Trends in mortality from major cancers in the European Union, including acceding countries, in 2004

Addressing disparities in European cancer outcomes: a qualitative study Protocol of the BEACON project

Introduction

Health disparities represent a crucial factor in cancer survival rates, awareness, quality of life, and mental health of people receiving a cancer diagnosis and their families. Income, education, geographic location, and ethnicity are some of the most important underlying reasons for health disparities in cancer across Europe. Costs of healthcare, access to information, psycho-oncological support options, integration of cancer research and innovative care, and multidisciplinary cancer teams are the main target areas when it comes to addressing disparities in the cancer context. As part of the Beacon Project (BEACON), we developed a protocol for a qualitative study to explore and identify any relevant reasons for cancer inequalities and disparities in Europe.

Methods

Our four stakeholders namely, cancer patients, healthcare providers, researchers, and policymakers will be recruited online, facilitated by collaborative efforts with cancer organizations from various European countries, including but not limited to Italy, Croatia, Estonia, and Slovenia. Qualitative online focus group discussions for each stakeholder will be conducted and transcribed. Subsequently, thematic analysis will be used to identify reasons and aspects that may contribute to the existing disparities in cancer outcomes at various levels of engagement and from different stakeholders' perspectives. Results from focus groups will inform a subsequent Delphi study and a SWOT analysis methodology.

Discussion

Although advances in medical research, cancer screening and treatment options are constantly progressing, disparities in access to and awareness of healthcare in cancer patients are even more noticeable. Thus, mapping the capacity and capability of cancer centres in the European Union, creating decision support tools that will assist the four stakeholders' information needs and improving the quality of European cancer centres will be the main objectives of the BEACON project. The current protocol will outline the methodological and practical procedures to conduct online focus group discussions with different stakeholders.

European Groundshot-addressing Europe's cancer research challenges: a Lancet Oncology Commission

Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.

Global, regional, and national burden of ovarian cancer and the attributable risk factors in all 194 countries and territories during 2007-2017: A systematic analysis of the Global Burden of Disease Study 2017

BACKGROUND

We estimated the global burden of ovarian cancer (OC) in 194 countries and territories between 2007 and 2017.

METHODS

Data were extracted from the Global Burden of Disease (GBD), Injuries, and Risk Factors 2017 study.

RESULTS

Globally, 286 126.80 (95% UI = 278 075.38-295 311.41) incident cases, 4.67 million (4.53-4.83) disability-adjusted life-years (DALYs), and 175 981.99 (171 384.15-181 198.43) deaths were reported in 2017. The age-standardized incidence and DALY rates increased by 2.05% and 1.34% during 2007-2017, respectively, while the age-standardized mortality rate decreased by -0.14%. The age-standardized incidence, DALY, and mortality rates in 2017 were the highest in the high socio-demographic index (SDI) quintile, but the largest percentage increase during 2007-2017 was in the low-SDI quintile. Among regions, Central Europe showed the highest 2017 age-standardized incidence, DALY, and mortality rates, whereas South Asia and East Asia showed the largest percentage increases in both rates during 2007-2017. Among countries, India showed the largest percentage increase in age-standardized incidence and DALY rates, whereas Iran showed the largest percentage increase in age-standardized mortality rates. Globally, the largest percentage increase in risk-attributable DALYs was associated with metabolic risk factors (e.g., high fasting plasma glucose levels).

CONCLUSION

The global age-standardized incidence, DALYs, and mortality rates of OC remain stable during 2007-2017. However, the low SDI quintile and the greatest burden in South and East Asia, India, and Iran suggested that more targeted strategies should be performed in those regions and countries.

Breast cancer mortality gaps in Romanian women compared to the EU after 10 years of accession: Is breast cancer screening a priority for action in Romania? (Review of the Statistics)

Breast cancer remains the most common cause of morbidity and mortality by cancer in females worldwide, even though it is largely preventable through population screening. Despite notable progress in the last years in the EU, breast cancer screening programs still maintain wide variations among countries and socio-economic groups. This statistical review aimed to investigate the breast cancer-related health gaps in Romanian women compared to the average EU female population after 10 years of accession (2007-2016). We evaluated breast cancer-related deaths, age-standardized mortality rates and contribution of breast cancer to life expectancy. Trends and percentage changes were compared between Romania and EU-27 for breast cancer, all cancer and all causes of mortality. We found a higher increase of breast cancer deaths in Romania, an increasing trend of mortality (opposite to EU) and a contribution to life expectancy at birth that increased gradually from 0.45 to 0 48 years. All these health gaps compared to EU are aggravated by the fact that no population screening for breast cancer is organized in the country. The opportunities for organizing such a program are consistent, but they should be increased in the future, in order to control the health gap between Romania and EU.

Cancer mortality in the elderly in 11 countries worldwide, 1970-2015

BACKGROUND

Population ageing results in an increasing cancer burden in the elderly. We aimed to evaluate time-trends in cancer mortality for adults aged 65 and over for 17 major cancer types and all cancers combined in 11 countries worldwide over the period 1970-2015.

MATERIALS AND METHODS

We obtained cancer death certification and population figures from the WHO and PAHO databases. We computed age-standardised (world standard population) rates for individuals aged 65 and over, and applied joinpoint regression models.

RESULTS

Age-standardised mortality rates for all cancers combined showed a heterogeneous, but widespread decline. Lung cancer mortality rates have been decreasing among men, and increasing among women. Pancreatic cancer had unfavourable trends in all countries for both sexes. Despite variability across countries, other tobacco-related cancers (except kidney) showed overall favourable trends, except in Poland and Russia. Age-standardised mortality rates from stomach cancer have been declining in all countries for both sexes. Colorectal mortality has been declining, except in Poland and Russia. Liver cancer mortality increased in all countries, except in Japan, France and Italy, which had the highest rates in the past. Breast cancer mortality decreased for most countries, except for Japan, Poland and Russia. Trends for age-standardised uterine cancer rates in the USA, Canada and the UK were increasing over the last decade. Ovarian cancer rates showed declines in most countries. With the exception of Russia, prostate cancer rates showed overall declines. Lymphoid neoplasms rates have been declining in both sexes, except in Poland and Russia.

CONCLUSION

Over the last decades, age-standardised cancer mortality in the elderly has been decreasing in major countries worldwide and for major cancer sites, with the major exception of lung and uterine cancer in women and liver, pancreatic and kidney cancers in both sexes. Cancer mortality for the elderly in central and eastern Europe remains comparatively high.

European cancer mortality predictions for the year 2020 with a focus on prostate cancer

BACKGROUND

Current cancer mortality figures are important for disease management and resource allocation. We estimated mortality counts and rates for 2020 in the European Union (EU) and for its six most populous countries.

