The assessment of path linearity in swimming: a pilot study

The lateral-medial displacement (LF) and the overall drift from a straight path (DT) were quantified and compared in 5 top-level (TLS) and 5 low-level (LLS) crawl swimmers. Sixteen repetitions of 25-m crawl at increasing intensity were performed and videotaped. The performances were divided into 3 intensities (< 80 %, 80 - 90 % and > 90 % of maximal speed). LF was expressed as overlength swum (OLS) and coefficient of variation (CV) of the Z-component movement. OLS revealed a significant main effect for swimmer level (p < 0.01), intensity (p < 0.01) and their interaction (0.48, 0.37, 0.31-m for TLS and 0.47, 0.43, 0.44-m for LLS, p < 0.05). CV was significantly higher in LLS at the lowest (0.69 vs. 0.22, p < 0.05) and highest intensity (0.71 vs. 0.33, p < 0.05). DT, expressed as the slope of the linear regression of position data vs. time, was significantly higher in LLS only at the highest intensity (0.025 vs. 0.013, p < 0.05). The amount of dissipated energy due to LF, quantified by means of discrete Fourier analysis, revealed a difference only when the 0 - 5 Hz and 5 - 10 Hz spectral windows were analysed separately. While LF has a practical significance since it contributes to increase drag, DT is negligible at least for short-distance events.

Survival differences between European and US patients with colorectal cancer: role of stage at diagnosis and surgery

BACKGROUND

Population based colorectal cancer survival among patients diagnosed in 1985-89 was lower in Europe than in the USA (45% v 59% five year relative survival).

AIMS

To explain this difference in survival using a new analytic approach for patients diagnosed between 1990 and 1991.

SUBJECTS

A total of 2492 European and 11 191 US colorectal adenocarcinoma patients registered by 10 European and nine US cancer registries.

METHODS

We obtained clinical information on disease stage, number of lymph nodes examined, and surgical treatment. We analysed three year relative survival, calculating relative excess risks of death (RERs, referent category US patients) adjusted for age, sex, site, surgery, stage, and number of nodes examined, using a new multivariable approach.

RESULTS

We found that 85% of European patients and 92% of US patients underwent surgical resection. Three year relative survival was 69% for US patients and 57% for European patients. After adjustment for age, sex, and site, the RER was significantly high in all 10 European populations, ranging from 1.07 (95% confidence interval 0.86-1.32) (Modena, Italy) to 2.22 (1.79-2.76) (Thames, UK). After further adjustment for stage, surgical resection, and number of nodes examined (a determinant of stage), RERs ranged from 0.77 (0.62-0.96) to 1.59 (1.28-1.97). For some European registries the excess risk was small and not statistically significant.

CONCLUSIONS

US-Europe survival differences in colorectal cancer are large but seem to be mostly attributable to differences in stage at diagnosis. There are wide variations in diagnostic and surgical practice between Europe and the USA.

The EUROCARE-3 database: methodology of data collection, standardisation, quality control and statistical analysis

The EUROCARE database contains data on 6.5 million cancer patients diagnosed from 1978 to 1994 in populations covered by 67 cancer registries in 22 European countries. The quality-checked entries specify age, sex, diagnosis date, cancer site, morphology, microscopic confirmation and vital status, as well as containing broad indicators of stage. For EUROCARE-3, which refers to diagnoses from 1990 to 1994, 3389 cases with major data problems and 142,525 second or subsequent cancers were removed, leaving more than 2 million cases for analysis. From these data, observed and relative survival for each cancer site and country were calculated at 1, 3 and 5 years from diagnosis. Overall European survival for each cancer site and for all cancers combined were calculated combining country-specific survival figures. Overall, 1.1% of cases were lost to follow-up, 4.2% were known from death certificates only and 1.2% were known at autopsy only. The percentage of microscopically confirmed cases varied with cancer site and country, and was always higher in northern European countries. Comparison of quality indicators for the EUROCARE-3 database with earlier EUROCARE databases indicates that data quality and standardisation have improved.

