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Salari N, Ghasemi H, Fatahian R, Mansouri K, Dokaneheifard S, Shiri MH, Hemmati M, Mohammadi M. The global prevalence of primary central nervous system tumors: a systematic review and meta-analysis. Eur J Med Res 2023; 28:39. [PMID: 36670466 PMCID: PMC9854075 DOI: 10.1186/s40001-023-01011-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Primary central nervous system (CNS) tumors are a heterogeneous group of neoplasms, including benign and malignant tumors. Since there are many heterogeneities in the prevalence reported in previous studies on this type of tumor, this study was performed to determine the overall prevalence of different primary CNS tumors. METHOD The study was conducted as a systematic review and meta-analysis by searching international databases, including PubMed, Scopus, Science Direct, Web of science, and the Google Scholar search engine until August 2020. After transferring the studies to information management software (EndNote) and eliminating duplicate studies, the remaining studies were reviewed based on inclusion and exclusion criteria according to three stages of primary and secondary evaluation and qualitative evaluation. Comprehensive Meta-Analysis software, Begg, Mazumdar, and I2 tests were used for data analysis, publication bias analysis, and heterogeneity analysis, respectively. RESULTS After performing the systematic review steps, 80 studies were included for final analysis. Based on 8 studies, the prevalence of brain tumors was 70.9%. Also, studies on 7 other studies showed that the prevalence of spinal tumors was 12.2%. A review of 14 studies showed that the prevalence of neuroepithelial tumors was 34.7%. The analysis of 27 studies reported a prevalence of glioma tumors of 42.8%. Analyses performed on other studies showed that the prevalence of pituitary adenomas was 12.2%, embryonal tumors 3.1%, ependymal tumors 3.2%, meningiomas 24.1%, glial tumors 0.8%, astrocytic 20.3%, oligodendroglial 3.9%, glioblastoma 17.7%, schwannoma 6.7%, medulloblastoma 7.7% and Polycystic astrocytomas 3.8%. CONCLUSION As a result, it can be stated that brain tumors are the most common type of primary CNS tumors. It was also observed that tumors involving neuroepithelial cells are more common in patients than other types of tumors.
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Affiliation(s)
- Nader Salari
- grid.412112.50000 0001 2012 5829Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- grid.412112.50000 0001 2012 5829Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Fatahian
- grid.412112.50000 0001 2012 5829Department of Neurosurgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Mansouri
- grid.412112.50000 0001 2012 5829Medical Biology Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sadat Dokaneheifard
- grid.26790.3a0000 0004 1936 8606Department of Human Genetics, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136 USA
| | - Mohammad hossain Shiri
- grid.412112.50000 0001 2012 5829Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahvan Hemmati
- grid.412112.50000 0001 2012 5829Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- grid.512375.70000 0004 4907 1301Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
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2
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Ferrazzoli V, Shankar A, Cockle JV, Tang C, Al-Khayfawee A, Bomanji J, Fraioli F, Hyare H. Mapping glioma heterogeneity using multiparametric 18 F-choline PET/MRI in childhood and teenage-young adults. Nucl Med Commun 2023; 44:91-99. [PMID: 36378239 DOI: 10.1097/mnm.0000000000001636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The heterogeneity of post-treatment imaging remains a significant challenge in children and teenagers/young adults (TYA) diagnosed with glioma. The aim of this study was to evaluate the utility of 18 F-choline PET/MRI in determining intratumoural heterogeneity in paediatric and TYA gliomas. METHODS Twenty-six patients (mean age 16 years, range 8-22 years) with suspected glioma disease progression were evaluated with 18 F-choline PET/MRI. Relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC) and maximum standardised uptake values (SUV max ) in enhancing (enh) and non-enhancing (ne) tumour volumes and normal-appearing white matter (wm) were calculated (rCBV enh , rCBV ne , rCBV wm , ADC enh , ADC ne , ADC wm , SUV enh , SUV ne and SUV wm ). RESULTS Significantly higher SUV enh and SUV ne compared with SUV wm were observed [SUV enh 0.89 (0.23-1.90), SUV ne 0.36 (0.16-0.78) versus SUV wm 0.15 (0.04-1.19); P < 0.001 and P = 0.004, respectively]. Equivalent results were observed for ADV and rCBV (ADC enh , ADC ne : P < 0.001 versus ADC wm ; rCBV enh , rCBV ne : P < 0.001 versus rCBV wm ). The highest values for mean SUV max [0.89 (0.23-1.90)] and mean rCBV [2.1 (0.74-5.08)] were in the enhancing component, while the highest values for ADC [1780 mm 2 /s (863-2811)] were in the necrotic component. CONCLUSION 18 F-choline PET/MRI is able map imaging heterogeneity in paediatric and TYA gliomas, detecting post-treatment enhancing, non-enhancing, and necrotic tumour components equivalent to ADC and DSC-derived rCBV. This offers potential in the response assessment of diffuse non-enhancing gliomas and in selected cases such as posterior fossa tumours where quantitative MRI is technically difficult.
