulation (GDPR) imposes stricter conditions on the collection, processing, and sharing of personal data. It also considers pseudonymised data as personal data. The new regulation motivates the need to find solutions that allow a continuation of the smooth processes leading to harmonised European cancer-registry data. One element in this regard would be the availability of a data-validation software tool based on a formalised depiction of the harmonised data-validation rules, allowing an eventual devolution of the data-validation process to the local level.

Results

A semantic data model was derived from the data-validation rules for harmonising cancer-data variables at European level. The data model was encapsulated in an ontology developed using the Web-Ontology Language (OWL) with the data-model entities forming the main OWL classes. The data-validation rules were added as axioms in the ontology. The reasoning function of the resulting ontology demonstrated its ability to trap registry-coding errors and in some instances to be able to correct errors.

Conclusions

Describing the European cancer-registry core data set in terms of an OWL ontology affords a tool based on a formalised set of axioms for validating a cancer-registry’s data set according to harmonised, supra-national rules. The fact that the data checks are inherently linked to the data model would lead to less maintenance overheads and also allow automatic versioning synchronisation, important for distributed data-quality checking processes.

Estimated Cancer Incidence and Mortality in Europe for the year 2020

Background

Up-to-date cancer burden indicators are essential to support political decision making, to enable epidemiological research and as an information source for citizens. Nevertheless, observed cancer incidence and mortality suffer from an endemic registration delay in the data production workflow. To overcome this, the European Commission's Joint Research Centre in collaboration with the WHO's International Agency for Research on Cancer have computed estimates of cancer incidence and mortality, for the year 2020 and for European countries, in the framework of the European Cancer Information System (ECIS).

Methods

Predicted values for the year 2020 are based on the incidence data of more than 150 European population-based cancer registries included in the ECIS, and on the WHO mortality database. According to previously developed and applied methodology, the estimates of 2020 cancer incidence and mortality rates were produced for 40 European countries, on the basis of the most recent time trends of observed data, where possible. Estimated rates were then applied to the projected 2020 population from EUROSTAT, to calculate the predicted number of new cases and deaths for 2020 in each European country.

Results

The number of new cancer cases and deaths in 2020 has been estimated per country by sex and age group, for 25 major cancer sites. The results are included and disseminated through the ECIS web application (https://ecis.jrc.ec.europa.eu/).

Conclusions

The release of up-to-date cancer incidence and mortality estimates is of crucial importance in supporting evidence-based EU cancer policies. The homogeneity of the estimation methods applied throughout Europe guarantees the comparability of the estimated values between countries. Reliable and comparable estimates enable highlighting differences between countries in cancer incidence and mortality, thus facilitating the identification of possible intervention areas.

Key messages

The EC’s JRC, in collaboration with WHO’s IARC, have computed estimates of cancer incidence and mortality for the year 2020 for European countries, in the framework of the ECIS. The number of new cancer cases and deaths in 2020 has been estimated in 40 European countries for 25 major cancer sites and included in the ECIS web application (https://ecis.jrc.ec.europa.eu/).

Burden of cancer and human exposure to chemicals

Cancer has important impacts on the EU's health systems and economies, with around 3 million new patients diagnosed each year. However, up to 40% of cancers are attributed to preventable causes. For these reasons, cancer is one of the main priorities of the EC in the health domain.

The new Europe's Beating Cancer Plan of the EC, to be launched at the end of 2020, aims to support EU Member States to improve cancer control and care, by proposing actions at every key stage of the disease: prevention (lifestyle, pollution, vaccination), diagnosis, treatment and survivorship. Reliable cancer statistics are essential to propel both epidemiological research and political decision making, and provide the supporting evidence to allow assessment of best practices in all those key stages. To this purpose, the European Cancer Information System (ECIS), built on European population-based cancer registries' data, provides the latest information on indicators that quantify the burden of cancer in Europe. It permits the exploration of geographical patterns and temporal trends of incidence, mortality and survival by granting access to harmonised and validated cancer incidence data.

Population-based cancer registries have been essential in many of the epidemiological studies that led to the identification of several carcinogens in the work place as well as those linked to certain lifestyle habits such as tobacco and alcohol consumption. However, In conditions of low exposure, the identification of cancer hazards has remained largely inconclusive, due to the unavailability of sufficient exposure data and appropriate models that can account for multiple exposures over extended periods.

