Investigating the completeness of a histopathological cancer registry: estimation by capture-recapture analysis in a French geographical unit Alpes-Maritimes, 2008

Cancer incidence in the vicinity of a waste incineration plant in the Nice area between 2005 and 2014

INTRODUCTION

Few studies on cancer incidence have been conducted since the adoption of the EU 2000/76/EC waste incineration directive which aimed to limit dioxin emission levels to less than 0.1 ng TEQ/m³ before December 31, 2005.

OBJECTIVE

To measure cancer incidence among the population exposed to atmospheric emissions from the waste incineration plant near the town of Nice (South-Eastern France), compared to the unexposed population of the Alpes-Maritimes department (A-M).

METHODS

All primary invasive cancers and haematological malignancies diagnosed among AM residents between 2005 and 2014 were recorded. The exposed surface was modeled on an average dioxin deposition model ≥4.25 ng/m²/year. Each case was geolocated and assigned to one of 36 predefined geographic units of exposed area, or one of 462 units in the unexposed area. The adjusted incidence rate, the standardized incidence ratio and the Comparative Morbidity Figure were calculated for two periods: 2005-2009/2010-2014.

RESULTS

We recorded 80,865 new cancers in the A-M population. Between 2005 and 2009, we observed a higher incidence among exposed women of acute myeloid leukaemia, myelodysplastic syndromes and myeloma and, among exposed men, of soft tissue sarcomas, myeloma and lung cancer. Between 2010 and 2014, there was no excess incidence among women, while among men incidence of myeloma and lung cancer remained higher.

CONCLUSION

Only among men, the incidence of myeloma and lung cancer remained higher in the exposed area during the second period. The EU directive resulting in the limitation of atmospheric emissions from incinerators could explain the decrease in incidence of cancers with protracted latency. Consideration of other risk factors and further data collection will be necessary to validate this hypothesis.

Population-based incidence of lymphomas in the French Nord-Pas-de-Calais region between 2001 and 2005: Annual estimations and spatial analysis

BACKGROUND

Non-Hodgkin's lymphomas (NHL) are the seventh most commonly diagnosed cancer in France. Nord-Pas-de-Calais is ranked as the region with the highest incidence of cancers and deaths by cancer in France. With its rich industrial past and its contrasted population densities between urban and rural territories, Nord-Pas-de-Calais represents a geographic area of interest to study the overall incidence of NHL and examine spatial variation of NHL incidence between the 170 cantons of the region.

METHODS

LYMPHONOR was a population-based multicentre retrospective study of patients residing in the Nord-Pas-de-Calais region and diagnosed with NHL between January 2001 and December 2005. Spatial distribution of NHL incidence in Nord-Pas-de-Calais was explored using two complementary approaches: adjusted smoothed standardised incidence ratio (SIR) and spatial scan statistics (detection of atypical clusters).

RESULTS

Between 2001 and 2005, 2132 new cases of NHL were diagnosed in the Nord-Pas-de-Calais region. In 2005, age-standardised NHL incidence rates were 10.2 and 7.0 cases per 100,000 person-years in male and female residents, respectively. No significant spatial disparities in NHL incidence were found within the Nord-Pas-de-Calais region. The age-adjusted smoothed SIR varied from 0.82 to 1.25 between cantons. Consistently, spatial scan statistics did not detect any significant atypical cluster of high NHL incidence.

CONCLUSION

Comparison with national data collected during the same period does not show an overincidence of NHL in the Nord-Pas-de-Calais region. In addition, no evidence for spatial heterogeneity and clustering of NHL incidence was found within this region. Future epidemiological research using large-scale registries is needed to better appraise spatial variation of NHL incidence in France and to investigate possible reasons for significant clusters.

Development of a tool for comprehensive evaluation of population-based cancer registries

OBJECTIVE

Several methods have been suggested for evaluation of population-based cancer registries (PBCR) worldwide. However, most of these methods evaluate the data and outputs of the cancer registries. This study aimed to develop a comprehensive tool and protocol for evaluation of inputs, processes and outputs of a PBCR.