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Affiliation(s)
| | - Ananth Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust
| | - Julia V Cockle
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust
| | | | | | | | | | - Harpreet Hyare
- Department of Imaging, University College London Hospital NHS Foundation Trust
- Department of Brain Repair and Rehabilitation, London, UK
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Lim PS, Tran S, Kroeze SGC, Pica A, Hrbacek J, Bachtiary B, Walser M, Leiser D, Lomax AJ, Weber DC. Outcomes of adolescents and young adults treated for brain and skull base tumors with pencil beam scanning proton therapy. Pediatr Blood Cancer 2020; 67:e28664. [PMID: 32881313 DOI: 10.1002/pbc.28664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND The use of proton therapy (PT) in adolescents and young adults (AYAs) is becoming increasingly popular. This study aims to assess the outcomes and late toxicity consequences in AYAs (15-39 years) with brain/skull base tumors treated with pencil beam scanning proton therapy. METHODS One hundred seventy six AYAs treated curatively at the Paul Scherrer Institute (PSI) were identified. Median age was 30 years (range 15-39) and median prescribed dose was 70.0 Gy (relative biological effectiveness [RBE]) (range 50.4-76.0). The most common tumors treated were chordomas/chondrosarcomas (61.4%), followed by gliomas (15.3%), and meningiomas (14.2%). RESULTS After a median follow up of 66 months (range 12-236), 24 (13.6%) local only failures and one (0.6%) central nervous system (CNS) distant only failure were observed. The 6-year local control, distant progression-free survival, and overall survival were 83.2%, 97.4%, and 90.2%, respectively. The 6-year high-grade (≥grade [G] 3) PT-related late toxicity-free survival was 88.5%. Crude late toxicity rates were 26.2% G1, 37.8% G2, 12.2% G3, 0.6% G4, and 0.6% G5. The one G4 toxicity was a retinopathy and one G5 toxicity was a brainstem hemorrhage. The 6-year cumulative incidences for any late PT-related pituitary, ototoxicity, and neurotoxicity were 36.3%, 18.3%, and 25.6%; whilst high-grade (≥G3) ototoxicity and neurotoxicity were 3.4% and 2.9%, respectively. No secondary malignancies were observed. The rate of unemployment was 9.5% pre-PT, increasing to 23.8% post-PT. Sixty-two percent of survivors were working whilst 12.7% were in education post-PT. CONCLUSIONS PT is an effective treatment for brain/skull base tumors in the AYA population with a reasonable late toxicity profile. Despite good clinical outcomes, around one in four AYA survivors are unemployed after treatment.