EUROCARE-3: survival of cancer patients diagnosed 1990-94--results and commentary

EUROCARE-3 analysed the survival of 1815584 adult cancer patients diagnosed from 1990 to 1994 in 22 European countries. The results are reported in tables, one per cancer site, coded according to the International Classification of Diseases (ICD)-9 classification. The main findings of the tables are summarised and commented on in this article. For most solid cancers, wide differences in survival between different European populations were found, as also reported by EUROCARE-1 and EUROCARE-2, despite a remarkable (10%) overall increase in cancer survival from 1985 to 1994. Survival was highest in northern Europe (Sweden, Norway, Finland and Iceland), and fairly good in central-southern Europe (France, Switzerland, Austria and Spain). Survival was particularly low in eastern Europe, low in Denmark and the UK, and fairly low in Portugal and Malta. The mix of tumour stage at diagnosis explains much of the survival differences for cancers of the digestive tract, female reproductive system, breast, thyroid, and also skin melanoma. For tumours of the urinary tract and prostate, the differences were explained mainly by differences in diagnostic criteria and procedures. The case mix by anatomic subsite largely explains differences in survival for head and neck cancers. For oesophagus, pancreas, liver and brain cancer, with poor prognoses, survival differences were limited. Tumours, for which highly effective treatments are available, such as testicular cancer, Hodgkin's lymphoma and some haematological malignancies, had fairly uniform survival across Europe. Survival for all tumours combined (an indicator of the overall cancer care performance of a nation's health system) was better in young than old patients, and better in women than men. The affluence of countries influenced overall cancer survival through the availability of adequate diagnostic and treatment procedures, and screening programmes.

Adenocarcinoma of ethmoid sinus: an occupational disease

Sinonasal tumours, particularly those of ethmoidal origin, are rare neoplasms, of which adenocarcinoma is the most frequent histotype in Europe. The association between sinonasal malignancies and exposure to wood or leather dusts has been widely documented, however, the precise tumour site and histology has seldom been reported. In the present study, exposure to wood or leather dusts was investigated in 499 patients diagnosed with sinonasal tumours, who were treated at the Head and Neck Surgery Department of the National Cancer Institute of Milan, Italy, between 1987 and 2001. The original tumour site and histology were carefully assessed. Of the 499 patients evaluated, 249 had ethmoidal tumours; 124 of which adenocarcinomas, affecting 115 males; 9 females. Of the males with adenocarcinoma, 90.4% had been exposed to wood or leather dusts; 16.3% of these had only been exposed for a short time and long before onset of the disease (median exposure 11 years; median latency 31 years). Of the remaining 125 patients with ethmoidal tumours other than adenocarcinomas, only 2 (1.6%) had ever been exposed to these dusts. Non-ethmoidal sinonasal tumours were seen in 250 cases; 17 of these (6.8%) were adenocarcinomas; no exposure to wood or leather dusts was reported in any of these patients. Ethmoid proved to be the sinonasal site affected by adenocarcinomas induced by exposure to wood or leather dusts. Even brief exposure, which may have occurred a very long time before onset of the disease, seems to be sufficient to increase the incidence of this tumour type. No significant correlation was observed between exposure and either non-ethmoidal sinonasal neoplasms or ethmoidal tumours other than adenocarcinomas.

Colon cancer prevalence and estimation of differing care needs of colon cancer patients

BACKGROUND

Cancer prevalence-the proportion of people in a population with a diagnosis of cancer-includes groups with widely differing cancer care needs. We estimated the proportions of the prevalent colon cancer cases requiring initial care, terminal care and follow-up.

PATIENTS AND METHODS

Prevalence by year since diagnosis was estimated from incidence and vital status data on 243,471 colon cancer cases collected by EUROPREVAL from 36 European population-based cancer registries. The proportions of cured and fatal cases were estimated by applying 'cure' survival models to the dataset. The proportion of recurrence-free cases was estimated by analysis of a representative sample of 278 colon cancer patients from the Lombardy Cancer Registry (LCR), northern Italy.

RESULTS

The proportions of total prevalence requiring initial care was estimated at 12% in the LCR and 10% in Italy and Europe. Recurrence-free patients formed 89% of the total prevalence in the LCR and 91% in Italy and Europe. Eleven per cent (LCR) and 9% (Italy, Europe) of the total prevalence had recurred and consisted of patients in the terminal phase of their illness.