METHODS

The standards of the North American Association of Central Cancer Registries (NAACCR) were used to draft a comprehensive checklist. In addition, the national guidelines of PBCR were used to develop a questionnaire for evaluation of knowledge and practice of the PBCR personnel. Furthermore, a protocol for evaluation of the completeness and validity of the PBCR data was developed according to the International Agency for Research on Cancer (IARC) and the NAACCR guidelines. A 0-4 Likert based score and expert opinions (10 experts) were used to assess validity of the eight questionnaires/checklists. A modified Delphi method was applied to validate the checklists and questionnaires. Questions with a score higher than 3 remained in the final tools.

RESULTS

The final package consists of 546 questions including 108 (19.8%) for evaluation of guidelines, 54 (9.9%) for analysis and reports, 87 (15.9%) for governance and infrastructure, 155 (28.4%) for information technology, 21 (3.8%) for personnel knowledge and 121 (22.2%) for their practice. Additionally, data quality indicators were also considered for evaluation of PBCRs.

CONCLUSION

This comprehensive tool can be used to show the gaps and limitations of the PBCR programs and provide informative clues for their improvement.

Estimation of Completeness of Cancer Registration for Patients Referred to Shiraz Selected Centers through a Two Source Capture Re-capture Method, 2009 Data

BACKGROUND

Cancer has important social consequences with cancer registration as the basis of moving towards prevention. The present study aimed to estimate the completeness of registration of the ten most common cancers in patients referred to selected hospitals in Shiraz, Iran by using capture-recapture method.

MATERIALS AND METHODS

This cross-sectional analytical study was performed in 2014 based on the data of 2009, on a total of 4,388 registered cancer patients. After cleaning data from two sources, using capture-recapture common findings were identified. Then, the percentage of the completeness of cancer registration was estimated using Chapman and Chao methods. Finally, the effects of demographic and treatment variables on the completeness of cancer registration were investigated.

RESULTS

The results showed that the percentages of completeness of cancer registration in the selected hospitals of Shiraz were 58.6% and 58.4%, and influenced by different variables. The age group between 40-49 years old was the highest represented and for the age group under 20 years old was the lowest for cancer registration. Breast cancer had the highest registration level and after that, thyroid and lung cancers, while colorectal cancer had the lowest registration level.

CONCLUSIONS

According to the results, the number of cancers registered was very few and it seems that factors like inadequate knowledge of some doctors, imprecise diagnosis about the types of cancer, incorrectly filled out medical documents, and lack of sufficient accuracy in recording data on the computer cause errors and defects in cancer registration. This suggests a necessity to educate and teach doctors and other medical workers about the methods of documenting information related to cancer and also conduct additional measures to improve the cancer registration system.

Bayesian estimation of a cancer population by capture-recapture with individual capture heterogeneity and small sample

BACKGROUND

Cancer incidence and prevalence estimates are necessary to inform health policy, to predict public health impact and to identify etiological factors. Registers have been used to estimate the number of cancer cases. To be reliable and useful, cancer registry data should be complete. Capture-recapture is a method for estimating the number of cases missed, originally developed in ecology to estimate the size of animal populations. Capture recapture methods in cancer epidemiology involve modelling the overlap between lists of individuals using log-linear models. These models rely on assumption of independence of sources and equal catchability between individuals, unlikely to be satisfied in cancer population as severe cases are more likely to be captured than simple cases.

METHODS

To estimate cancer population and completeness of cancer registry, we applied M(th) models that rely on parameters that influence capture as time of capture (t) and individual heterogeneity (h) and compared results to the ones obtained with classical log-linear models and sample coverage approach. For three sources collecting breast and colorectal cancer cases (Histopathological cancer registry, hospital Multidisciplinary Team Meetings, and cancer screening programmes), individual heterogeneity is suspected in cancer population due to age, gender, screening history or presence of metastases. Individual heterogeneity is hardly analysed as classical log-linear models usually pool it with between-"list" dependence. We applied Bayesian Model Averaging which can be applied with small sample without asymptotic assumption, contrary to the maximum likelihood estimate procedure.