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Affiliation(s)
- Pei S Lim
- Department of Radiation Oncology, University College London Hospitals, London, United Kingdom
| | - Sébastien Tran
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Stephanie G C Kroeze
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Dominic Leiser
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,Department of Physics, ETH Zürich, Zürich, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,University of Zürich, Zürich, Switzerland.,University of Bern, Bern, Switzerland
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Almuhaisen G, Alhalaseh Y, Mansour R, Abu-Shanab A, Al-Ghnimat S, Al-Hussaini M. Frequency of mismatch repair protein deficiency and PD-L1 in high-grade gliomas in adolescents and young adults (AYA). Brain Tumor Pathol 2020; 38:14-22. [PMID: 32897465 DOI: 10.1007/s10014-020-00379-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
Central nervous system tumors in adolescents and young adults (AYA) are rarely reported in the literature. The association with cancer predisposition syndrome is not established. Programmed death ligand 1 (PD-L1) can predict the potential response of patients to immunotherapy. A link between mismatch repair protein deficiency (MMRP-D) and response to immunotherapy is established. P53 is reported to be positive in MMRD-D cases. We aim to investigate the frequency of MMRP-D in AYA with high-grade glioma and any potential association with PD-L1. A total of 96 cases were tested including 49 (51.0%) cases of glioblastoma. Six cases (6.25%) were MMRP-D, 17 (17.7%) were PD-L1 positive, mostly in grade IV tumors (8.7% in grade III compared to 26% in grade IV, p value = 0.027), and 69 (71.9%) were P3 positive. None of the MMRP-D cases expressed PD-L1. P53-positive cases were mostly MMRP proficient (n = 67; 74.4%, p value 0.051). Fourteen cases (28.7%) were positive for both PD-L1 and P53, while p53-positive grade IV tumors were mostly associated with negative PD-L1 (n = 29, 58%, p value = 0.043). MMRP deficiency does not appear to be prevalent in high-grade glioma in AYA. Expression of PD-L1 in a quarter of cases might suggest a role for immunotherapy in high-grade glioma.
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Affiliation(s)
| | - Yazan Alhalaseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Razan Mansour
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Amer Abu-Shanab
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Sura Al-Ghnimat
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdullah Street, Al-Jubaiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdullah Street, Al-Jubaiha, P.O. Box 1269, Amman, 11941, Jordan.
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5
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Wanner M, Rohrmann S, Korol D, Shenglia N, Gigineishvili T, Gigineishvili D. Geographical variation in malignant and benign/borderline brain and CNS tumor incidence: a comparison between a high-income and a middle-income country. J Neurooncol 2020; 149:273-282. [PMID: 32813185 PMCID: PMC7541360 DOI: 10.1007/s11060-020-03595-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/08/2020] [Indexed: 11/28/2022]
Abstract
Purpose There is large variability in reported incidence rates of primary brain/CNS tumors across the world, with mostly higher rates in higher-income countries. The aim was to compare malignant and benign brain/CNS tumor incidence between Zurich (Switzerland), a high-income country, and Georgia, a lower middle-income country. Methods For the period March 2009 to February 2012, we extracted the following tumors based on topography according to ICD-O3: C70.0–C72.9, and C75.1 (pituitary gland). Data were categorized into histology groups based on the WHO 2007 histological classification. Age-standardized rates per 100,000 person-years were calculated by subgroups. Results We included 1104 and 1476 cases of primary brain/CNS tumors for Zurich and Georgia, respectively. Mean age of patients was significantly lower in Georgia compared to Zurich (50.0 versus 58.3 years). Overall age-standardized incidence rates for malignant and benign brain/CNS tumors were 10.5 (95% CI 9.9–11.0) for Georgia and 23.3 (95% CI 21.9–24.7) for Zurich with a ratio of benign to malignant tumors of 1.656 for Georgia and 1.946 for Zurich. The most frequent histology types were meningiomas in both regions, followed by glioblastomas in Zurich, but pituitary tumors in Georgia. Conclusion Age-adjusted incidence rates of brain/CNS tumors were considerably higher in Zurich compared to Georgia, both for benign and malignant tumors, which is in line with other studies reporting higher rates in high-income than in low- and middle-income countries. The frequency distribution may be related to differences in diagnosing techniques and the population age structure. Electronic supplementary material The online version of this article (10.1007/s11060-020-03595-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miriam Wanner
