Trends in the survival of patients diagnosed with cancers in the respiratory system in the Nordic countries 1964-2003 followed up to the end of 2006

BACKGROUND

Previous studies have shown that there have been systematic differences between the Nordic countries in population-based relative survival of patients with respiratory cancer (lung, pleura, larynx, nose and sinuses).

MATERIAL AND METHODS

Relative survival of patients with respiratory cancer diagnosed in the Nordic countries in 1964-2003 and followed up to the end of 2006 was studied and contrasted with developments in incidence and mortality.

RESULTS

For cancer of the lung, relative survival is lower in Danish patients than in the other countries during the first months of follow-up after diagnosis. For cancer of pleura, the relative survival ratios indicate that there may be problems in the official coding of the causes of death in Denmark, Norway and Sweden. There has been little improvement in survival of patients with cancer of the respiratory organs in the Nordic countries over time.

CONCLUSIONS

The slightly lower survival of Danish lung cancer patients may be related to a less favourable stage distribution and to an increased prevalence of causal factors, affecting the mortality due to competing risks of death. A reclassification of official causes of death at the cancer registry may be needed for cancer of the pleura in order to make the corresponding mortality rates comparable between countries.

[Recurrent respiratory papillomatosis: update review]

This paper updates information on epidemiology, etiology, clinical features, surgical and anti-relapse treatment of recurrent respiratory papillomatosis in children.

Lung cancer patients with previous or simultaneous the upper aerodigestive cancers

There have been few reports on clinical characteristics of lung cancer patients with previous or simultaneous upper aerodigestive cancers. To evaluate them, we conducted a retrospective study. The medical records of all lung cancer patients at our division from January 1984 through July 2008 were reviewed. Twenty-one (1.7%) of 1242 patients had previous or simultaneous upper aerodigestive cancers. Twenty patients were smokers. For non-small cell lung cancer (NSCLC), 6 patients underwent surgical resection and 3 were treated with chemotherapy. Three small cell lung cancer (SCLC) patients had chemotherapy. None of the severe complication related to the comorbidities were observed. The median survival for NSCLC and SCLC patients was 15 and 6 months, respectively. For patients with upper aerodigestive cancers, smoking cessation, a chest radiograph or computed tomography scan at least yearly and swift evaluation of signs or symptoms that are suggestive of lung cancer should be recommended.

Human papilloma virus (HPV)-associated gynecological alteration in mothers of children with recurrent respiratory papillomatosis during long-term observation

BACKGROUND

Human papilloma virus (HPV) is one of the most frequently observed sexually transmitted infections. The study' purpose was to investigate the relation between a mother's gynecological history and the local status of her child with recurrent respiratory papillomatosis (RRP).

METHODS

Forty-two patients enrolled in a prospective multicenter study between 1983 and 1990. The study included patients with juvenile-onset and adult-onset RRP. All patients underwent surgery and treatment with alpha-interferon. Thirty-eight patients were followed up until 31.01.2006. Twenty-five mothers of these patients participated in a parallel prospective study of genital HPV infection. In 1989-1990, all received a routine gynecological examination, an expanded colposcopy, a Pap smear, and a cervical biopsy. The mothers were followed up until February 2006.

RESULTS

74% of patients with RRP were the first-born children. Five (20%) mothers had condylomata acuminata, newly diagnosed during pregnancy. Indicators of HPV infection such as koilocytes, koilocytotic dysplasia and condyloma acuminatum were revealed cytologically in 17% of cases and histologically in 71.4% of cases. Six (24%) of mothers had had a hysterectomy. HPV type 11 was prevalent in the children of mothers who had had a hysterectomy. Among the patients with juvenile-onset RRP, the death rate from squamous cell carcinoma of the lung was significantly higher in those patients whose mothers had a hysterectomy (p=0.028).

CONCLUSIONS

Mothers of patients with RRP demonstrated cytological and histological indicators of HPV infection in the genital tract. An adverse outcome of the disease in the child was associated with adverse gynecological history in the mother.

Cancer incidence and mortality in a Swedish rubber tire manufacturing plant

BACKGROUND

A classification of 12 work categories was used to evaluate the cancer incidence and mortality among a cohort of Swedish rubber tire workers.