CONCLUSIONS

In 1992, 660,000 people were living with a diagnosis of colon cancer in Europe. We have estimated the proportions of this prevalence requiring particular types health care in the years following diagnosis, providing data useful for planning the allocation of health-care resources.

Differences in colorectal cancer survival between European and US populations: the importance of sub-site and morphology

A previous study has shown a lower survival for colorectal cancer in Europe than in the United States of America (USA). It is of interest to examine the extent to which anatomical location and morphological type influence this difference in colorectal cancer survival. We analysed survival for 151,244 European and 53,884 US patients diagnosed with colorectal cancer aged 15-99 years during the period of 1985-1989, obtained from 40 cancer registries that contribute to the EUROCARE study from 17 countries, and nine Surveillance, Epidemiology and End-Results (SEER) registries in the USA. Cases included in the analysis were first primary malignant tumours (ICD-O behaviour code 3 or higher). Relative survival was estimated to correct for competing causes of mortality. The Hakulinen-Tenkanen multiple regression approach was used to examine the prognostic impact of sub-site and ICD-O histology codes. Relative excess risks (RERs) derived from this approach estimate the extent to which the hazard of death differs from that in a reference region after adjustment for mortality in the general population. In order to explore geographical variation, we defined three groups of European registries within which survival rates were known to be broadly similar. The proportion of cases with unspecified sub-site was higher in Europe than the USA (10% versus 2%), but sub-site distributions were broadly similar in the two populations. With the exception of appendix, 5-year survival was 13-22% higher in the USA than in Europe for each anatomical sub-site. The proportion of non-microscopically-verified cases was higher in Europe than the USA (16 versus 3%). Adenocarcinomas arising in a polyp (ICD-O-2 8210, 8261, 8263) were more frequent in the USA than Europe (13 versus 2%). Five-year survival was higher in the USA than Europe for each morphological group, with the exception of non-microscopically-verified cases. When age, gender and sub-site were considered, RERs ranged from 1.52 to 2.40 for the European populations (with the USA as a reference). After inclusion of morphology codes, the range of RERs fell to between 1.28 and 1.86, mainly because of the high frequency of adenocarcinoma in polyps in the USA. This analysis suggests that the large survival advantage for colorectal cancer patients in the USA can only marginally be explained by differences in the distribution of sub-site and morphology. The main explanatory difference is the proportion of adenocarcinoma in polyps.

Childhood cancer survival in Europe

BACKGROUND

EUROCARE-3 collected data from 45 population-based cancer registries in 20 countries on 24 620 European children aged from 0 to 14 years diagnosed with malignancy in the period 1990-1994.

METHODS

Five-year survival between countries was compared for all malignancies and for the major diagnostic categories, adjusting for age, and estimated average European survival weighting for differences in childhood populations.

RESULTS

For all cancers combined, survival variation was large (45% in Estonia to 90% in Iceland), and was generally low (60-70%) in eastern Europe and high (> or =75%) in Switzerland, Germany and the Nordic countries (except Denmark). The Nordic countries had the highest survival for four of the seven major tumour types: nephroblastoma (92%), acute lymphoid leukaemia (85%), CNS tumours (73%) and acute non-lymphocytic leukaemia (62%). The eastern countries had lowest survival: 89% for Hodgkin's disease, 71% for nephroblastoma, 68% for acute lymphoid leukaemia, 61% for non-Hodgkin's lymphoma, 57% for central nervous system (CNS) tumours and 29% for acute non-lymphocytic leukaemia.

CONCLUSIONS

The Nordic countries represent a survival gold standard to which other countries can aspire. Since most childhood cancers respond well to treatment, survival differences are attributable to differences in access (including referral and timely diagnosis) and use of modern treatments; however, the obstacles to access and application of standard treatments probably vary markedly with country.