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland. .,Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Sabine Rohrmann
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland.,Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dimitri Korol
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Nino Shenglia
- Department of Neurology & Neurosurgery, Tbilisi State University, Tbilisi, Georgia
| | | | - David Gigineishvili
- Department of Neurology & Neurosurgery, Tbilisi State University, Tbilisi, Georgia
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Ng S, Zouaoui S, Bessaoud F, Rigau V, Roux A, Darlix A, Bauchet F, Mathieu-Daudé H, Trétarre B, Figarella-Branger D, Pallud J, Frappaz D, Roujeau T, Bauchet L. An epidemiology report for primary central nervous system tumors in adolescents and young adults: a nationwide population-based study in France, 2008-2013. Neuro Oncol 2020; 22:851-863. [PMID: 31796950 PMCID: PMC7283028 DOI: 10.1093/neuonc/noz227] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Primary central nervous system tumors (PCNST) among adolescents and young adults (AYA, 15-39 y) have rarely been reported. We present a nationwide report of PCNST histologically confirmed in the French AYA population between 2008 and 2013. METHODS Patients were identified through the French Brain Tumor Database (FBTDB), a national dataset that includes prospectively all histologically confirmed cases of PCNST in France. Patients aged 15 to 39 years with histologically confirmed PCNST diagnosed between 2008 and 2013 were included. For each of the 143 histological subtypes of PCNST, crude rates, sex, surgery, and age distribution were provided. To enable international comparisons, age-standardized incidence rates were adjusted to the world-standard, European, and USA populations. RESULTS For 6 years, 9661 PCNST (males/females: 4701/4960) were histologically confirmed in the French AYA population. The overall crude rate was 8.15 per 100 000 person-years. Overall, age-standardized incidence rates were (per 100 000 person-years, population of reference: world/Europe/USA): 7.64/8.07/8.21, respectively. Among patients aged 15-24 years, the crude rate was 5.13 per 100 000. Among patients aged 25-39 years, the crude rate was 10.10 per 100 000. Age-standardized incidence rates were reported for each of the 143 histological subtypes. Moreover, for each histological subtype, data were detailed by sex, age, type of surgery (surgical resection or biopsy), and cryopreserved samples. CONCLUSION These data represent an exhaustive report of all histologically confirmed cases of PCNST with their frequency and distribution in the French AYA population in 2008-2013. For the first time in this age group, complete histological subtypes and rare tumor identification are detailed.
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Affiliation(s)
- Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, University Hospital Center (CHU) Montpellier, Montpellier University Medical Center, Montpellier, France
| | - Sonia Zouaoui
- Department of Neurosurgery, Gui de Chauliac Hospital, University Hospital Center (CHU) Montpellier, Montpellier University Medical Center, Montpellier, France
| | - Faiza Bessaoud
- Tumor Registry of the Hérault, Institut du Cancer de Montpellier, Montpellier, France
| | - Valérie Rigau
- Department of Neuropathology, Gui de Chauliac Hospital, CHU Montpellier, Montpellier University Medical Center, Montpellier, France
| | - Alexandre Roux
- Department of Neurosurgery, University Hospital Group Paris, Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Imaging Biomarkers of Brain Disorders, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Amélie Darlix
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
- University of Montpellier, Montpellier, France
- Neuro-Oncology Group of Languedoc Roussillon, Institut du Cancer de Montpellier, Montpellier, France
| | - Fabienne Bauchet
- Neuro-Oncology Group of Languedoc Roussillon, Institut du Cancer de Montpellier, Montpellier, France
| | - Hélène Mathieu-Daudé
- Neuro-Oncology Group of Languedoc Roussillon, Institut du Cancer de Montpellier, Montpellier, France
- Department of Medical Informatics, Institut du Cancer de Montpellier, Montpellier, France
| | - Brigitte Trétarre
- Tumor Registry of the Hérault, Institut du Cancer de Montpellier, Montpellier, France
| | - Dominique Figarella-Branger
- Aix-Marseille University, National Center for Scientific Research, Institute of Neuro-Physiopathology, Marseille, France
- Department of Pathology and Neuropathology, Timone Hospital, Marseille, France
| | - Johan Pallud
- Department of Neurosurgery, University Hospital Group Paris, Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Imaging Biomarkers of Brain Disorders, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | | | - Thomas Roujeau