MATERIALS AND METHODS

We obtained cancer death certification and population data from the World Health Organization and Eurostat databases for 1970-2015. We estimated projections to 2020 for 10 major cancer sites plus all neoplasms and calculated the number of avoided deaths over 1989-2020.

RESULTS

Total cancer mortality rates in the EU are predicted to decline reaching 130.1/100 000 men (-5.4% since 2015) and 82.2 in women (-4.1%) in 2020. The predicted number of deaths will increase by 4.7% reaching 1 428 800 in 2020. In women, the upward lung cancer trend is predicted to continue with a rate in 2020 of 15.1/100 000 (higher than that for breast cancer, 13.5) while in men we predicted further falls. Pancreatic cancer rates are also increasing in women (+1.2%) but decreasing in men (-1.9%). In the EU, the prostate cancer predicted rate is 10.0/100 000, declining by 7.1% since 2015; decreases for this neoplasm are ∼8% at age 45-64, 14% at 65-74 and 75-84, and 6% at 85 and over. Poland is the only country with an increasing prostate cancer trend (+18%). Mortality rates for other cancers are predicted to decline further. Over 1989-2020, we estimated over 5 million avoided total cancer deaths and over 400 000 for prostate cancer.

CONCLUSION

Cancer mortality predictions for 2020 in the EU are favourable with a greater decline in men. The number of deaths continue to rise due to population ageing. Due to the persistent amount of predicted lung (and other tobacco-related) cancer deaths, tobacco control remains a public health priority, especially for women. Favourable trends for prostate cancer are largely attributable to continuing therapeutic improvements along with early diagnosis.

The breast cancer paradox: A systematic review of the association between area-level deprivation and breast cancer screening uptake in Europe

Breast cancer rates are lower amongst women from more socio-economically deprived areas. However, their mortality rates are higher. One explanation of this breast cancer paradox is that women from more deprived areas are less likely to attend breast cancer screening programmes. This systematic review is the first to examine this issue in Europe. A systematic review of Embase, Medline and PsychINFO (from 2008 to 2019) was undertaken (PROSPERO registration number: CRD42018083703). Observational studies were included if they were based in Europe, measured breast cancer screening uptake, compared at least two areas, included an area-level measure of socio-economic deprivation and were published in the English language. The Joanna Briggs Institute critical appraisal checklist was used to assess study quality and risk of bias. Thirteen studies from seven different European countries met our inclusion criteria and were included in the review. In ten of the thirteen studies, there was a significant negative association between screening uptake and area-level socio-economic deprivation - with women living in more socio-economically deprived neighbourhoods less likely to attend breast cancer screening. Although universal screening programmes were provided in most studies, there were still strong negative associations between screening uptake and area-level socio-economic deprivation. Future breast cancer screening strategies should acknowledge these challenges, and consider developing targeted interventions in more deprived areas to increase screening participation.

Metastasis-associated protein 1 (MTA1) in gastric cancer tissues is positively associated with poorer prognosis

BACKGROUND

The present study examined the clinical significance of metastasis-associated protein 1 (MTA1) in the progression and patient survival of gastric cancer.

METHODS

Paraffin-embedded resected tissues of gastric cancer mucosa (n = 436) and adjacent normal mucosa (n = 92) were assessed immunohistochemically for MTA1 protein, and scored according to the percentage of cells positively stained for MTA1 combined with stain intensity. Associations between MTA1 staining scores and clinicopathological factors, including survival time, were evaluated.

RESULTS

The staining scores for MTA1 were significantly higher in gastric cancer tissues than in matched normal tissues. MTA1 scores positively correlated with tumor size, depth of invasion, presence of lymph node metastasis, lymphatic involvement, venous invasion, distal metastasis, and advanced clinical staging. Patients with high MTA1 scores in gastric cancer tissues had a significantly lower five-year survival rate compared with patients with low MTA1 scores. The multivariate analysis indicated that MTA1 protein levels in resected gastric cancer tissues, as reflected by immunohistochemical staining, are an independent prognostic index of gastric carcinoma (P < 0.01).

CONCLUSION

MTA1 immunopositivity was significantly associated with progression of gastric cancer, and may be helpful in gastric cancer prognosis.

Patterns of Care for Brachytherapy in Europe, in Spain and Italy: Comparative Results

Aims and Background

The aim of the study was to compare the facilities for brachytherapy in two similar countries, as are Italy and Spain. This survey reports the differences in the use of brachytherapy in these countries.

Methods

The data regarding brachytherapy was obtained in 2002 by means of a specially designed web site, because Internet allowed the access to the questionnaire in an easy and safe way. In the first edition of the survey, only the countries in which more than 50% of its centers had completed the questionnaire were included. Among these countries there were Italy and Spain.

Results

Data was available in 127 centers in Italy and 72 centers in Spain, where 35 and 39, respectively, provided brachytherapy. Although both countries had a similar number of radiotherapy patients and the average number of radiotherapy patients per center was similar in both countries (P = 0.29), there were several differences related to brachytherapy. For instance, the mean number of radiation oncologists regularly performing brachytherapy per center was higher in Spain (P = 0.001). There were also differences in the average number of patients per center in the following tumor sites: breast (P <0.001) and gynaecological (P <0.001). In fact, the average number of patients per center who were treated with brachytherapy in these tumor sites was higher in Spain than Italy.

Conclusions

Although the estimated workload of the radiation oncologists, physicists and radiation technologists was higher in Spain, no statistically significant differences were found in the average number of patients per center for the following tumor sites: bronchus, head and neck, intracoronary, esophagus, prostate, rectum and skin. Several differences in the use of the brachytherapy procedures applied were also found.

Trends and predictions to 2020 in breast cancer mortality in Europe

OBJECTIVES

We analyzed trends in mortality from breast cancer in women in 36 European countries and the European Union (EU) over the period 1970-2014, and predicted numbers of deaths and rates to 2020.

MATERIALS AND METHODS

We derived breast cancer death certification data and population figures from the World Health Organization and Eurostat databases. We obtained 2020 estimates using a joinpoint regression model.

RESULTS

Overall, EU breast cancer mortality rates (world standard) declined from 17.9/100,000 in 2002 to 15.2 in 2012. The predicted 2020 rate is 13.4/100,000. The falls were largest in young women (20-49 years, -22% between 2002 and 2012). Within the EU, declines were larger in the United Kingdom (UK) and other northern and western European countries than in most central and eastern Europe. The UK has the second lowest predicted breast cancer mortality rate in 2020 (after Spain), starting from the highest one in 1970. Breast cancer mortality is predicted to rise in Poland, where the predicted 2020 rate is 15.3/100,000. We estimated that about 32,500 breast cancer deaths will be avoided in 2020 in the EU as compared to the peak rate of 1989, and a total of 475,000 breast cancer deaths over the period 1990-2020.