Cancer survival in European adolescents and young adults

Survival of patients aged 15-24 years, diagnosed with cancer during the period of 1990-1994, is described within Europe. Data on 15101 patients, extracted from the files of the 56 adult cancer registries included in the EUROCARE-3 database, representing 20 European countries, were analysed and compared. Five-year survival for 'all cancers combined' was 75% in males (ranging from 59% in Estonia to 89% in Iceland), and 78% in females (ranging from 59% in Estonia to 89% in Norway). The Northern European countries (except Denmark) and Austria had the highest survival figures, while survival in the Eastern European countries was lower than the European average. Denmark, UK, and the pool of the central European countries, had intermediate survival figures. Haemopoietic tumours were the most common malignancies: 5-year survival was high for Hodgkin's disease (89%), intermediate for non-Hodgkin's lymphoma (68%) and lower for acute lymphoblastic leukaemia (ALL) (47%) and acute myeloblastic leukaemia (AML) (39%). Five-year survival for gonadal germ cell cancers, the second most common malignancy in young adults, was 90%. Five-year survival for the other cancers under consideration was as follows: 89% for skin melanoma, 66% for all Central Nervous System (CNS) tumours, 57% for bone tumours, 58% for osteosarcoma, 42% for Ewing's sarcoma, 57% for soft-tissue sarcomas, 99% for thyroid carcinoma, 82% for uterine cervical carcinoma, and 83% for ovarian carcinoma. For more 'adult-specific tumours', 5-year survival was good for colon (77%) and lung (60%) cancers, and less favourable, compared with adults, for breast cancer (68%). Adolescents (15-19 years) had significantly worse survival than young adults (20-24 years) for all malignancies combined. Survival for Hodgkin's lymphoma, CNS tumours, melanoma and colon cancer showed marked regional variability. Since many of the tumours occurring in young adults are curable, these results should encourage, without delay, efforts to identify obstacles to improving outcome and reducing geographical inequalities in survival for this group of patients.

Comparison of stomach cancer incidence and survival in four continents

The aim of this study was to compare stomach cancer incidence and survival rates between four very distinct areas: Campinas (Brasil), Latin America, Iowa (USA), Northern America, Varese (Italy), Europe and Osaka (Japan) in Asia, and determine which of the differences are due to variations in the case mix and which are due to the care received. A proportional hazards regression method was applied to the relative survival rates to obtain geographical differences that were adjusted for age, gender, period of diagnosis, sub-site and stage. Age, gender, period and stage explained most of the variability between the areas (50-100% excess risk of death with respect to Osaka) in the survival rates for stomach cancer patients. In Iowa and Varese, information on the sub-site fully explained the remaining variability. The large survival differences between the four areas were almost totally due to the different case mixes of the stomach cancer patients. The importance of stage indicates that diagnostic delay may be a major clinical factor affecting survival.

Is steam sterilization really making any difference in dialysis-induced cytokine release?

Ethylene oxide (ETO) is presently the most commonly used sterilization method for medical devices. Although alternative sterilization modes such as steam sterilization have been suggested, the effect of steam on dialysis-induced cytokine release is unknown. We enrolled 9 patients on chronic hemodialysis and evaluated at different intervals IL-1beta production while treated with ETO (NC 1785-Bellco) and steam sterilized NC 1785S-Bellco) Synthetically Modified Cellulose (SMC). A basal test during treatment with NC 1785 was performed (A); the same test was set up 4 weeks after treatment with NC 1785S (B) and, lastly, 4 weeks after returning to NC 1785 (C). Peripheral blood mononuclear cells (PBMC) were purified before and after the dialysis session, were isolated on a Ficoll/Hypaque gradient and incubated for 24 h. Spontaneous IL-1beta release was evaluated in the supernatant and in the lysate. In A, IL-1beta levels were (in pg/ml/10(6) cells, in supematant and lysate, respectively): 5.8 +/- 4.8 and 7.6+/-5.2 in pre-HD and 4.68 +/- 3.6 and 9.7 +/- 6.65 in post-HD. These levels showed a clear reduction in B: 2.5 +/- 2.2 and 4.4 +/- 3.1 in pre-HD, and 4.35+/- 6.6 and 7.52 +/- 7.22 in post-HD. In the C test, 4 weeks after the return to the ETO membrane, IL-1beta levels remained unchanged: 2.9 +/- 1.8 and 4.5 +/- 3.1 in pre-HD; and 2.6 +/- 3 and 5.7 +/- 6.6 in post-HD. Statistical analysis showed significant changes in the pre-HD levels both in supematant (p < 0.04) and in lysate (p < 0.04). Steam sterilization of SMC induced a lower spontaneous IL-1beta release, but this effect was not statistically significant due to the large inter-individual variation. Hence, contrary to claims of better biocompatibility, steam sterilization does not result in a reduced production of pro-inflammatory IL-1beta.