The linkage between cancer registries data and administrative databases, biobanks, environmental data and extensive lifestyle questionnaires could help identifying or consolidate the available information on emerging carcinogens and populations at risk, thus allowing the development of preventable measures.

Cancer registries - guardians of breast cancer biomarker information: A systematic review

BACKGROUND

Breast cancer is the most common cancer and the leading cause of cancer-related death in females, with a large societal and economic impact. Decisions regarding its treatment are largely affected by the categorization into different subtypes with hormone receptor status and HER2 status being the most important predictive factors. Other biological markers play an important role for prognostic and predictive reasons. The data collection and harmonization of cancer cases are performed by cancer registries whose collection of parameters largely differs, partially including results from biomarker testing.

METHODS

This systematic literature review consisting of a total of 729 reports determined whether information about biomarker testing in breast cancer cases is collected and published by cancer registries worldwide.

RESULTS

The number of publications using breast cancer biomarker data from registries steeply rose with the beginning of the 21st century and some hospital-based and population-based cancer registries reacted with immediate collection of biomarker data following the recommendation of clinical guidelines. For female breast cancer, biomarkers have achieved an essential clinical value and this review points to a steady increase in the collection of biomarker data by cancer registries during the last decade.

CONCLUSIONS

In the future, recommendations for biomarker data collection and coding by cancer registries may be required to ensure harmonization and comparability of the data.

Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018

INTRODUCTION

Europe contains 9% of the world population but has a 25% share of the global cancer burden. Up-to-date cancer statistics in Europe are key to cancer planning. Cancer incidence and mortality estimates for 25 major cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for Europe and the European Union (EU-28) for 2018.

METHODS

Estimates of national incidence and mortality rates for 2018 were based on statistical models applied to the most recently published data, with predictions obtained from recent trends, where possible. The estimated rates in 2018 were applied to the 2018 population estimates to obtain the estimated numbers of new cancer cases and deaths in Europe in 2018.

RESULTS

There were an estimated 3.91 million new cases of cancer (excluding non-melanoma skin cancer) and 1.93 million deaths from cancer in Europe in 2018. The most common cancer sites were cancers of the female breast (523,000 cases), followed by colorectal (500,000), lung (470,000) and prostate cancer (450,000). These four cancers represent half of the overall burden of cancer in Europe. The most common causes of death from cancer were cancers of the lung (388,000 deaths), colorectal (243,000), breast (138,000) and pancreatic cancer (128,000). In the EU-28, the estimated number of new cases of cancer was approximately 1.6 million in males and 1.4 million in females, with 790,000 men and 620,000 women dying from the disease in the same year.

CONCLUSION

The present estimates of the cancer burden in Europe alongside a description of the profiles of common cancers at the national and regional level provide a basis for establishing priorities for cancer control actions across Europe. The estimates presented here are based on the recorded data from 145 population-based cancer registries in Europe. Their long established role in planning and evaluating national cancer plans on the continent should not be undervalued.

Variability of cancer risk within an area: time to complement the incidence rate

The aim of this study was to show that age-adjusted cancer incidence rates for an area may not be representative of the incidence in subareas. We propose a simple measure to show the amount of geographical variability. European age-standardized incidence rates (ASRs) for 'all sites excluding nonmelanoma skin cancer', for men, in 2014, for Nordic countries as a whole, for each country (Denmark, Faroe Islands, Finland, Greenland, Iceland, Sweden and Norway) and for their regions, were retrieved from the Nordcan with corresponding standard errors SEs. We compared the ASR for Nordic countries versus single country and single country versus specific regions. The overlapping of 95% confidence intervals was used for ASRs comparisons. As a measure of variability, we computed the range between the highest and the lowest ASR within an area and the ratio between this range and the ASR of the overall area, r/R=(range/ASR)×100. The 95% confidence interval of the ASR for Nordic countries as a whole did not overlap those of the majority of the single countries; in fact, the r/R - which provides a clue for the amount of underlying geographical variability - was rather large (57.1%). Within countries, the variability was negligible in Iceland (r/R=9.6%), whereas the highest value was found in Sweden (37.1%). The ASR does not provide any information on underlying geographical variability. Therefore, its interpretation could be misleading. When data for subareas are available, the r/R, which is simple to compute and to understand, should be added to the ASR for providing more truthful information.