METHODS

Cancer incidence and mortality in the cohort was compared with expected values from national rates. Standardized incidence and mortality ratios were calculated for the total cohort, for sub-cohorts and with the inclusion of a latency requirement.

RESULTS

Among men, increased incidence and mortality risks were found for cancer in the larynx; SIR=2.10; 95% confidence intervals (95% CI): 1.05-3.76, SMR=2.08; 95% CI: 0.42-6.09. Increased risks were also seen for cancer in the trachea, bronchus, and lung; SIR=1.62; 95% CI: 1.28-2.02, SMR=1.54; 95% CI: 1.21-1.94, the incidence risk was highest among those with the longest exposure duration and among workers in compounding/mixing, milling, and maintenance. Decreased incidence risks were seen for cancer of the prostate (SIR=0.74; 95% CI: 059-0.92) and skin (SIR=0.57; 95% CI: 0.36-0.84).

CONCLUSIONS

The finding of an excess of tumors in the respiratory system is in agreement with earlier findings in other studies on rubber tire workers. The results on other cancer types are compared to earlier findings and related to work processes and chemical exposures of possible causal importance.

The epidemiology and treatment of mesothelioma in South East England 1985-2002

OBJECTIVES

To describe trends in the incidence of mesothelioma for men and women in South East England and the geographical variation at the level of primary care trust. To describe treatment patterns by cancer network of residence, and relative survival by cancer network, disease stage and treatment modality.

METHODS

5753 cases were extracted from the Thames Cancer Registry database. We calculated age standardised incidence rates for each year, age specific incidence rates in 10 year age groups, and we used linear regression to compute the average annual percentage change in age standardised incidence. We used Poisson regression to analyse generational trends in incidence.

RESULTS

Men had five times higher incidence of mesothelioma than women. In men, there was an overall 4% increase per year between 1985 and 2002. Over the same period, the overall increase in incidence for women was 5% per year. The incidence was highest in men aged over 70 years, and men aged over 80 years had the highest increase of 8% per year. The incidence rate ratio increased for men born between 1892 and 1942 and started to slow for those born from 1947 onwards. Areas along the Thames and its estuary had the highest incidence. There was some variation by cancer network in the proportion of patients receiving cancer surgery, radiotherapy and chemotherapy. There were no discernable differences in relative survival by cancer network of residence or disease stage but those receiving combined treatment had higher 5 year survival.

CONCLUSIONS

Mesothelioma incidence has increased in South East England, particularly for men aged over 70 years. The highest incidence occurs along the Thames and its estuary, reflecting areas of asbestos use in shipbuilding and industry in the past. More research is needed to understand the interrelationships of prognostic factors, treatment choices and survival, and to determine the best care and support for these patients and their families.

Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study

BACKGROUND

Despite several lines of evidence suggesting the biological plausibility of marijuana being carcinogenic, epidemiologic findings are inconsistent. We conducted a population-based case-control study of the association between marijuana use and the risk of lung and upper aerodigestive tract cancers in Los Angeles.

METHODS

Our study included 1,212 incident cancer cases and 1,040 cancer-free controls matched to cases on age, gender, and neighborhood. Subjects were interviewed with a standardized questionnaire. The cumulative use of marijuana was expressed in joint-years, where 1 joint-year is equivalent to smoking one joint per day for 1 year.

RESULTS

Although using marijuana for > or =30 joint-years was positively associated in the crude analyses with each cancer type (except pharyngeal cancer), no positive associations were observed when adjusting for several confounders including cigarette smoking. The adjusted odds ratio estimate (and 95% confidence limits) for > or =60 versus 0 joint-years was 1.1 (0.56, 2.1) for oral cancer, 0.84 (0.28, 2.5) for laryngeal cancer, and 0.62 (0.32, 1.2) for lung cancer; the adjusted odds ratio estimate for > or =30 versus 0 joint-years was 0.57 (0.20, 1.6) for pharyngeal cancer, and 0.53 (0.22, 1.3) for esophageal cancer. No association was consistently monotonic across exposure categories, and restriction to subjects who never smoked cigarettes yielded similar findings.