CONCLUSION

The overall favourable breast cancer mortality trends are mainly due to a succession of improvements in the management and treatment of breast cancer, though early diagnosis and screening played a role, too. Improving breast cancer management in central and eastern Europe is a priority.

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999-2008

Spain's immigrant population has increased 380% in the last decade, accounting for 13.1% of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999-2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (-17.8% for men and -16.6% for women) as well as in the foreign-born one (-45.9% for men and -35.7% for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Years of Life Lost due to Premature Mortality in a Province with the Shortest Life Expectancy in Poland

AIM

The aim of the study was to evaluate years of life lost for citizens of the Lodz Province, which is characterized by the lowest life expectancy in Poland, and to identify current trends in this area according to the most common causes of death.

METHODS

The study material included a database containing information gathered from 470,000 death certificates of Lodz Province inhabitants, who died between 1999 and 2011. In order to calculate years of life lost, the authors applied the SEYLLp (Standard Expected Years of Life Lost per living person) and SEYLLd (per death) indices. The analysis of time trends was carried out with the application of joinpoint models.

RESULTS

The SEYLLp measure was 2,300 years per 10,000 males and 1,500 years per 10,000 females in 2011. Cardiovascular diseases contributed to the highest number of years of life lost (SEYLLp=682 years per 10,000 males and 559 years per 10,000 females). Next were malignant neoplasms (SEYLLp=505 years per 10,000 males and 437 years per 10,000 females), external causes of death (SEYLLp=361 years per 10,000 males and 83 years per 10,000 females). The number of years of life lost due to acute myocardial infarction decreased most rapidly, the Annual Percent Change (APC) was -10.1% in males and -3.7% in females. However, heart failure contributed to the highest increase in the number of years of life lost (APC=10.8% in males and 10.9% in females).

CONCLUSIONS

A further decrease in the mortality rate due to cardiovascular diseases might contribute to the highest reduction of years of life lost. The most effective preventive activities are those aimed at reducing productive years of life lost due to a particular cause of death, i.e. road traffic accidents, suicides, cirrhosis of the liver, alcoholic liver disease, and malignant neoplasms of the trachea, bronchi and lungs.

Cancer Control in Central and Eastern Europe

In Central and Western Europe, cancer mortality is declining at slower rates as compared with rates in the rest of the world. More than a generation has now passed since the end of nonmarket economies in Central and Eastern Europe. It is time for this area of the continent to close the gap in cancer incidence and mortality rates between it and Western Europe and other high-income areas of the world.

Trends in Gastrointestinal Cancer Mortality Rate in Hungary

The aim of this study was to investigate the annual death trends for gastrointestinal cancer in Hungary between 1963 and 2012. Data on the numbers of cancer deaths were obtained from the published nationwide population register. Numbers of deaths from esophageal, gastric and colorectal cancer were available during the study period. However, the mortality data for hepatic, pancreatic and gallbladder cancer have been published only since 1979. Joinpoint regression was applied to investigate the annual trends in the rates of cancer mortality. The annual mortality rates of gastric and gallbladder cancer decreased throughout the study period. Furthermore, declines in mortality from esophageal and hepatic cancers have been observed since 1998 and 1995, respectively. However, the rates of colorectal and pancreatic cancer mortality have been increasing in the past few years. Nevertheless, the mortality rates of colorectal and pancreatic cancers have increased in males aged 40-59 years during the study period. Moreover, significantly higher risks of gastrointestinal cancer-related deaths have been observed in males as compared with females except for death related to cancer of the gallbladder. The presented data suggest that the Hungarian mortality rates are particularly high. The detection of gastrointestinal cancers at an early stage would significantly improves the outcome of these malignancies.

Expression of eukaryotic translation initiation factor 5A-2 (eIF5A-2) associated with poor survival in gastric cancer

Altered expression of eukaryotic translation initiation factor 5A-2 (eIF5A-2) was associated with human carcinogenesis and progression. This study assessed eIF5A-2 expression in gastric cancer tissues for association with clinicopathological parameters and survival of patients. A total of 436 gastric cancer tissues and 92 normal mucosal blocks were collected for construction of tissue microarrays and immunohistochemical assessment of eIF5A-2 expression. The data were statistically analyzed for association with clinicopathological factors and survival of patients. Immunohistochemical data showed that eIF5A-2 protein was highly expressed in gastric cancer tissues (p < 0.001). Upregulated expression of eIF5A-2 protein was associated with tumor Lauren classification, size, location, invasion, TNM stages, and lymph node and distant metastases. The 3- and 5-year cumulative survival rates of these 436 patients were 88.5 and 58.1 %, respectively. In contrast, the mean survival time of patients with increased tumor eIF5A-2 was 30.22 ± 1.23 vs. 51.29 ± 0.86 months for those with low tumor eIF5A-2 (p < 0.001). Multivariate analysis showed that eIF5A-2 expression and related tumor parameters were independent indicators of overall survival in gastric cancer patients. In conclusion, the current study indicates that overexpression of eIF5A-2 protein was associated with poor overall survival of gastric cancer patients.

Pharmacoeconomic and clinical implications of sequential therapy for metastatic renal cell carcinoma patients in Central and Eastern Europe

INTRODUCTION

The incidence and mortality rates of kidney cancer in the Central and Eastern European (CEE) region are among the highest in the world. Access to second and subsequent lines of metastatic renal cell carcinoma (mRCC) therapies is highly varied in the region. Despite the increasing body of evidence supporting the clinical benefit of multiple lines of treatment, access to treatment beyond first line is restricted in many of these countries.

AREAS COVERED

The adoption of targeted therapies for the first-line treatment of mRCC in the region was slow and faced many obstacles. In order to evaluate the current status of treatment beyond the first-line setting in the CEE region, this review examines the availability and reimbursement of mRCC drugs and clinical practice in institutions that treat patients with mRCC.

EXPERT OPINION

This review highlights the need to raise awareness among physicians, payers and regulators on clinical trial and cost-effectiveness data regarding the treatment of mRCC beyond the first line. The obstacles to mRCC drug access highlighted in this review need to be overcome to ensure that patients are receiving the best treatment available.

Novel Monte Carlo approach quantifies data assemblage utility and reveals power of integrating molecular and clinical information for cancer prognosis

Current clinical practice in cancer stratifies patients based on tumour histology to determine prognosis. Molecular profiling has been hailed as the path towards personalised care, but molecular data are still typically analysed independently of known clinical information. Conventional clinical and histopathological data, if used, are added only to improve a molecular prediction, placing a high burden upon molecular data to be informative in isolation. Here, we develop a novel Monte Carlo analysis to evaluate the usefulness of data assemblages. We applied our analysis to varying assemblages of clinical data and molecular data in an ovarian cancer dataset, evaluating their ability to discriminate one-year progression-free survival (PFS) and three-year overall survival (OS). We found that Cox proportional hazard regression models based on both data types together provided greater discriminative ability than either alone. In particular, we show that proteomics data assemblages that alone were uninformative (p = 0.245 for PFS, p = 0.526 for OS) became informative when combined with clinical information (p = 0.022 for PFS, p = 0.048 for OS). Thus, concurrent analysis of clinical and molecular data enables exploitation of prognosis-relevant information that may not be accessible from independent analysis of these data types.

