Cancer incidence and mortality in young adults in Vaud, Switzerland, 1974-1992

Global incidence of oral and oropharynx cancer in patients younger than 45 years versus older patients: A systematic review

Head and neck squamous cell carcinoma (HNSCC) is typically regarded as a disease of elderly people. However, increasing numbers of patients worldwide with HNSCC at younger age (defined as <45 years old) have been reported in recent years. To assess geographical variations and trends worldwide in incidence of oral and oropharyngeal cancer in young patients, a systematic review was conducted in PubMed and Google scholar databases from 1975 to June 2016. Seventy-eight studies were selected for further study. Nineteen population-based studies on incidence rate were available from 13 countries, showing a prominent increase over time except for the Netherlands. A notable rise of oral (mobile) tongue cancer among white women and oropharyngeal cancer in white men was observed. Data suggest that cancer in young patients may be a distinct clinical entity and characterised by different aetiology and pathogenesis. Additionally, the relative proportion of oral and oropharyngeal cancer in young patients to total incidence revealed a significant difference between estimates from North America (5.5%) and both Africa (17.2%) and Middle East (14.5%). It is concluded that (i) a rising trend in oral and oropharynx cancers is observed in young patients worldwide; (ii) incidence studies should properly define outcomes in age cohorts and use a consensus cut-off for young patients; (iii) more population-based studies should be performed in non-Western regions to get accurate global measures of incidence for these cancers in young subpopulations and (iv) there is an urge to identify new aetiological factors in these young patients.

Quantitative body fluid proteomics in medicine - A focus on minimal invasiveness

Identification of new biomarkers specific for various pathological conditions is an important field in medical sciences. Body fluids have emerging potential in biomarker studies especially those which are continuously available and can be collected by non-invasive means. Changes in the protein composition of body fluids such as tears, saliva, sweat, etc. may provide information on both local and systemic conditions of medical relevance. In this review, our aim is to discuss the quantitative proteomics techniques used in biomarker studies, and to present advances in quantitative body fluid proteomics of non-invasively collectable body fluids with relevance to biomarker identification. The advantages and limitations of the widely used quantitative proteomics techniques are also presented. Based on the reviewed literature, we suggest an ideal pipeline for body fluid analyses aiming at biomarkers discoveries: starting from identification of biomarker candidates by shotgun quantitative proteomics or protein arrays, through verification of potential biomarkers by targeted mass spectrometry, to the antibody-based validation of biomarkers. The importance of body fluids as a rich source of biomarkers is discussed.

SIGNIFICANCE

Quantitative proteomics is a challenging part of proteomics applications. The body fluids collected by non-invasive means have high relevance in medicine; they are good sources for biomarkers used in establishing the diagnosis, follow up of disease progression and predicting high risk groups. The review presents the most widely used quantitative proteomics techniques in body fluid analysis and lists the potential biomarkers identified in tears, saliva, sweat, nasal mucus and urine for local and systemic diseases.

Age as a determinant of outcomes for patients with oral cancer

To determine whether survival outcomes of younger patients with oral cavity squamous cell cancer (OSCC) differs from older patients in the US. A retrospective cohort study using data from the Surveillance, Epidemiology and End Results (SEER) registry. We studied cases (n=19681) of OSCC diagnosed from 1973 to 1999 and used age cutoffs at 40, 45, 50, and 55 years. Control groups of older patients were retrospectively matched on gender, race, cancer subsite, and stage of disease. Survival was estimated using the Kaplan-Meier method. A propensity score matching produced groups with similar distributions of patient and disease characteristics. Between these matched groups, younger patients had a significantly better five-year survival (age 40: 63.4% vs. 80.6%, p<0.0001; age 45: 59.0% vs. 72.8%, p<0.0001; age 50: 55.5% vs. 67.2%, p<0.0001; age 55: 54.0% vs. 64.3%, p<0.0001). These results confirm recent results using population-based data that suggest better overall survival in younger patients.