RESULTS

Cancer population estimates were based on the results of the M(h) model, with an averaged estimate of 803 cases of breast cancer and 521 cases of colorectal cancer. In the log-linear model, estimates were of 791 cases of breast cancer and 527 cases of colorectal cancer according to the retained models (729 and 481 histological cases, respectively).

CONCLUSIONS

We applied M(th) models and Bayesian population estimation to small sample of a cancer population. Advantage of M(th) models applied to cancer datasets, is the ability to explore individual factors associated with capture heterogeneity, as equal capture probability assumption is unlikely. M(th) models and Bayesian population estimation are well-suited for capture-recapture in a heterogeneous cancer population.

Menstrual and reproductive factors in the risk of differentiated thyroid carcinoma in young women in France: a population-based case-control study

The incidence of thyroid cancer has increased in eastern Europe since the Chernobyl nuclear power plant accident. Although the radioactive fallout was much less severe and the thyroid radiation dose was much lower in France, a case-control study was initiated in eastern France. The present study included 633 young women who were diagnosed with differentiated thyroid cancer before 35 years of age between 2002 and 2006 and matched with 677 controls. Face-to-face interviews were conducted from 2005 to 2010. Odds ratios were calculated using conditional logistic regressions and were reported in the total group and by histopathological type of cancer ("only papillary" and "excluding microcarcinomas"). The risk of thyroid cancer was higher in women who had a higher number of pregnancies, used a lactation suppressant, or had early menarche. Conversely, breastfeeding, oral contraceptive use, and late age at first pregnancy were associated with a lower risk of thyroid cancer. No association was observed between thyroid cancer and having irregular menstrual cycle, undergoing treatment for menstrual cycle regularity shortly after menarche, having a cessation of menstruation, use of another contraceptive, history of miscarriage or abortion for the first pregnancy, or having had gestational diabetes. This study confirms the role of hormonal and reproductive factors in thyroid cancer, and our results support the fact that exposure to estrogens increases thyroid cancer risk.

Data coverage of a cancer registry in southern Iran before and after implementation of a population-based reporting system: a 10-year trend study

Background

Cancer registries help to decrease the burden of cancers by collecting accurate and complete data. We aimed to measure the completeness of coverage of information recorded between 2000 and 2009 in a cancer registry program in Fars province, southern Iran.

Methods

The cancer registry program run by Shiraz University of Medical Sciences was investigated in two periods: pathology-based data from 2000 to 2007 and population-based data from 2007 to 2009. Completeness of yearly coverage was measured as the number of reported cases of cancer in each year divided by estimated cases based on 107.3 new cases per 100 000 individuals. The percentage of complete data registration (patient’s name, age, gender, address, phone number and father’s name) and correct cancer encoding was calculated for each year and compared to the maximum acceptable error rate for each item.

Results

A total of 29 277 non-duplicate cancer records were studied. Completeness of coverage varied from 22.68% in 2000 to 118.7% in 2008. Deficiencies in patients’ demographic data were highest for name in 2002 (0.09%), age in 2006 (2.36%), gender in 2001 (0.06%) and father’s name in 2001 (52.5%). Incomplete address (99.7%) and missing phone number (100%) were most frequent in 2000, and deficiencies in encoding information were highest in 2008 (6.36%).

Conclusions

The cancer registry program in Fars province (southern Iran) was considered satisfactory in terms of completeness of coverage and information about age. However, it was deficient in recording patients’ phone number and address, and father’s name. The error level for cancer encoding was unacceptably high. Enhancing hardware and software resources, education and motivation in all public and private sectors involved in the cancer registry program, and greater attention to epidemiological research are needed to increase the quality of the cancer registry program, including its completeness.