Potential for improvement in cancer management: reducing mortality in the European Union

Overall age-standardized cancer mortality rates in the European Union (EU) have declined by approximately 20% through 2010 (17% in women, 22% in men) since the peak value reached in 1988. This corresponds to the avoidance of more than 250,000 cancer deaths in 2010 alone and approximately 2.2 million deaths over the 1989-2010 22-year period. A more than twofold difference remains between the highest cancer mortality rates (in Hungary and other central European countries) and the lowest (in selected Nordic countries and Switzerland). Part of this gap is due to tobacco, alcohol, and other lifestyle and environmental exposures, and another part is attributable to differences in cancer diagnosis, treatment, and management. There are also appreciable differences in 5-year cancer survival across the EU, with lower survival rates in central and eastern Europe. If overall cancer survival in EU countries with low rates could be raised to the median, approximately 50,000 additional cancer deaths would be avoided per year, and more than 100,000 would be avoided if overall survival in all countries were at least that of the 75% percentile--4% and 8%, respectively, of the approximately 1.3 million cancer deaths registered in the EU in 2010. There is, however, substantial uncertainty about any such estimate because differences in cancer survival are partly or largely attributable to earlier diagnosis, in variable proportion for each cancer site and probably to different degrees in different countries, even in the absence of changes in the date of death or avoidance of death. Consequently, these approximations are the best available and may be used cautiously to compare countries, health care approaches, and changes that occur over time.

The burden of premature mortality in Poland analysed with the use of standard expected years of life lost

Background

Despite positive changes in the health of the population of Poland, compared to the EU average, the average life expectancy in 2011 was 5 years shorter for males and 2.2 years shorter for females. The immediate cause is the great number of premature deaths, which results in years of life lost in the population. The aim of the study was to identify the major causes of years of life lost in Poland.

Methods

The analysis was based on a database of the Central Statistical Office of Poland, containing information gathered from 375,501 death certificates of inhabitants of Poland who died in 2011. The SEYLL_p (Standard Expected Years of Life Lost per living person) and the SEYLL_d (SEYLL per death) measures were calculated to determine years of life lost.

Results

In 2011, the total number of years of life lost by in Polish residents due to premature mortality was 2,249,213 (1,415,672 for males and 833,541 for females). The greatest number of years of life lost in males were due to ischemic heart disease (7.8 per 1,000), lung cancer (6.0), suicides (6.6), cerebrovascular disease (4.6) and road traffic accidents (5.4). In females, the factors contributing to the greatest number of deaths were cerebrovascular disease (3.8 per 1,000), ischemic heart disease (3.7), heart failure (2.7), lung cancer (2.5) and breast cancer (2.3). Regarding the individual scores per person in both males and females, the greatest death factors were road traffic accidents (20.2 years in males and 17.1 in females), suicides (17.4 years in males and 15.4 in females) and liver cirrhosis (12.1 years in males and 11.3 in females).

Conclusions

It would be most beneficial to further reduce the number of deaths due to cardiovascular diseases, because they contribute to the greatest number of years of life lost. Moreover, from the economic point of view, the most effective preventative activities are those which target causes which result in a large number of years of life lost at productive age for each death due to a particular reason, i.e. road traffic accidents, suicides and liver cirrhosis.

Trends and results in treatment of gastric cancer over last two decades at single East European centre: a cohort study

Background

A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. However it is still not clear if this trend applies to Eastern Europe where high incidence rate of gastric cancer is observed.

Methods

This was a retrospective non-randomized, single center, cohort study. During the study period 557 consecutive patients diagnosed with gastric cancer in which curative operation was performed met the inclusion criteria. The study population was divided into two groups according to two equal time periods: 01-01-1994 – 31-12-2000 (Group I – 273 patients) and 01-01-2001 – 31-12-2007 (Group II – 284 patients). Primary (five-year survival rate) and secondary (postoperative complications, 30-day mortality rate and length of hospital stay) endpoints were evaluated and compared.

Results

Rate of postoperative complications was similar between the groups, except for Grade III (Clavien-Dindo grading system for the classification of surgical complications) complications that were observed at significantly lower rates in Group II (26 (9.5%) vs. 11 (3.9%), p = 0.02). Length of hospital stay was significantly (p = 0.001) shorter (22.6 ± 28.9 vs. 16.2 ± 17.01 days) and 30-day mortality was significantly (p = 0.02) lower (15 (5.5%) vs. 4 (1.4%)) in Group II. Similar rates of gastric cancer related mortality were observed in both groups (92.3% vs. 90.7%). However survival analysis revealed significantly (p = 0.02) better overall 5-year survival rate in Group II (35.6%, 101 of 284) than in Group I (23.4%, 64 of 273). There was no difference in 5-year survival rate when comparing different TNM stages.

Conclusions

Gastric cancer treatment results remain poor despite decreasing early postoperative mortality rates, shortening hospital stay and improved overall survival over the time. Prognosis of treatment of gastric cancer depends mainly on the stage of the disease. Absence of screening programs and lack of clinical symptoms in early stages of gastric cancer lead to circumstances when most of the patients presenting with advanced stage of the disease can expect a median survival of less than 30 months even after surgery with curative intent.

Years of life lost due to malignant neoplasms characterized by the highest mortality rate

INTRODUCTION

The analysis of premature deaths measured with years of life lost between the studied and referential populations helps to emphasize the social and economic aspect of a loss caused by deaths due to malignant neoplasms. The aim of the study was to analyze years of life lost by inhabitants of the Lodz province due to malignant neoplasms.

MATERIAL AND METHODS

The study material included a database which contained information gathered from 313,144 death certificates (including 66,899 people who died of malignant neoplasms) of inhabitants of the Lodz province who died between 1999 and 2008. The SEYLLp (Standard Expected Years of Life Lost per living person) method was used to determine years of life lost. Jointpoint models were used to analyze time trends.

RESULTS

In males the diseases which mostly contributed to death were tracheal, bronchial and lung malignant neoplasms (SEYLLp = 170.7) and cancer of the large intestine, rectum and anus (SEYLLp = 47.5). In females the principal diseases were tracheal, bronchial and lung malignant neoplasms (SEYLLp = 61.6), breast cancer (SEYLLp = 60.4) and cancer of the large intestine, rectum and anus (SEYLLp = 42.3). The years of life lost were growing in the period under study.