CONCLUSIONS

Our results may have been affected by selection bias or error in measuring lifetime exposure and confounder histories; but they suggest that the association of these cancers with marijuana, even long-term or heavy use, is not strong and may be below practically detectable limits.

Second neoplasms after oesophageal cancer

The authors considered the incidence of second neoplasms among 1,672 oesophageal cancers diagnosed between 1974 and 2004 in the Cancer Registries of the Swiss Cantons of Vaud and Neuchâtel, and followed-up to 2004. A total of 141 second neoplasms were observed versus 38.5 expected, corresponding to a standardized incidence ratio (SIR) of 3.7 (95% confidence interval: 3.1-4.3). The SIRs were statistically significant for cancers of the oral cavity and pharynx (57.3), larynx (24.3), lung (6.6) and intestines (2.6). The SIRs were higher in subjects diagnosed below age 50 and in the first year after diagnosis. The SIR of upper digestive and respiratory tract neoplasms was higher for oesophageal cancers diagnosed in the upper (87.5) and middle (68.1), as compared with the lower third (19.4). There was no rise of second oral, pharyngeal and laryngeal cancer with advancing age, and their incidence tended indeed to decline from 100/1,000 at age 40-49 to 25/1,000 at age 70-79. There was no tendency to rise with age in the incidence of first oesophageal cancer in subjects who subsequently developed another upper digestive or respiratory tract neoplasm. The excess risks of upper digestive and respiratory tract neoplasms are attributable to increased diagnosis and registration of second neoplasms following a diagnosis of oesophageal cancer, as well as to heavy tobacco and alcohol consumption in oesophageal cancer cases. The absence of rise in incidence with age is also compatible with the existence of a subset of the population of susceptible individuals.

[Tobacco smoking and multiple primary cancers]

Seventy six patients (55 males and 21 females) aged from 39 to 89 (mean 63.7 +/- 9.7) years with multiple primary cancers were described. Larynx cancer was the most commonly seen multiple primary cancer component (35.5%) followed by lung cancer (12.5%). Combination of larynx cancer and lung cancer was the most often observed connection (21.1%). In seventeen patients two cancers were diagnosed concurrently. In other cases the interval between two cancers varied from 1 to 24 (mean 6.9 +/- 6.1) years. Smoking rate was 80.3% at diagnosis of the second cancer and only 10 patients (13.1%) quit smoking when first cancer was recognized. The results of the research indicate the necessity of conducting wide prophylactic actions.

[The assessment of age-standardised cancer incidence rates in the chosen organ systems]

Age-standardised cancer incidence rates in reproductive system, digestive system and respiratory system were analyzed taking into account the statistics for 38 States of USA (1996-2001), European Union (2006) and Europe (2006). Age-standardized incidence rate in the reproductive system was higher in comparison with the corresponding rates for digestive and respiratory systems. The authors put under discussion a hypothesis of this phenomenon.

Occupational exposures to polycyclic aromatic hydrocarbons, and respiratory and urinary tract cancers: a quantitative review to 2005

BACKGROUND

Exposure to polycyclic aromatic hydrocarbons (PAHs) has been reported in several industries, including those of the aluminum production, coal gasification, coke production, iron and steel foundries, coal tar and related products, carbon black and carbon electrodes production.

PATIENTS AND METHODS

This paper reviews the results from cohort studies conducted on workers exposed to PAHs in these industries, with a focus on cancers of the respiratory and urinary tract.

RESULTS

An excess risk from lung/respiratory cancers was found in most industries, the pooled relative risk (RR) being 2.58 (95% CI 2.28-2.92) for coal gasification, 1.58 (95% CI 1.47-1.69) for coke production, 1.40 (95% CI 1.31-1.49) for iron and steel foundries, 1.51 (95% CI 1.28-1.78) for roofers and 1.30 (95% CI 1.06-1.59) for carbon black production. The evidence for cancers of the bladder and of the urinary system is less consistent, with a significant increased risk only for workers in aluminum production (pooled RR = 1.29, 95% CI 1.12-1.49), coal gasification (pooled RR = 2.39, 95% CI 1.36-4.21), and iron and steel foundries (pooled RR = 1.29, 95% CI 1.06-1.57).