Postmenopausal hormone therapy-also use of estradiol plus levonorgestrel-intrauterine system is associated with an increased risk of primary fallopian tube carcinoma

Data on the possible impact of postmenopausal hormone therapy (HT) on the incidence of rare primary fallopian tube carcinoma (PFTC) are scarce. Therefore, we conducted a nationwide case-control study analyzing the association between the use of different HTs and PFTC. All women aged 50 years or older with an incident PFTC (n = 360) during 1995-2007 were identified from the Finnish Cancer Registry. For each case of PFTC, ten age- and place of residence-matched controls were selected from the Finnish National Population Register, which also provided information on parity. Data on HT purchases were received from the Prescription Register, and data on hysterectomies and sterilizations from the National Care Register. Controls with a salpingectomy before the PFTC diagnosis of the respective case were excluded. The PFTC risk in relation to different HTs was estimated with a conditional logistic regression model, adjusted for parity, age at last delivery, hysterectomy and sterilization. The use for five years or more of estradiol combined with levonorgestrel-releasing-intrauterine system (odds ratio 2.84, 95% confidence interval 1.10-7.38) and sequential estradiol-progestin therapy (EPT; 3.37; 2.23-5.08) were both linked with increases in the risk of PFTC, while the risk with use of estradiol-only therapy or continuous EPT was not statistically significantly increased. The OR for the use of tibolone for one year or more was 1.56 (0.55-4.41). The use of HT is related to an increased risk of PFTC, particularly when a progestin component is intrauterine or systemic progestin is given in sequential manner.

Pregnancy incidence and outcome before and after cervical intraepithelial neoplasia: a retrospective cohort study

We performed a retrospective cohort study of 3530 women treated for cervical intraepithelial neoplasia (CIN) in Helsinki University Central Hospital, Finland, to investigate whether CIN treatment itself affects pregnancy incidence and outcome. We estimated the incidence of live births, miscarriages, extrauterine pregnancies, molar pregnancies, and termination of pregnancies (TOPs) before and after CIN treatment using nationwide registers. Women were followed up until death, emigration, sterilization, or the end of 2004. The comparison of incidence of pregnancy outcomes before and after the treatment was estimated by calculating hazard ratios (HRs) with conditional Poisson regression. After 76,162 woman-years of follow-up, the incidence of any pregnancy remained constant over CIN-treatment, HR 1.02 and 95% confidence interval (CI) 0.97-1.08, but the incidence of the first pregnancy was significantly elevated after treatment, HR 1.13, and 95% CI 1.03-1.23. The incidence of live births was significantly elevated after treatment, HR 1.08 and 95% CI 1.01-1.15. Incidence of miscarriages, TOPs, extrauterine pregnancies, and molar pregnancies was not elevated. TOPs was significantly increased in the first pregnancy, HR 1.40, 95% CI 1.15-1.72 and after treatment by the loop electrosurgical excision procedure (LEEP), HR 1.36, 95% CI 1.15-1.60. CIN treatment did not reduce pregnancy incidence and women had more live births after than before CIN treatment. TOPs was more common in the first pregnancy or after treatment by LEEP. We encourage research on the psychosocial consequences of CIN treatment also in other countries and settings.

Pulmonary function following allogeneic stem cell transplantation in childhood: a retrospective cohort study of 51 patients

HSCT is associated with a high risk of late morbidity. The aim of this study was to evaluate the frequency, time frame, risk factors, and possible etiology of pulmonary dysfunction following allogeneic HSCT in childhood. We evaluated the pulmonary function of 51 HSCT patients (>6 yr), by including FVC and FEV1 values prior to (baseline) and annually up to five yr after HSCT. A Cox proportional hazards model was used to analyze the risk factors for a pulmonary event. Over half (59%) of the patients developed pulmonary dysfunction, mainly consisting of restrictive abnormalities. Acute GvHD (HR 4.31, 95% CI 1.47-12.63), chronic GvHD (HR 10.20, 95% CI 2.42-43.03), and an abnormal baseline pulmonary function (HR 4.82, 95% CI 1.02-22.84) were associated with post-transplant dysfunction. FEV1 (p < 0.001) and FVC (p < 0.001) declined significantly by 12 months after HSCT and both remained below the pre-HSCT level at up to four yr post-transplantation. HSCT in childhood is associated with early and persistent restrictive impairment of pulmonary function. Patients with extensive chronic GvHD are particularly vulnerable to severe pulmonary dysfunction. Scheduled pulmonary function testing is warranted as part of the follow-up of survivors of HSCT in childhood.