- Department of Neurosurgery, Gui de Chauliac Hospital, University Hospital Center (CHU) Montpellier, Montpellier University Medical Center, Montpellier, France
| | - Luc Bauchet
- Department of Neurosurgery, Gui de Chauliac Hospital, University Hospital Center (CHU) Montpellier, Montpellier University Medical Center, Montpellier, France
- Neuro-Oncology Group of Languedoc Roussillon, Institut du Cancer de Montpellier, Montpellier, France
- National Institute of Health and Medical Research unit 1051, Montpellier, France
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7
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Luna-Abanto J, Ruiz LG, Laura-Martinez J, Tairo-Cerron T. Cancer incidence and mortality trends in young adults in Metropolitan Lima young adults, 1990-2012. Ecancermedicalscience 2020; 14:1025. [PMID: 32346391 PMCID: PMC7176066 DOI: 10.3332/ecancer.2020.1025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Indexed: 01/19/2023] Open
Abstract
Aims The purpose of this research was to calculate and compare standardised incidence and mortality ratios in young adults, based on the data published by the population-based cancer registry of Metropolitan Lima. Method A secondary analysis was carried out on the data published by the population-based cancer registry of Metropolitan Lima in its last five volumes. Calculating the standardised incidence ratio, in accordance with the World Health Organization’s standard population, was done using the direct method, and the annual percentage change was calculated using the Joinpoint Regression Program. Results From 1990 to 2012, 12,380 new cases of cancer in young adults between the ages of 20 and 49 were reported in Metropolitan Lima. The neoplasms with the highest standardised incidence ratio in the young adult male group were testicular cancer, brain and nervous system cancer, stomach cancer, non-Hodgkin’s lymphoma and bowel cancer. The neoplasms with the highest standardised mortality ratio for this group were stomach cancer, brain and nervous system cancer, non-Hodgkin’s lymphoma, tracheal cancer, bronchial and lung cancer and liver cancer. The neoplasms with the highest standardised incidence ratio in the young adult female group were breast cancer, cervical cancer, thyroid cancer, ovarian cancer and brain and nervous system cancer. The neoplasms with the highest standardised mortality ratio for this group were breast cancer, cervical cancer, stomach cancer, brain and nervous system cancer and non-Hodgkin’s lymphoma. Conclusions Young adults represent a highly unique group, characterised by little diagnostic suspicion, distribution and aggressiveness of the neoplasms that occur in them. Assessing and reporting incidence and mortality ratios in this age group can contribute to decision making.
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Affiliation(s)
- Jorge Luna-Abanto
- Department of Oncological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
| | - Luis García Ruiz
- Department of Oncological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
| | - Jheff Laura-Martinez
- Department of Oncological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
| | - Tessy Tairo-Cerron
- Department of Nuclear Medicine, National Institute of Neoplastic Diseases, Lima, Peru
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Papageorgiou GI, Razis ED. CNS Tumors in Adolescents and Young Adults: The Need for a Holistic Specialized Approach. JCO Oncol Pract 2020; 16:155-162. [DOI: 10.1200/jop.18.00767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CNS tumors are one of the most common causes of cancer-related death in the 15- to 39-year-old age group. The management of adolescents and young adults (AYAs) who are diagnosed with brain tumors presents unique endocrine, developmental, and psychosocial issues. AYAs are frequently diagnosed late, after a prolonged period of misdiagnosis. The epidemiology, biology, prognosis, and overall management of these tumors differ from those of both older and younger age groups. AYAs are usually in a transitional phase in their lives, and brain tumors in this age group carry a better prognosis than in older adults; thus, special attention should be paid to survivorship care. Fertility and other treatment-related sequelae that affect the quality of life, as well as the increased risk of secondary malignancies in long-term survivors, are such examples. Although most AYAs are managed by adult or, to a lesser extent pediatric, oncologists, a multidisciplinary approach in the setting of specialized centers with increased participation in clinical trials is preferable. End-of-life and palliative care remain an unmet need for these patients, because most physicians lack the training to discuss such issues with young patients.