CONCLUSIONS

The number of years lost due to malignant neoplasms in the Lodz province between 1999 and 2008 was growing. The main reasons for deaths in females were tracheal, bronchial and lung malignant neoplasms as well as breast cancer and in males - cancer of the large intestine, rectum and anus as well as prostate cancer.

Molecular targeting to treat gastric cancer

Trastuzumab that targets human epidermal growth factor receptor 2 (HER2) protein is the only approved molecular targeting agent for treating gastric cancer in Japan and the outcomes have been favorable. However, trastuzumab is effective for only 10% to 20% of the population with gastric cancer that expresses HER2 protein. Molecular targeting therapy with bevacizumab against vascular endothelial growth factors (VEGF) and with cetuximab and panitumumab against the epidermal growth factors pathway that have been approved for treating colorectal cancer are not considered effective for treating gastric cancer according to several clinical trials. However, ramucirumab that targets VEGF receptor-2 prolonged overall survival in a large phase III clinical trial and it might be an effective molecular targeting therapy for gastric cancer. The significance of molecular targeting therapy for gastric cancer remains controversial. A large-scale randomized clinical trial of novel molecular targeting agents with which to treat gastric cancer is needed.

Management of Helicobacter pylori-related diseases in the Baltic States

Helicobacter pylori infection has been recognized as the main trigger of stomach-related diseases. The huge variation in H. pylori infection patterns across the globe requires targeted research and close monitoring of this infection in different regions. The Baltic countries have witnessed enormous changes in socioeconomic conditions in the last years. Evolution of H. pylori infection and related diseases has been a key interest of gastroenterology centers in the Baltic States over the last two decades, translating into up-to-date scientific data that are valuable locally and on the European level. The East-West gradient in the prevalence of H. pylori infection is still evident in the Baltic countries, but the gap is becoming smaller, and similar trends are expected for the coming years. Clarithromycin-based triple therapy remains the first-line treatment of H. pylori in the region; however, careful monitoring of resistance rates in the future remains highly relevant, though routine resistance testing is not available in all the countries. A high prevalence of gastric cancer is still notable in the Baltic States; nevertheless, a steady decline in gastric cancer incidence in Lithuania, Latvia and Estonia is present and expected to be continuing during the coming decades. Currently, H. pylori-related diseases still constitute a substantial part of gastroenterologists' workload in the region. This paper reviews epidemiological, diagnostic, treatment as well as basic research trends on H. pylori infection and related diseases in the Baltic States during the last two decades.

Insights into cancer surveillance in Central and Eastern Europe, Israel and Turkey

The current cancer landscape within transitional economies in central and Eastern Europe and the Mediterranean area is not particularly optimistic. Current perceptions are often based on extrapolations from other countries and regions; and hence the authors collaborated with the South Eastern Europe Oncology Group (SEEROG) to collect information on cancer registration in Central and Eastern Europe, Israel and Turkey. Healthcare authorities and specialist oncology centres in 21 countries in the region were contacted for information on cancer registries in their countries. Based on this information, the authors believe that the recording and reporting of data on cancer in the region is at an acceptable level. The authors discuss and compare institution- and population-based registries, and present opinions on elements of an 'ideal registry' based on the survey replies and comparisons with other registries. A comparison with the sources used for GLOBOCAN 2008 illustrates the need for consistent data to be communicated, published and utilised throughout the region and the oncology community. The authors conclude by considering the potential value of collaboration between health authorities across the region, as well as between the clinical and epidemiological communities, to ensure that cancer data are consistently collected, verified and made public.

Pancreatic cancer mortality in Serbia from 1991-2010 - a joinpoint analysis

AIM

To analyze the trends of pancreatic cancer mortality in Serbia.

METHODS

The study covered the population of Serbia in the period 1991 to 2010. Mortality trends were assessed by the joinpoint regression analysis by age and sex.

RESULTS

Age-standardized mortality rates ranged from 5.93 to 8.57 per 100 000 in men and from 3.51 to 5.79 per 100 000 in women. Pancreatic cancer mortality in all age groups was higher among men than among women. It was continuously increasing since 1991 by 1.6% (95% confidence interval [CI] 1.1 to 2.0) yearly in men and by 2.2% (95% CI 1.7 to 2.7) yearly in women. Changes in mortality were not significant in younger age groups for both sexes. In older men (≥55 years), mortality was increasing, although in age groups 70-74 and 80-84 the increase was not significant. In 65-69 years old men, the increase in mortality was significant only in the period 2004 to 2010. In ≥50 years old women, mortality significantly increased from 1991 onward. In 75-79 years old women, a non-significant decrease in the period 1991 to 2000 was followed by a significant increase from 2000 to 2010.

CONCLUSION

Serbia is one of the countries with the highest pancreatic cancer mortality in the world, with increasing mortality trend in both sexes and in most age groups.

Differential diagnosis of lung carcinoma with coherent anti-Stokes Raman scattering imaging

Aimed at bridging imaging technology development with cancer diagnosis, this paper first presents the prevailing challenges of lung cancer detection and diagnosis, with an emphasis on imaging techniques. It then elaborates on the working principle of coherent anti-Stokes Raman scattering microscopy, along with a description of pathologic applications to show the effectiveness and potential of this novel technology for lung cancer diagnosis. As a nonlinear optical technique probing intrinsic molecular vibrations, coherent anti-Stokes Raman scattering microscopy offers an unparalleled, label-free strategy for clinical cancer diagnosis and allows differential diagnosis of fresh specimens based on cell morphology information and patterns, without any histology staining. This powerful feature promises a higher biopsy yield for early cancer detection by incorporating a real-time imaging feed with a biopsy needle. In addition, molecularly targeted therapies would also benefit from early access to surgical specimen with high accuracy but minimum tissue consumption, therefore potentially saving specimens for follow-up diagnostic tests. Finally, we also introduce the potential of a coherent anti-Stokes Raman scattering-based endoscopy system to support intraoperative applications at the cellular level.

Advanced lung adenocarcinoma in an EGFR-positive patient treated with Erlotinib for 52 months

The authors present a case of a 53-years-old non-smoker Caucasian female who was diagnosed with lung adenocarcinoma (stage IA) and underwent surgical resection in 2002. Five years later, the tumor relapsed (stage IV disease) and she initiated chemotherapy with carboplatin, gemcitabine and bevacizumab as a first-line therapy. Despite partial remission after four cycles, this regimen was discontinued due to unacceptable toxicity. In 2008, the disease progressed and the patient was started on Erlotinib as second-line treatment. The patient had a sustained partial remission which she maintains at present – 52 months after initiation of Erlotinib. Molecular testing performed on the primary lung tumor revealed an Epidermal Growth Factor Receptor (EGFR) gene mutation (deletion in exon 19).