CONCLUSIONS

Increased risks from lung and bladder cancers were found in PAH-related occupations. These were modest in most industries, apart from those for coal gasification, and whether they are due at least partially to some bias or confounding remains open to discussion.

Assessment of respiratory carcinogenicity associated with exposure to metallic nickel: a review

Human studies prior to 1990 have shown an association between respiratory cancer and exposure to some nickel compounds, but not to metallic nickel. Numerous reviews have examined the nature of the association between nickel compounds and respiratory cancer, but little has been published on metallic nickel. This paper reviews the animal and human cancer-related data on metallic nickel to determine whether the conclusions regarding metallic nickel reached a decade ago still apply. Based upon past and current human studies, metallic nickel appears to show little evidence of carcinogenicity when present at the same or higher concentrations than those seen in current workplace environments. By comparison, animal studies currently available have shown mixed results. A number of studies have shown evidence of carcinogenicity in animals exposed to nickel powders via injection, but other studies have shown no or inconsistent results in animals exposed via inhalation or intratracheal instillation. Further studies in animals via inhalation and humans would be helpful in elucidating the respiratory carcinogenic potential of metallic nickel.

Clinical course of thoracic cancers in Hodgkin's disease survivors

BACKGROUND

Hodgkin's disease survivors have a high risk of subsequently developing thoracic cancers. Our goal was to evaluate the prognosis and treatment outcomes of thoracic cancers after Hodgkin's disease.

PATIENTS AND METHODS

Thirty-three patients treated for Hodgkin's disease at Harvard-affiliated hospitals subsequently developed small-cell lung carcinoma, non-small-cell lung carcinoma (NSCLC) or mesothelioma. Information was obtained from medical records about the initial treatment for Hodgkin's disease, any salvage therapy, smoking history, and the stage, histology, treatment and survival for thoracic cancers.

RESULTS

Of the 33 patients, 29 (88%) had a history of radiotherapy to the thorax, 17 (52%) had received alkylating chemotherapy, and 24 (73%) had a known history of smoking. The median time between diagnosis of Hodgkin's disease and diagnosis of thoracic cancer was 17.3 years (range 1.2-27.9 years). Among patients with NSCLC and a known stage, 85% presented with stage III or stage IV disease. Among patients whose treatment details were available, 40% underwent surgery, 40% received radiotherapy and 65% received chemotherapy. The median survival was 9 months (range 1-47 months).

CONCLUSIONS

Most patients with thoracic cancers after Hodgkin's disease have a history of exposure to risk factors and present at an advanced stage. Patients with thoracic cancers after Hodgkin's disease have a poor survival.

Epidemiology of alcohol-associated cancers

Alcohol, especially in combination with smoking, is a well-established risk factor for cancers of the oral cavity and pharynx, esophagus, and larynx, with 25% to 80% of these cancers being attributable to alcohol. Rates of these cancers in the United States have been decreasing in recent years, possibly because of reductions in cigarette smoking and alcohol use. Chronic alcohol consumption has been linked with increased risk of liver cancer in epidemiologic studies. However, the rising rates of this cancer in the United States are most likely due to the increasing prevalence of chronic hepatitis B and C infections. Epidemiologic evidence has linked light to moderate intake of alcohol to cancers of the colorectum and female breast. These cancers are common in developed countries, so even small increases in risk can have important public health implications. Although results of most epidemiologic studies have provided little or no support for a causal relation between light and moderate alcohol use and risk of pancreatic cancer, a possible role of heavy alcohol consumption cannot be ruled out. Further studies of these cancers are needed to clarify the role of type of alcoholic beverage, the role of alcohol concentration, and the dose-response curve at low concentrations of alcohol. Future research also should be designed to promote the use of uniform ways to report alcohol intake and uniform measures for analysis, to include the investigation of alcohol-associated cancer risks in U.S. minority populations, to enhance experimental work to better understand the underlying mechanisms through which alcohol promotes carcinogenesis, and to develop preventive strategies.