Breast carcinoma detection modes and death in a female population in relation to population-based mammography screening

Purpose

Associations between population-based screening, breast carcinoma detection modes and breast carcinoma death have not been studied using nationwide data at individual level. We evaluated these in Finland, where invitational age is gradually expanding from 50–59 to 50–69 years in 2008–2017. We also predicted breast carcinoma patterns in 2020 to assess the impact of changing invitational policy on breast carcinoma incidence and mortality.

Methods

The data included breast carcinomas in 2000–2010 (n = 48 040), and deaths due to these carcinomas (n = 4722). We divided carcinomas into those detected before or after the screening age, and those detected at the screening age. The latter was further divided into screen-detected and interval carcinomas, and carcinomas in the non-attendees. The prediction of future patterns was based on incidence data from the ten-year period 1998–2007 preceding the period of expanding invitational age in the national programme.

Results

Approximately 13% of in situ carcinomas were detected before, 29% after, and 57% at the screening age. In invasive cancers, the percentages were 16%, 42%, and 42%, respectively. At the screening age, more than half of invasive cancers were screening-detected, one quarter interval cancers, and one out of six cancers in the non-attendees. Almost 60% of breast cancer deaths were due to cancers detected after the screening age. By 2020, breast cancers detected at the screening age will increase from 42% to 65%, and breast cancers detected by screening from 23% to 38%.

Conclusions

The study demonstrates a novel approach to examine associations between breast carcinoma incidence and mortality within and outside population-based screening. The results show mammography screening having a distinct role in overall breast carcinoma incidence and mortality.

Electronic supplementary material

The online version of this article (doi:10.1186/2193-1801-3-348) contains supplementary material, which is available to authorized users.

Stillbirth, early death and neonatal morbidity among offspring of female cancer survivors

BACKGROUND

Increased awareness of the adverse effects of cancer treatments has prompted the development of fertility preserving regimens for the growing population of cancer survivors who desire to have children of their own.

MATERIAL AND METHODS

We conducted a registry-based study to evaluate the risk of stillbirth, early death and neonatal morbidity among children of female cancer survivors (0-34 years at diagnosis) compared with children of female siblings. A total of 3501 and 16 908 children of female cancer patients and siblings, respectively, were linked to the national medical birth and cause-of-death registers.

RESULTS

The risk of stillbirth or early death was not significantly increased among offspring of cancer survivors as compared to offspring of siblings: the risk [Odds Ratio (OR)] of early neonatal death, i.e. mortality within the first week was 1.35, with a 95% confidence interval (CI) of 0.58-3.18, within 28 days 1.40, 95% CI 0.46-4.24 and within the first year of life 1.11, 95% CI 0.64-1.93 after adjustment for the main explanatory variables. All these risk estimates were reduced towards one after further adjustment for duration of pregnancy. Measures of serious neonatal morbidity were not significantly increased among the children of survivors. However, there was a significant increase in the monitoring of children of cancer survivors for neonatal conditions (OR 1.56, 95% CI 1.35-1.80), which persisted even after correcting for duration of pregnancy, that might be related to parental cancer and its treatment or increased surveillance among the children.

CONCLUSION

Offspring of cancer survivors were more likely to require monitoring or care in a neonatal intensive care unit, but the risk of early death or stillbirth was not increased after adjustment for prematurity. Due to the rarity of the mortality outcomes studied, collaborative studies may be helpful in ruling out the possibility of an increased risk among offspring of cancer survivors.

Pregnancy incidence and outcome among patients with cervical intraepithelial neoplasia: a retrospective cohort study

OBJECTIVE

To investigate the effect of cervical intraepithelial neoplasia (CIN) treatment on incidence of pregnancy and pregnancy outcome.