Natural history of gastro-entero-pancreatic and thoracic neuroendocrine tumors. Data from a large prospective and retrospective Italian epidemiological study: the NET management study

BACKGROUND

The few epidemiological data available in literature on neuroendocrine tumors (NET) are mainly based on Registry databases, missing therefore details on their clinical and natural history.

AIM

To investigate epidemiology, clinical presentation, and natural history of NET.

DESIGN AND SETTING

A large national retrospective survey was conducted in 13 Italian referral centers. Among 1203 NET, 820 originating in the thorax (T-NET), in the gastro-enteropancreatic tract (GEP-NET) or metastatic NET of unknown primary origin (U-NET) were enrolled in the study.

RESULTS

93% had a sporadic and 7% a multiple endocrine neoplasia type 1 (MEN1)-associated tumor; 63% were GEP-NET, 33% T-NET, 4% U-NET. Pancreas and lung were the commonest primary sites. Poorly differentiated carcinomas were <10%, all sporadic. The incidence of NET had a linear increase from 1990 to 2007 in all the centers. The mean age at diagnosis was 60.0 ± 16.4 yr, significantly anticipated in MEN1 patients (47.7 ± 16.5 yr). Association with cigarette smoking and other non-NET cancer were more prevalent than in the general Italian population. The first symptoms of the disease were related to tumor burden in 46%, endocrine syndrome in 23%, while the diagnosis was fortuity in 29%. Insulin (37%) and serotonin (35%) were the most common hormonal hypersecretions. An advanced tumor stage was found in 42%, more frequently in the gut and thymus. No differences in the overall survival was observed between T-NET and GEP-NET and between sporadic and MEN1-associated tumors at 10 yr from diagnosis, while survival probability was dramatically reduced in U-NET.

CONCLUSIONS

The data obtained from this study furnish relevant information on epidemiology, natural history, and clinico-pathological features of NET, not available from the few published Register studies.

Cancer epidemiology in Central, South and Eastern European countries

AIM

To collect cancer epidemiology data in South Eastern European countries as a basis for potential comparison of their performance in cancer care.

METHODS

The South Eastern European Research Oncology Group (SEEROG) collected and analyzed epidemiological data on incidence and mortality that reflect cancer management in 8 countries - Croatia, Czech Republic, Hungary, Romania, Poland, Slovakia, and Serbia and Montenegro in the last 20-40 years.

RESULTS

The most common cancer type in men in all countries was lung cancer, followed by colorectal and prostate cancer, with the exception of the Czech Republic, where prostate cancer and colorectal cancer were more common. The most frequent cancer in women was breast cancer followed by colorectal cancer, with the exceptions of Romania and Central Serbia where cervical cancer was the second most common. Cancer mortality data from the last 20-40 years revealed two different patterns in men. In Romania and in Serbia and Montenegro, there was a trend toward an increase, while in the other countries mortality was declining, after increasing for a number of years. In women, a steady decline was observed over many years in the Czech Republic, Hungary, and Slovakia, while in the other countries it remained unchanged.

CONCLUSIONS

There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors which provides a clear challenge to prevention. There are some differences in incidence and mortality that cannot be explained by exposure to known risk factors or treatment availabilities.

Investigating gene expression profile of non-small cell lung cancer

Lung cancer is mainly a lifestyle-associated disease with poor prognosis and the lowest five year survival rate of all types of cancer. Lung cancers are divided into two main groups: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Surgical treatment is generally indicated in cases of early stage NSCLC, and those patients treated with radical and aggressive surgery have a somewhat better survival rate. The main problems with lung cancer treatment are due to late diagnosis, rapidly developing drug resistance and side effects of the treatment that are experienced by almost all patients. The next step for distinguishing histologically complicated lung cancers and determining optimal treatment strategies is gene expression analysis. Supported by gene expression data, it is possible to prognosticate the course of the disease.

Trends in Prostate Cancer Incidence and Mortality before and after the Introduction of PSA Testing in the Slovak and Czech Republics

Aims and background

As two neighboring countries in central Europe with national cancer registries, the Slovak (SR) and Czech Republics (CR) are countries with a medium global rate in the occurrence of prostate cancer. This paper analyzes the incidence of prostate cancer and mortality before and after the introduction of PSA testing in the two Republics and the possible reasons for any differences discovered and compares the results with selected regions and countries of the world.

Study design and results

In the Slovak Republic, prostate cancer incidence (age-adjusted to the world standard population) has risen from 14.6/100, 000 in 1968 (95% CI, ±1.5772) to 36.2/100, 000 in 2005 (95% CI, ±2.0678). The estimated annual increase in the incidence during the period 1968–1991 (before nationwide PSA testing) was 0.421; from 1991 (when nationwide PSA testing began) to up to 2003 it was 0.941. Mortality rates grew from 7.3/100, 000 in 1968 to 14.9/100, 000 in 2005. In spite of the geographic proximity of the two countries, the increase in incidence occurred faster in the Czech than in the Slovak Republic, from 15.8/100, 000 in 1977 (95% CI, ±0.9748) to 59.5/100, 000 in 2005 (95% CI, ±1.7187). The estimated annual increase in incidence in the Czech Republic for the period of 1977–1991 was 0.581. From 1991 (when national PSA testing began) until 2003, it was 1.981. In the period before 1991, mortality rose more sharply in the Czech than in the Slovak Republic, whereas after the introduction of PSA testing mortality stabilized more quickly in the Czech than in the Slovak Republic. In the Slovak Republic, a significant reduction in mortality was observed after 2002 and has continued to the present and probably is not affected only by the results connected with the increase in PSA testing.

Conclusions

The difference in the incidence and mortality of prostate cancer in the Slovak and the Czech Republics results from a difference in the intensity of PSA testing as well as from the introduction of complex, more effective treatment in advanced clinical stages.

An age-period-cohort analysis of gastric cancer mortality from 1950 to 2007 in Europe

PURPOSE

To analyze the components of the favorable trends in gastric cancer in Europe.

METHODS

From official certified deaths from gastric cancer and population estimates for 42 countries of the European geographical region, during the period 1950 to 2007, age-standardized death rates (World Standard Population) were computed, and an age-period-cohort analysis was performed.

RESULTS

Central and Northern countries with lower rates in the 2005 to 2007 period, such as France (5.28 and 1.93/100,000, men and women respectively) and Sweden (4.49 and 2.21/100,000), had descending period and cohort effects that decreased steeply from the earliest cohorts until those born in the 1940s, to then stabilize. Former nonmarket economy countries had mortality rates greater than 20/100,000 men and 10/100,000 women, and displayed a later start in the cohort effect fall, which continued in the younger cohorts. Mortality remained high in some countries of Southern and Eastern Europe.