Synchronous primary adenocarcinoma and adenosquamous carcinoma of the esophagus

Multiple malignant esophageal tumors of the same cell type are described. In the esophageal mucosa, widespread carcinomatous transformation may be observed and multicentric invasive squamous cell carcinomas may develop. The concomitance of two independent esophageal malignant neoplasms of different epithelial histogenesis is uncommon. Synchronous adenocarcinoma and squamous cell carcinoma of the esophagus is reported. Adenosquamous carcinoma of the esophagus is a rare tumor. Adenocarcinoma of the esophagus represents 10% of esophageal cancer. We report a case of a synchronous primary invasive adenosquamous carcinoma and adenocarcinoma of the esophagus. Both tumors were demonstrated radiographically. The peculiarity of this neoplastic association and the importance of complete radiographic esophageal evaluation in patients with one obvious obstructing tumor of the esophagus are emphasized.

Cancer prevalence in European registry areas

BACKGROUND

Information on cancer prevalence is of major importance for health planning and resource allocation. However, systematic information on cancer prevalence is largely unavailable.

MATERIALS AND METHODS

Thirty-eight population-based cancer registries from 17 European countries, participating in EUROPREVAL, provided data on almost 3 million cancer patients diagnosed from 1970 to 1992. Standardised data collection and validation procedures were used and the whole data set was analysed using proven methodology. The prevalence of stomach, colon, rectum, lung, breast, cervix uteri, corpus uteri and prostate cancer, as well as of melanoma of skin, Hodgkin's disease, leukaemia and all malignant neoplasms combined, were estimated for the end of 1992.

RESULTS

There were large differences between countries in the prevalence of all cancers combined; estimates ranged from 1170 per 100000 in the Polish cancer registration areas to 3050 per 100000 in southern Sweden. For most cancers, the Swedish, Swiss, German and Italian areas had high prevalence, and the Polish, Estonian, Slovakian and Slovenian areas had low prevalence. Of the total prevalent cases, 61% were women and 57% were 65 years of age or older. Cases diagnosed within 2 years of the reference date formed 22% of all prevalent cases. Breast cancer accounted for 34% of all prevalent cancers in females and colorectal cancer for 15% in males. Prevalence tended to be high where cancer incidence was high, but the prevalence was highest in countries where survival was also high. Prevalence was low where general mortality was high (correlation between general mortality and the prevalence of all cancers = -0.64) and high where gross domestic product was high (correlation = +0.79). Thus, the richer areas of Europe had higher prevalence, suggesting that prevalence will increase with economic development.

CONCLUSIONS

EUROPREVAL is the largest project on prevalence conducted to date. It has provided complete and accurate estimates of cancer prevalence in Europe, constituting essential information for cancer management. The expected increases in prevalence with economic development will require more resources; allocation to primary prevention should therefore be prioritised.

[Increased in vitro and ex vivo proliferation of erythroid precursors induced by calcitriol in chronic renal failure. Synergistic effect with rHuEPO]

BACKGROUND

Calcitriol (C) improves anemia in chronic renal failure. This improvement may be related to the suppression of iPTH release, but also to a direct effect on erythropoiesis.