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9
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Ryzhov A, Bray F, Ferlay J, Fedorenko Z, Goulak L, Gorokh Y, Soumkina O, Michailovich Y, Znaor A. Recent cancer incidence trends in Ukraine and short-term predictions to 2022. Cancer Epidemiol 2020; 65:101663. [PMID: 31882366 DOI: 10.1016/j.canep.2019.101663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Using data from the National Cancer Registry of Ukraine (NCRU), we analyzed recent trends in incidence rates (2003-2012) and used these to predict the future cancer incidence burden up to 2022. METHODS All cancer cases (excluding non-melanoma of skin) for the years 2003-2012 were retrieved from the NCRU's database (n = 1,459,851). Age-standardized incidence rates (ASRs) were estimated and the numbers of new cases and incidence rates predicted for 2022 using age-period modeling. RESULTS ASR increased from 2003 to 2012 for most cancers except lip and stomach cancers (in both sexes) and laryngeal and lung cancers (in males). Assuming these trends will continue, lung cancer will remain the most common male cancer in 2022 (ASR 40.5/100,000), followed by prostate cancer (36.8/100,000), colorectal cancer (34.6/100,000), and cancers of the oral cavity and pharynx (18.5/100,000). In females, the order of the four most common cancers will not change in 2022 compared with 2012, with cervical cancer remaining the fourth most common cancer (17.5/100,000). We predict an overall increase of 18 % in the number of cancer cases in Ukraine (relative to 2012) to 179,493 cases in 2022. CONCLUSION The anticipated increase in the number of cancer patients in Ukraine clearly has knock-on effects on a healthcare system undergoing reforms. Tobacco control appears to be the only functioning aspect of cancer prevention in the country, and there is a need for a broader national cancer control plan. The continued monitoring and evaluation of implemented cancer control measures by the NCRU will help prioritize targets and allocate future resources to cancer services.
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Affiliation(s)
- Anton Ryzhov
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Taras Shevchenko National University of Kyiv, Kyiv, Ukraine.
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Zoya Fedorenko
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Liudmyla Goulak
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Yevgeniy Gorokh
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Olena Soumkina
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Yuriy Michailovich
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Ariana Znaor
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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10
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Sun J, Jiang R, Song M, Yao J, Hou S, Zhu Y, Ji X, Sheng H, Tang Z, Liu Q, Jia Z, Shi W, Shi J. Pathological Grade-Associated Transcriptome Profiling of lncRNAs and mRNAs in Gliomas. Front Oncol 2020; 10:253. [PMID: 32211318 PMCID: PMC7076085 DOI: 10.3389/fonc.2020.00253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
Abstract
The aim of the present study was to explore the expression profiles of lncRNAs and mRNAs in glioma patients and to elucidate any potential relationship between lncRNAs and mRNAs in glioma. High-throughput transcriptome sequencing of mRNAs and lncRNAs from six normal tissues and 16 glioma tissues (grade II, six cases; grade III, four cases; and grade IV, six cases) was performed. Series test of cluster (STC) analysis was used to screen significant trending models associated with glioma. Gene co-expression networks were constructed for the differentially expressed lncRNAs and mRNAs, and gene-ontology (GO) and pathway-enrichment analyses were further performed. Quantitative real-time PCR was performed to validate the five most differentially expressed lncRNAs and mRNAs. After filtering the raw sequencing data, we found 578 lncRNAs and 3,216 mRNAs that were significantly dysregulated in glioma (fold change ≥ 2, p < 0.05). Twenty model profiles of lncRNA and 10 model profiles of mRNA were summarized, and three patterns of lncRNAs and two patterns of mRNAs were of clinical significance. Three gene co-expression networks between mRNAs and lncRNAs were built to clarify the relationship between lncRNAs and mRNAs in glioma. GO and pathway analyses indicated that the differentially expressed lncRNAs and mRNAs were enriched in several biological processes and signaling pathways associated with tumorigenesis. Both lncRNAs and mRNAs exhibited dynamic differential expression profiles that indicated their potential roles in different degrees of glioma malignancy. A series of bioinformatics analyses indicated that most of these lncRNAs and mRNAs are involved in important biological processes and pathways associated with the pathogenesis of glioma. These results provide potential directions and valuable resources for future investigations via the comprehensive integration of these lncRNAs and mRNAs.