DESIGN

Retrospective cohort study.

SETTING

Helsinki University Central Hospital, Finland, the sole reference centre in the Helsinki-Uusimaa region for women referred for colposcopy.

POPULATION

A cohort of 6179 women treated for CIN between 1974 and 2001, and a randomly selected, age- and municipality-matched, reference population of 30,436 women.

METHODS

Based on nationwide registers, all women were followed-up for pregnancy outcomes until death, emigration, sterilization, or until the end of 2004.

MAIN OUTCOME MEASURES

Incidence of any pregnancy, livebirths, miscarriages, extrauterine pregnancies, molar pregnancies, and terminations of pregnancies (TOPs) before and after CIN treatment, estimated by calculating hazard ratios (HRs) with stratified Cox regression and Poisson regression.

RESULTS

After CIN treatment, both incidence of pregnancy (HR 1.20; 95% CI 1.15-1.26; P < 0.001) and incidence of livebirths (HR 1.12; 95% CI 1.06-1.18; P < 0.001) were higher among the treated women than among the reference population. Before treatment, only incidence of pregnancy had been elevated among those treated (HR 1.06; 95% CI 1.04-1.09; P < 0.001). The incidence of extrauterine pregnancies and of TOPs was significantly elevated among those treated both before and after CIN treatment.

CONCLUSIONS

No clear evidence emerged of adverse effects resulting from the CIN treatment itself, because the women treated had more pregnancies and more children than their reference population. TOPs and extrauterine pregnancies were more common among the treated women already before the CIN treatment.

Future lung cancer incidence in Poland and Finland based on forecasts on hypothetical changes in smoking habits

OBJECTIVE

the aim is to estimate the future lung cancer incidence in Poland and Finland based on forecasts on hypothetical changes in smoking habits.

MATERIAL AND METHODS

data on population, lung cancer and smoking prevalence come from known sources. The simulation model utilized for forecasting was based on smoothing the smoking habit - specific risk ratios estimated for males and females in Europe.

RESULTS

depending on the analyzed scenario in 2030 in Poland mortality rates among men would range from 8 to 125/10(5) and among women from 7 to 47/10(5); in Finland among men 5 to 60/10(5) and among women 4 to 22/10(5).

CONCLUSIONS

the results obtained clearly indicate that cutting down on the number of smokers translates directly into a considerable reduction of the lung cancer incidence rate.

Preterm delivery among female survivors of childhood, adolescent and young adulthood cancer

We studied the deliveries of female cancer survivors and female siblings in a population-based setting in Finland. Nationwide cancer and birth registries were merged to identify 1,309 first postdiagnosis deliveries of early-onset (diagnosed under age 35) female patients with cancer and 5,916 first deliveries of female siblings occurring in 1987-2006. Multiple logistic regression models were used to estimate risk of preterm (<37 weeks), low birth weight (<2500 g) and small-for-gestational-age deliveries. The risk of preterm delivery among cancer survivors compared with siblings was overall increased [odds ratio (OR) 1.46, 95% confidence interval (CI) 1.14-1.85], the increase in risk being visible in all diagnostic age groups. Risk of low birth weight (LBW) was also significantly increased (OR 1.68; 95% CI 1.29-2.18) but not after adjustment for duration of pregnancy (OR 1.11; 95% CI 0.76-1.64). Neither was the risk of small-for-gestational-age (SGA) increased. The risk of preterm delivery was most pronounced in survivors delivering 10 years or more after diagnosis. Site-specific analyses indicated that survivors of germ cell tumors and central nervous system (CNS) tumors were at increased risk of preterm delivery, although numbers were small. In childhood survivors, kidney tumors formed the main cause of preterm delivery. Pediatric, adolescent and young adult cancer survivors are at risk for preterm delivery. Heightened surveillance is recommended especially for Wilms', germ cell and CNS tumor survivors. Such adverse pregnancy outcomes can occur a decade or more after cancer diagnosis, indicating a continued need for obstetric awareness, surveillance and counseling in former patients with cancer.