[Epidemiologic and radiobiologic features of neoplasms in respiratory and gastrointestinal tracts among patients who had occupational contact with uranium]

Morbidity structure among workers engaged into main production of nuclear industry had prevailing lung cancer (1.93 per 1,000), gastric carcinoma (1.09) and colon cancer (0.72). The lung cancer patients demonstrated the highest concentrations of uranium in lung tissue (0.8313 g/g) and liver tissue (0.3548 g/g); those with gastric carcinoma and of reference group--in lung radix nodes (0.1855 and 0.3685 g/g respectively).

[Occupational cancers in Poland, 1995-2003]

BACKGROUND

The aim of this paper is to present current data on the incidence of occupational cancer in Poland.

MATERIALS AND METHODS

This work is based on the information collected from forms reporting cases of occupational diseases in 1995-2003, received by the Central Register of Occupational Diseases run by the Nofer Institute of Occupational Medicine, Łódź, Poland. During that period, 1124 cases of cancer were registered.

RESULTS

Occupational cancer was diagnosed in 125 people per year on the average. The occupational cancer cases made 1.4% of all occupational diseases. In individual years, the contribution of occupational cancer showed the upward trend. The most frequent tumor sites were: lung (51.6%), larynx (18.9%), pleura (7.6%), urinary bladder (6.0%), lymphatic and hemopoietic tissues (3.9%), skin (3.7%). Asbestos was specified as a causal factor of every third case (32.8% of reported cases) of occupational cancer: 38.9% of lung tumors, 25.6% of larynx tumors and all pleural mesotheliomas. Occupational exposure to polycyclic aromatic hydrocarbons and ionising radiation was responsible for 10.8% of tumors each. Polycydic aromatic hydrocarbons were recorded as a causal factor of 15.4% of pulmonary, 10.6% of laryngeal, 12.8% of dermal, and 11.4% of lymphatic and hemopoietic tissue tumors, while ionising radiation for 12.8% of pulmonary, 23.1% of dermal, and 22.7% of lymphatic and hemopoietic tissue cancers. Males formed the majority (90.5%) of patients with diagnosed occupational cancer. Pulmonary (52.7%) and laryngeal (20.1%) cancers were the most frequent tumors in men. Among women, pulmonary cancer also occupied the first place (41.1%) and was followed by pleural mesothelioma (21,5%).

CONCLUSIONS

The proportion of malignant tumors in the overall number of occupational diseases shows the upward trend. Due to long latency period of the disease, the recorded cases reflect exposures of long time ago.

Occurrence of cancer among people with mental health claims in an insured population

OBJECTIVE

The objective of this research is to determine whether people with mental disorders are at increased risk for the subsequent development of malignancies compared with people without mental disorders.

METHODS

This is a retrospective cohort study of administrative claims data. The study population included 722,139 adults who filed at least one medical claim from 1989 to 1993. The mental disorder cohort included people with a) one psychiatric hospitalization, b) one outpatient psychiatrist visit, or c) two outpatient mental health claims occurring at least 6 months before a cancer claim. The controls were subjects filing claims for medical services who had no mental health visits. We calculated age-stratified odds ratios (ORs) for development of malignancy.

RESULTS

People with mental disorders were no more or less likely to develop a malignancy than those without after adjusting for age (women: OR, 1.03; 95% confidence interval [CI], 0.95-1.12; men: OR, 1.10; 95% CI, 0.97-1.24). People with mental disorders, however, developed cancer at younger ages and had increased odds of primary central nervous system tumors (women: OR, 2.12; 95% CI, 1.40-3.21; men: OR, 2.09; 95% CI, 1.22-3.59) and respiratory system cancers (women: OR, 1.57; 95% CI, 1.13-2.19; men: OR, 1.52; 95% CI, 1.09-2.12).

CONCLUSIONS

Insured people with mental disorder claims had an increased risk of certain malignancies and developed malignancies at younger ages. The increased odds of respiratory tumors are likely secondary to increased rates of smoking among people with mental disorders and support use of smoking cessation interventions in this population. The increased odds for brain tumors may reflect only the early presence of mental symptoms, or a true association between the two conditions. Further study of these findings is mandated.