CONCLUSIONS

The decrease in gastric cancer mortality was observed in both cohort and period effects but was larger in the cohorts, suggesting that the downward trends are likely to persist in countries with higher rates. In a few Western countries with very low rates an asymptote appears to have been reached for cohorts born after the 1940s, particularly in women.

Added value of molecular targeted agents in oncology

The treatment of certain cancers has been revolutionised in recent years by the introduction of novel drugs designed to target specific molecular factors implicated in tumour growth. Notable examples include trastuzumab, a humanized monoclonal antibody (mAb) against human epidermal growth factor receptor (HER)-2 in women with HER2-positive breast cancer; rituximab, an anti-CD20 mAb in patients with non-Hodgkin's lymphoma; imatinib, a tyrosine kinase inhibitor in KIT-positive gastrointestinal stromal tumours and sunitinib, another tyrosine kinase inhibitor, in metastatic renal cell carcinoma. For regulatory reasons, new molecular targeted agents are first evaluated in advanced and metastatic disease, wherein they prolong survival. However, their most profound impact has been observed in the adjuvant setting, where they may contribute to curative therapy rather than mere palliation. Expansion in the use of molecular targeted therapies will have important cost implications for health care systems. Although expensive, on a monthly basis, molecular targeted therapies may not be more costly than treatments for other major chronic diseases, especially considering the contribution of cancer to the global disease burden, the associated socioeconomic costs and the long-term benefits of therapy. Nevertheless, the use of these agents must be optimised, in part using molecular biomarkers associated with drug response.

Cetuximab with irinotecan, folinic acid and 5-fluorouracil as first-line treatment in advanced gastroesophageal cancer: a prospective multi-center biomarker-oriented phase II study

BACKGROUND

Cetuximab plus irinotecan/folinic acid/5-fluorouracil (5-FU) (IF) was evaluated as first-line treatment of patients with advanced gastric cancer and gastroesophageal junction tumors. Preplanned analyses of the influence of tumor biomarkers on treatment outcome were carried out.

PATIENTS AND METHODS

Patients received weekly cetuximab (400 mg/m(2) on day 1, subsequently 250 mg/m(2)) plus irinotecan (80 mg/m(2)) and a 24-hour continuous infusion of folinic acid (200 mg/m(2)) and 5-FU (1500 mg/m(2)) on days 1, 8, 15, 22, 29 and 36 of a 50-day cycle, until progressive disease (PD).

RESULTS

The most common grade 3/4 toxic effects in 49 patients were diarrhea (15%) and skin toxic effects (14%). In 48 assessable patients, the overall response rate was 46% and disease control rate was 79%. Median progression-free survival (PFS) and overall survival (OS) was 9.0 months [95% confidence interval (CI) 7.1-15.6] and 16.5 months (95% CI 11.7-30.1), respectively. Tumor response was more common than nonresponse in epidermal growth factor receptor-expressing tumors (P = 0.041). Tumor PTEN expression was associated with longer PFS (P = 0.035) and OS (P = 0.0127) than no PTEN expression.

CONCLUSION

Cetuximab plus IF was well tolerated and efficacy data were encouraging. This treatment combination and the role of selected biomarkers are under investigation in the ongoing phase III EXPAND trial.

An adsorptive transfer technique coupled with brdicka reaction to reveal the importance of metallothionein in chemotherapy with platinum based cytostatics

The drugs based on platinum metals represent one of the oldest, but also one of the most effective groups of chemotherapeutic agents. Thanks to many clinical studies it is known that resistance of tumor cells to drugs is a frequent cause of chemotherapy failure. With regard to platinum based drugs, multidrug resistance can also be connected with increased expression of low-molecular weight protein metallothionein (MT). This study aimed at investigating the interactions of MT with cisplatin or carboplatin, using the adsorptive transfer technique coupled with differential pulse voltammetry Brdicka reaction (AdTS DPV Brdicka reaction), and a comparison of in vitro results with results obtained in vivo. The results obtained from the in vitro study show a strong affinity between platinum based drugs and MT. Further, we analyzed extracts of neuroblastoma cell lines treated with cisplatin or carboplatin. It is clear that neuroblastoma UKF-NB-4 cisplatin-resistant and cisplatin-sensitive cell lines unlikely respond to the presence of the platinum-based cytostatics cisplatin and carboplatin. Finally, we determined the level of MT in samples from rabbits treated with carboplatin and patients with retinoblastoma treated with the same drug.

Dietary patterns and gastric cancer in a Portuguese urban population

Dietary patterns analysis is a powerful technique to study the relations between diet and cancer. We aimed to quantify the association between dietary patterns and gastric cancer, by location and histological type, according to Helicobacter pylori infection status. We analyzed 591 incident cases of gastric adenocarcinoma and 1,463 community controls. Dietary intake was assessed using a validated food frequency questionnaire. Principal components and cluster analyses were used to define dietary patterns. Anti-H. pylori IgG was assessed by ELISA. Age-, gender-, education- and total energy intake-adjusted odds ratios (OR) were computed. Three dietary patterns were identified, with the following main characteristics: (I) high consumption of fruits and dairy products, and low consumption of alcoholic beverages; (II) low consumption of fruit, salads, vegetables, dairy products, fish and meat; (III) high consumptions of most food groups and low vegetable soup intake. Compared to pattern I, the risk of gastric cancer was higher for pattern II (OR = 1.68, 95% CI: 1.31-2.14) but not for pattern III (OR = 0.80, 95% CI: 0.57-1.14), with no effect modification by H. pylori infection. The association was similar for cardia and non-cardia gastric cancer, but for tumors of the diffuse Laurén histological type, the association was weaker for pattern II vs. I (OR = 1.32, 95% CI: 0.83-2.08) and a protective effect was observed for pattern III vs. I (OR = 0.43, 95% CI: 0.22-0.87). Our results confirm the protective effect of high fruit and vegetables intake, and show a differential association according to histological type. No effect modification by H. pylori infection was observed.

The oral cancer epidemic in central and eastern Europe

To monitor recent trends in oral and pharyngeal cancer mortality in 38 European countries, we analyzed data provided by the World Health Organization over the period 1975-2004. Joinpoint analysis was used to identify significant changes in trends. In the European Union (EU), male mortality rates rose by 2.1% per year between 1975 and 1984, by 1.0% between 1984 and 1993, and declined by 1.3% between 1993 and 2004, to reach an overall age-standardized rate of 6.1/100,000 in 2000-2004. Mortality rates were much lower in women, and the rate in the EU rose by 0.9% per year up to 2000, and levelled off to 1.1/100,000 in 2000-2004. In France and Italy-which had the highest rates in the past-male rates have steadily declined during the last two decades (annual percent change, APC = -4.8% in 1998-2004 in France and -2.6% in 1986-2003 in Italy). Persisting rises were, however, observed in several central and eastern European countries, with exceedingly high rates in Hungary (21.1/100,000; APC = 6.9% in 1975-1993 and 1.4% in 1993-2004) and Slovakia (16.9/100,000; APC = 0.14% in 1992-2004). In middle aged (35 to 64) men, oral and pharyngeal cancer mortality rates in Hungary (55.3/100,000) and Slovakia (40.8/100,000) were comparable to lung cancer rates in several major European countries. The highest rates for women were in Hungary (3.3/100,000; APC = 4.7% in 1975-2004) and Denmark (1.6/100,000; APC = 1.3% in 1975-2001). Oral and pharyngeal cancer mortality essentially reflects the different patterns in tobacco smoking and alcohol drinking, including drinking patterns and type of alcohol in central Europe.