A case-control study on hormone therapy as a risk factor for breast cancer in Finland: Intrauterine system carries a risk as well

The purpose of this study was to evaluate the association between postmenopausal hormone therapy (HT) and the risk for breast cancer in recently postmenopausal Finnish women. All Finnish women with first invasive breast cancer diagnosed between the ages of 50 and 62 years during 1995-2007 (n = 9,956) were identified from the Finnish Cancer Registry. For each case, 3 controls of the same age were retrieved from the Finnish Population Register. The cases and controls were linked to the national medical reimbursement register to assess the use of HT. The odds ratios (ORs) and 95% confidence intervals (CIs) for breast cancer were calculated with conditional logistic regression analysis, adjusting for parity, age at the first birth and health care district. Estradiol-only therapy (991 users with breast cancer, n) or oral progestagen (n = 138) was not accompanied by an increased risk. Estradiol-progestagen therapy (EPT) (n = 1,731) was associated with an elevated risk in the whole series (OR 1.36; 95% CI 1.27-1.46). The risk became detectable in less than 3 years of use. Continuous EPT use tended to be associated with a higher risk for breast cancer than the sequential EPT use. The use of tibolone (n = 80) (1.36; 1.15-1.96), a levonorgestrel-releasing intrauterine system (LNG-IUS) alone (n = 154) (1.45; 1.97-1.77) or as a complement to estradiol (n = 137) (2.15; 1.72-2.68) was also associated with an increased risk. The association between HT use and the risk for breast cancer shows a large variation between various forms of HT, and also the use of LNG-IUS may carry a risk.

Probability of parenthood after early onset cancer: a population-based study

We evaluated in a population-based setting the postdiagnosis parenthood among survivors compared with the fertility patterns of siblings. Cancer patients aged 0-34 years at diagnosis were identified from the Finnish Cancer Registry (N = 25,784), and their siblings (N = 44,611) by registry linkage. Further linkage identified the offspring of the patient and sibling cohorts. The relative probabilities of parenthood for first and second births separately were estimated for male and female survivors in different diagnostic age-groups and subsites using a Cox proportional hazards model, with age as the time variable and adjusting for the birth cohort of parents. In addition, estimates were calculated for 5 diagnostic eras in all subsites combined. Compared to siblings, both female and male cancer survivors were less likely to parent at least 1 child (RR 0.46, 95% CI 0.44-0.48 and RR 0.57, 95% CI 0.54-0.60, respectively). The relative probability of parenthood was especially low in male childhood cancer survivors and female young adult cancer survivors. However, cancer patients were only slightly less likely than siblings to parent a second child, with RR 0.91, 95% CI 0.86-0.97 and RR 0.95, 95% CI 0.89-1.01 for females and males, respectively. The relative probability of parenthood increased over calendar time among young adult cancer patients. The relative probability of parenthood following early onset cancer was overall significantly reduced by approximately 50%. Parenting a second child, however, was not reduced among pediatric and adolescent survivors, and only slightly reduced among early adulthood cancer survivors compared to siblings.

Prevalence of oncogenic human papillomavirus infection in an organised screening population in Finland

A persistent high-risk human papillomavirus (hrHPV) infection is a necessary condition for developing a cervical intraepithelial neoplasia and cervical cancer. The viral aetiology in cervical carcinogenesis has stimulated attempts to use HPV DNA detection in cervical cancer screening. In Finland there is an ongoing study assessing the benefits of primary HPV DNA testing in the setting of centrally organised mass screening for cervical cancer. Here we present the age-specific prevalence of hrHPV infection and associated sociodemographic factors of 16,895 women aged 25-65 years attending the 5-yearly cervical cancer screening between years 2003 and 2004. The overall hrHPV prevalence rate was 7.5%. The peak prevalence at the age group of 25-29 was 24.1% decreasing steadily thereafter to approximately 2.9% in women aged 65 years. Young age and marital status were the main determinants for oncogenic HPV types. Our study confirms the inverse relationship between age and hrHPV prevalence reported in many developed countries. As our prevalence rates and hence background risk for cervical cancer are not lower than in other European countries, it is likely that our lowest cervical cancer burden in Europe is due to health care actions justifying the organised cervical cancer screening.

Baseline psychosocial predictors of survival in localized melanoma

OBJECTIVE

There is no certainty about the contributing factors or the psychological processes involved in cancer progression. Many studies have suffered from poor theoretical basis, methodological flaws, and only one or few psychosocial factors investigated at a time. We examined the simultaneous contribution of several theory-based psychosocial elements to survival time in melanoma.