Cancer incidence among union carpenters in New Jersey

A cohort of 13,354 male union carpenters in New Jersey was linked to cancer registry data to investigate cancer incidence during 1979 through 2000. Surveillance, Epidemiology and End Results data were used to calculate standardized incidence ratios (SIRs). A total of 592 incident cancers were observed among this cohort (SIR=1.07), which was not statistically in excess. However, significant excesses were observed for cancers of the digestive system and peritoneum (SIR=1.24) and the respiratory system (SIR=1.52). Workers in the union more than 30 years were at significant risk for cancers of the digestive organs and peritoneum (SIR=3.98), rectum (SIR=4.85), trachea, bronchus, and lung (SIR=4.56), and other parts of the respiratory system (SIR=11.00). Testicular cancer was significantly in excess (SIR=2.48) in analyses that lagged results 15 years from initial union membership. Additional etiologic research is needed to evaluate possible occupational and nonoccupational risk factors for testicular cancer.

Historical Cohort Study of U.S. Man-Made Vitreous Fiber Production Workers IX: Summary of 1992 Mortality Follow Up and Analysis of Respiratory System Cancer Among Female Workers

We report the 1946-1992 mortality experience of 4008 females employed in any of 10 U.S. fiberglass manufacturing plants between 1945 and 1978 relative to external population rates. We also examine respiratory system cancer (RSC) mortality as a function of estimated exposure to respirable fibers (RFib), formaldehyde (FOR), silica, phenolics, urea, and other agents based on internal cohort comparisons. No statistically significantly elevated standardized mortality ratios were observed for all-cause mortality (930 deaths), any of the 25 nonmalignant causes considered, all malignant neoplasms (266 deaths), or any of the 27 malignant causes considered. Internal cohort comparisons revealed no significant positive associations between RSC mortality (53 cases) and exposure to RFib, FOR, or any of the other agents considered, although exposure levels were generally low. Some demographic subgroups appear to be at relatively increased risk of RSC.

Glutathione S-transferase M1 or T1 null genotype as a risk factor for developing multiple primary neoplasms in the upper aero-digestive tract, in Indian males using tobacco

In this study conducted amongst Indian male tobacco users with upper aero-digestive tract (UADT) squamous carcinoma, 30 patients with multiple primary neoplasms (MPN) were compared with 28 age and sex matched patients with a single primary neoplasm (SPN) for various environmental factors (form of tobacco use, alcohol, radiotherapy for index cancer) and genetic parameters (family history of UADT cancers and GSTT1/GSTM1 genotype). The GSTM1/T1 null genotype, seen in 60% patients with MPN versus 33% patients with SPN (P=0.03) had an odds ratio of 3.7 [CI=1.14-11.99; P=0.03] for developing MPN. Tobacco use in the form of smoking with or without chewing, as opposed to only chewing, and regular alcohol intake were the two other factors with almost three fold increased risk for the development of MPN, although, the effect was not statistically significant. All three patients with a family history of UADT cancer developed MPN, suggesting an inherited predisposition.

Predictors of Remission in Juvenile-Onset Recurrent Respiratory Papillomatosis

OBJECTIVE

To determine factors associated with remission of juvenile-onset recurrent respiratory papillomatosis (JORRP).

DESIGN

Longitudinal study.

SETTING

Twenty-two tertiary care centers located across the United States.

STUDY PARTICIPANTS AND METHODS

The study included 165 patients diagnosed as having JORRP between January 1, 1997, and December 31, 2000. Kaplan-Meier curves and Cox proportional hazards models were used to determine associations between predictors and remission.

INTERVENTIONS

Surgical excision and drug therapy.

MAIN OUTCOME MEASURES

Remission of JORRP, defined as no surgical procedures for at least 1 year, as associated with age at diagnosis, drug therapy in the first year after diagnosis, number of surgical procedures in the first year after diagnosis, and number of anatomical sites of disease at diagnosis. Demographic factors (sex and race) and Medicaid status were also evaluated.

RESULTS

Older age at diagnosis was positively associated with remission of JORRP (hazards ratio for every increase of 1 year in age, 1.13; 95% confidence interval, 1.03-1.23).

CONCLUSIONS

Younger children were found to have persistent disease and often underwent an increased number of surgical procedures in the first year after diagnosis of JORRP. Sex and race were not important factors in determining remission.