Gastric cancer mortality trends in Spain, 1976-2005, differences by autonomous region and sex

BACKGROUND

Gastric cancer is the second leading cause of oncologic death worldwide. One of the most noteworthy characteristics of this tumor's epidemiology is the marked decline reported in its incidence and mortality in almost every part of the globe in recent decades. This study sought to describe gastric cancer mortality time trends in Spain's regions for both sexes.

METHODS

Mortality data for the period 1976 through 2005 were obtained from the Spanish National Statistics Institute. Cases were identified using the International Classification of Diseases 9th and 10th revision (codes 151 and C16, respectively). Crude and standardized mortality rates were calculated by geographic area, sex, and five-year period. Joinpoint regression analyses were performed to ascertain whether changes in gastric cancer mortality trends had occurred, and to estimate the annual percent change by sex and geographic area.

RESULTS

Gastric cancer mortality decreased across the study period, with the downward trend being most pronounced in women and in certain regions situated in the interior and north of mainland Spain. Across the study period, there was an overall decrease of 2.90% per annum among men and 3.65% per annum among women. Generally, regions in which the rate of decline was sharpest were those that had initially registered the highest rates. However, the rate of decline was not constant throughout the study period: joinpoint analysis detected a shift in trend for both sexes in the early 1980s.

CONCLUSION

Gastric cancer mortality displayed in both sexes a downward trend during the study period, both nationally and regionally. The different trend in rates in the respective geographic areas translated as greater regional homogeneity in gastric cancer mortality by the end of the study period. In contrast, rates in women fell more than did those in men. The increasing differences between the sexes could indicate that some risk factors may be modifying the sex-specific pattern of this tumor.

In vivo time-resolved spectroscopy of the human bronchial early cancer autofluorescence

Time-resolved measurements of tissue autofluorescence (AF) excited at 405 nm were carried out with an optical-fiber-based spectrometer in the bronchi of 11 patients. The objectives consisted of assessing the lifetime as a new tumor/normal (T/N) tissue contrast parameter and trying to explain the origin of the contrasts observed when using AF-based cancer detection imaging systems. No significant change in the AF lifetimes was found. AF bronchoscopy performed in parallel with an imaging device revealed both intensity and spectral contrasts. Our results suggest that the spectral contrast might be due to an enhanced blood concentration just below the epithelial layers of the lesion. The intensity contrast probably results from the thickening of the epithelium in the lesions. The absence of T/N lifetime contrast indicates that the quenching is not at the origin of the fluorescence intensity and spectral contrasts. These lifetimes (6.9 ns, 2.0 ns, and 0.2 ns) were consistent for all the examined sites. The fact that these lifetimes are the same for different emission domains ranging between 430 and 680 nm indicates that there is probably only one dominant fluorophore involved. The measured lifetimes suggest that this fluorophore is elastin.

Inequalities in mortality of men by oral and pharyngeal cancer in Barcelona, Spain and São Paulo, Brazil, 1995-2003

Background

Large inequalities of mortality by most cancers in general, by mouth and pharynx cancer in particular, have been associated to behaviour and geopolitical factors. The assessment of socioeconomic covariates of cancer mortality may be relevant to a full comprehension of distal determinants of the disease, and to appraise opportune interventions. The objective of this study was to compare socioeconomic inequalities in male mortality by oral and pharyngeal cancer in two major cities of Europe and South America.

Methods

The official system of information on mortality provided data on deaths in each city; general censuses informed population data. Age-adjusted death rates by oral and pharyngeal cancer for men were independently assessed for neighbourhoods of Barcelona, Spain, and São Paulo, Brazil, from 1995 to 2003. Uniform methodological criteria instructed the comparative assessment of magnitude, trends and spatial distribution of mortality. General linear models assessed ecologic correlations between death rates and socioeconomic indices (unemployment, schooling levels and the human development index) at the inner-city area level. Results obtained for each city were subsequently compared.

Results

Mortality of men by oral and pharyngeal cancer ranked higher in Barcelona (9.45 yearly deaths per 100,000 male inhabitants) than in Spain and Europe as a whole; rates were on decrease. São Paulo presented a poorer profile, with higher magnitude (11.86) and stationary trend. The appraisal of ecologic correlations indicated an unequal and inequitably distributed burden of disease in both cities, with poorer areas tending to present higher mortality. Barcelona had a larger gradient of mortality than São Paulo, indicating a higher inequality of cancer deaths across its neighbourhoods.

Conclusion

The quantitative monitoring of inequalities in health may contribute to the formulation of redistributive policies aimed at the concurrent promotion of wellbeing and social justice. The assessment of groups experiencing a higher burden of disease can instruct health services to provide additional resources for expanding preventive actions and facilities aimed at early diagnosis, standardized treatments and rehabilitation.

Improvement of the specificity of cancer detection by autofluorescence imaging in the tracheo-bronchial tree using backscattered violet light

BACKGROUND

Autofluorescence bronchoscopy (AFB) is a highly sensitive tool for the detection of early bronchial cancers. However, its specificity remains limited due to primarily false positive results induced by hyperplasia, metaplasia and inflammation. We have investigated the potential of blue-violet backscattered light to eliminate false positive results during AFB in a clinical pilot study.

METHODS

The diagnostic autofluorescence endoscopy (DAFE) system was equipped with a variable band pass filter in the imaging detection path. The backscattering properties of normal and abnormal bronchial mucosae were assessed by computing the contrast between the two tissue types for blue-violet wavelengths ranging between 410 and 490 nm in 12 patients undergoing routine DAFE examination. In a second study including 6 patients we used a variable long pass (LP) filter to determine the spectral design of the emission filter dedicated to the detection of this blue-violet light with the DAFE system.

RESULTS

(Pre-)neoplastic mucosa showed a clear wavelength dependence of the backscattering properties of blue-violet light while the reflectivity of normal, metaplastic and hyperplastic autofluorescence positive mucosa was wavelength independent.

CONCLUSIONS

Our results showed that the detection of blue-violet light has the potential to reduce the number of false positive results in AFB. In addition we determined the spectral design of the emission filter dedicated to the detection of this blue-violet light with the DAFE system.