Changing trends in oral squamous cell carcinoma with particular reference to young patients: 1971-2006. The Emory University experience

BACKGROUND

Several recent reports suggest an increasing incidence of oral squamous cell carcinoma (OSCC) among young persons in many regions of the world--a trend which is particularly concerning given the overall stabilization or even decline in incidence rates for head and neck cancer in general. The aim of this study is to determine whether there has been an increase in the number of cases of OSCC diagnosed in patients < 40 years old by our biopsy service from 1971 to 2006.

METHODS

A retrospective review of all OSCC cases diagnosed from 1971 to 2006 by the Emory University Hospital Oral Pathology biopsy service was performed. A comparison of demographic information, frequency, location and histologic grade was made between these cases as a whole and those occurring in a subset of patients < 40 years old. Statistical procedures included chi-square analyses.

RESULTS

From 1971-2006, 1,919 cases of OSCC were diagnosed, and 95 (5.0%) occurred in patients < 40 years old. A total of 8 cases were diagnosed from 1971 to 1980, compared to 36 cases during the period 1981-1990, 31 during the period 1991-2000 and 21 cases from 2001 to 2006. The increase in OSCC incidence from the 1970s when compared to 1981-2000 was statistically significant (P < 0.002). A 1.7:1 male:female ratio was seen in all decades. The mobile (oral) tongue was the most common location in all decades (62.1%) in young patients. In contrast, tongue cancers accounted for 27.4% in patients > or = 40. This difference between the two groups was statistically significant (P < 0.0001). Of great surprise, however, was the significant increase in tongue cancer during the study period in patients > or = 40 which accounted for 37.1% of all OSCC diagnoses from 2001 to 2006, compared to 20.5% of OSCC cases from 1971 to 1980 (P < 0.0001).

CONCLUSIONS

We demonstrated a greater than fourfold increase in the incidence of oral squamous cell carcinoma (OSCC) in young patients < 40 years old beginning in 1974 and peaking in the late 1980s, then remaining stable. The mobile tongue is the most common location for cancer in this age group accounting for 62.1% of cancers. However, the mobile tongue increasingly appears to be the most common site for oral cancer in all age groups.

Oral cancer survival in young people in South East England

The incidence rate of oral cancer among young people in the UK has been increasing since 1970s. The objective of this study was to compare relative survival of young people (under 45 years of age) diagnosed with oral cancer with that of older people (45 years and older) resident in South East England. Between 1986 and 2002, 5 year relative survival was higher among young people compared with the older group, suggesting age was a strong independent predictor of survival. Apart from age other independent predictors of survival included stage, treatment and affluence but residence was not a significant predictor of survival in either age group. For the young age group (0-44 years) mean relative survival for the period under study was relatively constant but consistently higher in younger women than in younger men.

Head and neck squamous cell carcinoma in the young patient

PURPOSE OF THE REVIEW

Squamous cell carcinoma of the upper aerodigestive tract most commonly develops in the sixth or seventh decade of life, usually in patients who have significant risk factors from smoking or alcohol use. A subgroup of patients less than 45 years old, however, develops squamous cell carcinoma of the head and neck in whom the role of tobacco or alcohol use is less clear in the etiology of their cancer. Furthermore, there has been considerable debate regarding the tumor biology in this group of patients and its effects on prognosis and overall survival. This paper reviews the current literature and controversies on the etiology and management of squamous cell carcinoma of the head and neck in young patients.

RECENT FINDINGS

Young patients with head and neck squamous cell carcinoma do not have a poorer prognosis or disease-specific survival.

SUMMARY

Young patients with squamous cell carcinoma of the head and neck have a similar prognosis to older patients. There is a trend, however, towards a higher regional recurrence in young patients with head and neck squamous cell carcinoma, suggesting that prophylactic neck treatment should be considered. Further research is needed to determine whether a subgroup of patients (young nonsmoking women with tongue cancer) have a worse prognosis and warrant more aggressive treatment.