MATERIALS AND METHODS

In order to verify this hypothesis, 33 patients with chronic renal failure were enrolled: 24 were undergoing hemodialysis, 9 managed conservatively. All patients were free from other chronic or hematological disease, had a negative DFO test and aluminum levels below 20 mcg/l. iPTH range was 250-480 pg/l. None had yet been treated with C. In vitro study- Samples were drawn for a basal erythroid precursors (Burst Forming Unit-Erythroid BFU-E) study. After mononuclear cells were isolated by centrifugation with Ficoll-Hypaque, they were incubated for 15 days with rHuEPO 3U/ml (A), rHuEPO 3U/l + C 30 pg (B), rHuEPO 3U/ml + C 300 pg (C), rHuEPO 30 U/ml + C 300 pg (D) was performed. Ex vivo study- After the basal evaluation, 10 pts on dialysis were treated with C (Calcijex-Abbott) 1 g three times a week. BFU-E studies were performed after 1,2 and 4 months.

RESULTS

In vitro, culture B showed an increased BFU-E proliferation vs A (41+/- 23 vs 27+/-15, p less than 0.02); in C and D cultures proliferation was 61+/-31 and 78+/- 42 respectively, p less than 0.01 vs A. There was no difference among pts with renal failure and pts treated conservatively. During the in vivo study all cultures showed a progressive proliferation increase, without a plateau level (basal, after 1, 2, 4 months respectively): in A: 17+/-8, 22+/-13, 30.9+/-14.9, 41.4+/-20; in B: 27.3+/-15, 35.6+/-20, 45.5+/-21, 57+/-26; in C: 48.2+/-20.6, 63.7+/-32, 75.7+/-37, 83+/-40; in D: 72+/-24, 91+/-42, 106+/-42, 110+/-42.3 (always p less than 0.001). The hematocrit and hemoglobin increase was constant but not significant. The iPTH decrease was not related to BFU-E proliferation.

CONCLUSIONS

In chronic uremia C has a direct effect on erythroid precursor proliferation, both in vitro and ex vivo, with a sinergystic effect with rHuEPO. This effect is not related to iPTH suppression. C may be a useful adjuvant therapy for rHuEPO treatment.

[Macrohaematuria post-partum: an unusual case of acquired haemophilia after pregnancy]

BACKGROUND

Acquired hemophilia is a rare disorder due to spontaneous development of antibodies directed against the factor VIII molecule in patients with previously normal levels of factor VIII. In this paper we report an unusual case of acquired hemophilia admitted to our department of nephrology due to persisting gross hematuria.

CASE REPORT

A 38-year-old primigravida woman, previously fit and well, had an uncomplicated pregnancy, labor and a caesarean delivery at 38 weeks of gestation. Two weeks after delivery she developed gross hematuria with anemia. She was therefore admitted to a department of urology where urinary system and hematological investigation did not reveal important anomalies. Due to persisting gross hematuria and suspected kidney disease, the patient was admitted to our department of nephrology where serious anemia and prolongation of aPTT were noted; factor VIII procoagulant activity was low with a Bethesda assay confirming the presence of anti human f VIII antibody. Diagnosis of acquired hemophilia was confirmed and treated with corticosteroid therapy, intravenous immunoglobulins and recombinant factor VIII. After 10 days, gross hematuria stopped with improvement of aPTT and level of factor VIII.

DISCUSSIONS

It is postulated that pregnancy leads to an altered immune status whereby the F VIII from the embryo, through transplacental leakage, may be considered as a foreign antigen by the mother, leading to the formation of antibodies. Bleeding symptoms usually became apparent within 3 months of delivery but could be as late as 12 months post-delivery and sometimes coagulation investigation results are normal at the beginning. It is therefore very important to estimate many times the activated partial thromboplastin time in macrohematuria post-partum. Mortality due to hemorrhage varies between 14 and 22 % in previous series. In the vast majority complete remission is achieved spontaneously within a few months. The diagnosis of acquired hemophilia is of fundamental importance for an adequate treatment preventing serious complications and high mortality.

[MR imaging in the follow-up of ACL reconstruction: retrospective analysis of 54 patients]

PURPOSE

The authors evaluated the possible presence of lesions, in patients treated for anterior cruciate ligament (ACL) reconstruction.

MATERIAL AND METHODS

MR examinations of the knee were performed in 54 patients previously surgically treated for an ACL lesion, with a patellar tendon graft. MR was performed in a period of time ranging from 10 to 36 months after surgery. The authors studied the new ligament, transosseous tunnel location, the patellar tendon, other possible articular lesions and the extent and signal of possible synovial fibrotic reaction.