METHODS

A consecutive sample of patients with localized (Clarke II-IV) melanoma (N=59) were evaluated with validated questionnaires on coping with cancer, anger expression, perceived social support, noncancer life stresses, and domains of quality of life (QOL) 3-4 months after diagnosis. Cox regression analyses were used to determine the predictors of survival time from the date of diagnosis to the date of death or the last follow-up.

RESULTS

After controlling for age, gender, and Breslow depth for the tumor, the baseline psychological variables related to the cancer-prone Type C response pattern, namely, anger nonexpression (repression), hopelessness, and better single-item self-reported QOL predicted shorter survival. Before hopelessness was added to the model, the amount of depressive symptoms and heavy perceived impact of diagnosis were also predictive. In addition, longer survival was strongly predicted by Cognitive Escape-Avoidance coping, which included items close to the concept of denial/minimizing.

CONCLUSION

Anger nonexpression, hopelessness, and overpositive reporting of QOL--all proposed to include in the Type C response style or reflect emotional nonexpression--seem to comprise a set of factors that reduce survival, whereas denial/minimizing response to the diagnosis as such predicts longer survival.

Cancer free survival after CIN treatment: Comparisons of treatment methods and histology

OBJECTIVE

Cervical cancer is one of the most lethal cancers among women worldwide. Women are treated and followed-up in several different manners. Long-term studies of cancer or death risks after different methods of treatment or after different initial histology are scarce.

METHODS

A retrospective cohort study with 7466 women treated of CIN between 1974 and 2001 in Helsinki University Hospital followed-up until the end of 2003. The Cox model was used to determine differences in cancer free or overall survival between women treated of CIN with different methods or after different initial grade of CIN.

RESULTS

Twenty-two cases of invasive cervical cancer (ICC) and 57 cases of CIN 3 after treatment of CIN were observed. There were no statistically significant differences in ICC free survival between different treatment methods or initial grade of CIN. In CIN 3 free survival, the hazard ratios for the 57 cases of CIN 3, when cold knife coagulation (CKC) was set as the reference, were 0.22 for laser, 0.55 for cryotherapy and 0.31 for LEEP. In CIN 3+ (CIN 3 or ICC) free survival, the hazard ratios of 79 CIN 3+ cases (CKC reference) were 0.25 for laser, 0.50 for cryotherapy and 0.27 for LEEP. There were no differences in overall survival between different grades of initial CIN.

CONCLUSIONS

The CKC seems to be the least favorable in terms of both further cancer and CIN 3 risk. The follow-up has to be well organized because the post-treatment cancer risk is independent of the initial grade of CIN.

Baseline psychosocial predictors of survival in localised breast cancer

Despite the large number of studies on the impact of psychosocial factors on breast cancer progression, there is no certainty about the contributing factors or processes involved. We investigated the relative impacts of socioeconomic, psychological, and psychosocial factors on survival in breast cancer. A consecutive sample of 102 patients (participation 82%) under 72 years of age with locoregional breast cancer completed validated questionnaires on coping with cancer, emotional expression (anger), perceived available support, noncancer life stresses, and quality of life 3-4 months after diagnosis. Survival times were measured from the date of diagnosis to the date of relapse and further to the date of death or date of last follow-up. Cumulative Cox regression analyses were carried out. After controlling for biological prognostic factors, age, and baseline treatment, longer survival was predicted by a long education and a minimising-related coping, while shorter survival was predicted by emotional defensiveness (antiemotionality), behavioural-escape coping, and a high level of perceived support. A shorter event-free time was also predicted by unemployment and depressive symptoms. Cancer survival is affected by a complex combination of psychosocial factors, among which minimising predicts a favourable prognosis and anger nonexpression and escape behaviour an unfavourable prognosis. Higher socioeconomic status is associated with longer survival. High scores in well-being scales may reflect emotional nonexpression.