Trends in cancer mortality at age 15 to 24 years in Europe

Trends in death certification rates from all cancers and seven selected cancer sites (bone sarcoma, soft-tissue sarcoma, ovary, testis, non-Hodgkin's lymphomas, Hodgkin's disease, leukaemias) were analysed for the population aged 15-24 years in Europe and, for comparative purposes, in the United States of America (USA) and Japan over the period of 1965-1998. Overall, there was a decrease in total cancer mortality of approximately 40% for both sexes. The declined mortality is largely attributable to better treatments and inclusion in multicentre clinical trials. The degree of improvement was similar in Japan and the USA, but was less in Eastern European countries, reflecting delays in the application of effective treatments, and limited involvement in large, well-designed clinical trials for these curable cancers in Eastern Europe.

Risk factors for squamous cell carcinoma of the oral cavity in young people--a comprehensive literature review

There have been several reports of a rising incidence of oral cancer from many parts of the world. Although it is well known that oral cancer increases with age, recent trends for a rising incidence particularly relates to cancer of the tongue and mouth in young males. This review critically examines 46 publications devoted to oral cancer in the young adult. Most studies suggest that 4-6% of oral cancers now occur at ages younger than 40 years. Several studies examining risk factors for oral cancer in the young provide evidence that many younger patients have never smoked or consumed alcohol, which are recognised risk factors in older groups, or that duration of exposure may be too short for malignant transformation to occur. Information on many aspects of aetiology for this disease in the young implicating occupational, familial risk, immune deficits and virus infection are meagre. The spectrum of genetic abnormality disclosed is similar to older patients, there is paucity of specific studies involving younger cohorts, but predisposition to genetic instability has been hypothesised as a likely cause. Conflicting evidence is also reported on the sex distribution and outcome compared with older patients. Much work is required to understand the caveats related to global demography, risk factors and their diagnostic and prognostic markers for this disease which might be considered a disease distinct from that occurring in older patients.

Incidence of Hodgkin's disease in Nordic countries

We analysed age and sex-specific trends in the incidence of Hodgkin's lymphoma in Denmark, Sweden, Norway, and Finland during 1978-97. The incidence of Hodgkin's lymphoma decreased significantly in all age groups above 40 years; there was a significant increase in incidence among adolescents and young adults. This increase occurred primarily for Hodgkin's lymphoma of the nodular sclerosis subtype. These observations emphasise the need to identify risk factors for Hodgkin's lymphoma in the young.

Trends in colorectal cancer incidence and mortality in New South Wales, 1973-1992

OBJECTIVE

To assess changes in incidence and mortality rates of colorectal cancer in different age groups in New South Wales (NSW) between 1973 and 1992.

DESIGN

Descriptive analysis of data on incidence and mortality from the population-based NSW Central Cancer Registry and on colorectal cancer diagnostic tests from the Health Insurance Commission.

MAIN OUTCOME MEASURES

Age-standardised incidence and mortality rates for colon and rectal cancer (defined by codes 153 and 154 in the International classification of diseases, 9th revision) by sex and age group (15-44, 45-59, 60-74 or > or = 75 years) and incidence by cancer spread at diagnosis; age-standardised rates for faecal occult blood tests, sigmoidoscopy and colonoscopy.

RESULTS

From 1973 to 1992, colorectal cancer incidence increased significantly in NSW by an average of 2.0% per year in males (95% confidence interval [CI], 1.8 to 2.3) and 0.9% in females (95% CI, 0.7 to 1.1). Mortality rates remained nearly constant in males, but fell significantly in females by an average of -1.0% per year (95% CI, -1.3 to -0.7). In the youngest age group (15-44 years) both incidence and mortality rates fell significantly, while rates were stable or rose in older age groups, except for a significant fall in mortality in women aged > or = 75 years. Use of colonoscopy (an early detection method) increased, but a corresponding shift to detection of earlier-stage cancers was not seen.

CONCLUSIONS

A reduction in risk factors and better treatment leading to longer survival may have contributed to the falls in incidence in younger people and in mortality in females.

Trends of Kaposi's sarcoma at AIDS diagnosis in Europe and the United States, 1987-94

As a proportion of AIDS-defining illnesses, Kaposi's sarcoma (KS) decreased from 1987-89 to 1993-94 in homosexual and bisexual men in all European regions and in the United States. Albeit underestimated, AIDS KS rates in the general male population at ages 25-49 are higher than those of the majority of cancer sites in the same age group.