RESULTS

Lesions of the new ligament were found in 21 patients with the following patterns: atrophic reabsorption of the new-ACL (6 patients), and diffuse or focal alterations in morfology and signal (15 patients). In 15 patients the new ACL lesions were associated with incorrect positioning of tibial tunnels. All of the new ligament lesions diagnosed with MR were arthroscopically confirmed. In 12 patients the patellar tendon in 12 patients was involved with inflammatory-degenerative alterations. Other associated lesions were found involving menisci (18 patients), medial collateral ligament (MCL) (8 patients), osteochondral surfaces (12 patients). In patients with an intact new ACL, instability was correlated with meniscal lesions associated with MCL irregularities. In 4 patients a diffuse fibrotic synovial tissue was responsible for limited articular excursion.

CONCLUSIONS

MR in post-ACL substitution has to panoramically investigate all articular compartments, with a complete evaluation of all articular lesions that can contribute to articular symptomatology in order to choose the correct therapeutic strategy.

Cancer survival increases in Europe, but international differences remain wide

The EUROCARE project analysed cancer survival data from 45 population-based cancer registries in 17 European countries, revealing wide international differences in cancer survival. We calculated 5-year relative survival for 1836287 patients diagnosed with one of 13 cancers during the period 1978-1989. The data, from 20 cancer registries in 13 countries, were grouped into four regions: Finland, Sweden, Iceland (Northern Europe); Denmark, England and Scotland (UK and Denmark); France, The Netherlands, Germany, Italy and Switzerland (Western Europe); Estonia and Poland (Eastern Europe), and broken down into four periods (1978-1980, 1981-1983, 1984-1986, 1987-1989). For each cancer, mean European and regional survival was estimated as the weighted mean of 5-year relative survival in each country. Survival increased with time for all tumours, particularly for cancers of testis (12% increase, i.e. from 79.9 to 91.9%), breast, large bowel, skin melanoma (approximately 9-10%), and lymphomas (approximately 7%). For most solid tumours, survival was highest in Northern Europe and lowest in Eastern Europe, and also low in the UK and Denmark. Regional variation was less marked for the lymphomas. Survival improved more in Western than Northern Europe, and the differences between these regions fell for bowel cancer (from 8.0% for those diagnosed in 1978-1980 to 2% for those diagnosed in 1987-1989), breast cancer (from 7.4% to 3.9%), skin melanoma (from 13.4% to 11.0%) and Hodgkin's disease (from 7.2 to 0.6%). For potentially curable malignancies such as Hodgkin's disease, large bowel, breast and testicular cancers, there were substantial increases in survival, suggesting an earlier diagnosis and more effective treatment. The persisting regional differences suggest there are corresponding differences in the availability of diagnostic and therapeutic facilities, and in the effectiveness of healthcare systems.

Incidence and prevalence of all cancerous diseases in Italy

The burden of cancer in ageing populations is causing great concern, particularly in Italy with Europe's fastest growing elderly population. Studying all cancers combined in one group, although of limited medical value, is of great interest from the viewpoints of public health, epidemiology and the economy. Using mortality data and an estimate of cancer patients' survival we have estimated and projected incidence and prevalence in Italy of all cancers combined in one group. Five major phenomena are highlighted in the paper: (1) the decrease in the age-adjusted cancer mortality rates among females and the stable mortality rates among males since 1990; (2) the changing pattern of cancer incidence since 1990, it has started to decrease for females and is stabilising for males; (3) the decrease in cancer incidence among males and females born after 1940; (4) the increase in the proportion of cancer patients that are cured with calendar years of diagnosis; (5) the increase in the total and the healthy life expectancy (i.e. cancer-free) among the Italian population since 1970. The declining and flat trends in age-adjusted cancer incidence and mortality rates since 1990 is the combined effect of survival improvements and cancer risk reduction for younger cohort groups, after 1940. These favourable trends contribute to the increase in healthy life expectation, thus supporting the idea that we live longer and healthier.