Comparison of different approaches to incidence prediction based on simple interpolation techniques

The paper compares three different methods for performing disease incidence prediction based on simple interpolation techniques. The first method assumes that the age-period specific numbers of observed cases follow a Poisson distribution and the other two methods assume a normal distribution for the incidence rates. The main emphasis of the paper is on assessing the reliability of the three methods. For this purpose, ex post predictions produced by each method are checked for different cancer sites using data from the Cancer Control Region of Turku in Finland. In addition, the behaviour of the estimators of predicted expected values and prediction intervals, crucial for investigation of the reliability of prediction, are assessed using a simulation study. The prediction method making use of the Poisson assumption appeared to be the most reliable of the three approaches. The simulation study found that the estimator of the length of the prediction interval produced by this method has the smallest coverage error and is the most precise.

A simple non-linear model in incidence prediction

A simple model is proposed for incidence prediction. The model is non-linear in parameters but linear in time, following models in environmental cancer epidemiology. Assuming a Poisson distribution for the age and period specific numbers of incident cases approximate confidence and prediction intervals are calculated. The major advantage of this model over current models is that age-specific predictions can be made with greater accuracy. The model also preserves in the period of prediction the age pattern of incidence rates existing in the data. It may be fitted with any package which includes an iteratively reweighted least squares algorithm, for example GLIM. Cancer incidence predictions for the Stockholm-Gotland Oncological Region in Sweden are presented as an example.

Evaluation of certain risk factors for lung cancer in Cracow (Poland)--a case-control study

The relationship of lung cancer risk to cigarette smoking, occupational exposure, air pollution at permanent residence and usual frequency of consumption of fruits and vegetables was analysed in a case control study in Cracow, Poland. The cases were 176 male lung cancer patients diagnosed in 1992-1994 with histological confirmation of the diagnosis, obtained from the population-based Cracow Cancer Registry, and 341 controls randomly selected from the general population. Classification of exposure to outside air pollution was based on measured level of total suspended particular matter and sulphur dioxide by particular districts of town (from 1973 to 1980). Except calculation of odds ratios for male lung cancer associated with exposures among all study subjects, the association between lung cancer risk and frequency of consumption of fruit and vegetables was examined among drinkers of vodka above average. Risk of lung cancer was increased significantly with increasing number of pack-years of smoking (OR = 18.7 for more than 40 pack-years). The significant inverse association of frequent usual consumption of boiled vegetables was present both among all subjects and among vodka drinkers (OR = 4.6 and 12.5, respectively, for a rare consumption). The risk of male lung cancer was negatively associated with the level of air pollution but positively with the percentage of occupationally exposed. Our study provides no evidence of a significant harmful effect of air pollution and found a strong inverse association between frequent fruit and vegetables consumption and lung cancer risk.

Cancer survival in Estonian migrants to Sweden

OBJECTIVE

To quantify the eventual extra loss of life incurred to cancer patients in Estonia compared with those in Sweden that was possibly attributable to differences in society.

DESIGN

Population based survival of cancer patients in Estonia was compared with that of Estonian immigrants to Sweden and that of all cancer patients in Sweden. The cancer sites studied were female breast and ovary, male lung and prostate, and male and female stomach and colon.

SETTING

Data on incident cases of cancer were obtained from the population based Swedish and Estonian cancer registries.

PARTICIPANTS

Data from Estonian patients in Sweden, Estonian patients in Estonia, and patients from the total Swedish population were included in the study.

MAIN RESULTS

Differences in survival among the three populations, controlling for follow-up time and age at diagnosis, were observed in breast, colon, lung, ovarian, and prostate cancers. The survival rates of Estonians living in Sweden and the total population of Sweden were better than that of the Estonians living in Estonia. For cancers of the breast and prostate, the excess mortality in the older age group (75 and above) was much greater in Estonia than in the other populations.

CONCLUSIONS

Most differences in cancer survival between Estonian and Swedish populations studied could be attributed to a longer delay in diagnosis, and also to inferior treatment (including access to treatment) in Estonia compared with Sweden. Estonia's lag in socioeconomic development, particularly in its public health organisation and funding, is probably the main source of the differences observed.

[Ovarian cancer and selected life style habits]

Analysis of population based case-control study performed in Cracow Poland in 1988-1990 on 81 cases of histologically proven epithelial ovarian cancer and 162 age matched controls have shown that frequent consumption of legumes was associated with significantly decreased risk. Smoking and drinking of vodka were not significant related to ovary cancer risk.