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Affiliation(s)
- Junlong Sun
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Rui Jiang
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Mengruo Song
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Junzhong Yao
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Shiqiang Hou
- Department of Neurosurgery, Chuzhou Clinical College of Anhui Medical University, The First Peoples Hospital Chuzhou, Chuzhou, China
| | - Yunhua Zhu
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Xiang Ji
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Hao Sheng
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Zhongyu Tang
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Qianqian Liu
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Zhongzheng Jia
- Medical Image Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Wei Shi
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
| | - Jinlong Shi
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
- Department of Clinic Research Center, The Affiliated Hospital of Nantong University, Nantong, China
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11
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Georgakis MK, Dessypris N, Papadakis V, Tragiannidis A, Bouka E, Hatzipantelis E, Moschovi M, Papakonstantinou E, Polychronopoulou S, Sgouros S, Stiakaki E, Pourtsidis A, Psaltopoulou T, Petridou ET. Perinatal and early life risk factors for childhood brain tumors: Is instrument-assisted delivery associated with higher risk? Cancer Epidemiol 2019; 59:178-184. [PMID: 30818125 DOI: 10.1016/j.canep.2019.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The childhood peak of brain tumors suggests that early-life exposures might have a role in their etiology. Hence, we examined in the Greek National Registry for Childhood Hematological Malignancies and Solid tumors (NARECHEM-ST) whether perinatal and early-life risk factors influence the risk of childhood brain tumors. METHODS In a nationwide case-control study, we included 203 cases (0-14 years) with a diagnosis of brain tumor in NARECHEM-ST (2010-2016) and 406 age-, sex-, and center-matched hospital controls. Information was collected via interviews with the guardians and we analyzed the variables of interest in multivariable conditional logistic regression models. RESULTS Instrument-assisted delivery was associated with higher (OR: 7.82, 95%CI: 2.18-28.03), whereas caesarean delivery with lower (OR: 0.67, 95%CI: 0.45-0.99) risk of childhood brain tumors, as compared to spontaneous vaginal delivery. Maternal alcohol consumption during pregnancy (OR: 2.35, 95%CI: 1.45-3.81) and history of living in a farm (OR: 4.98, 2.40-10.32) increased the odds of childhood brain tumors. Conversely, higher birth order was associated with lower risk (OR for 2nd vs. 1st child: 0.60, 95%CI: 0.40-0.89 and OR for 3rd vs. 1st: 0.34, 95%CI: 0.18-0.63). Birth weight, gestational age, parental age, history of infertility, smoking during pregnancy, allergic diseases, and maternal diseases during pregnancy showed no significant associations. CONCLUSIONS Perinatal and early-life risk factors, and specifically indicators of brain trauma, exposure to toxic agents and immune system maturation, might be involved in the pathogenesis of childhood brain tumors. Larger studies should aim to replicate our findings and examine associations with tumor subtypes.
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Affiliation(s)
- Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Papadakis
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Athanasios Tragiannidis
- Second Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel Hatzipantelis
- Second Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Maria Moschovi
- Haematology-Oncology Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | - Sophia Polychronopoulou
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Spyridon Sgouros
- Department of Neurosurgery, "Mitera" Childrens Hospital, Athens, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Heraklion, Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden.
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12
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Sun J, Zhou W, Mao K, He Y, Yao J, Tang Z, Song M, Liu Q, Zhu H, Ju S, Shi J, Shi W. Examination of Plasma Cell-Free DNA of Glioma Patients by Whole Exome Sequencing. World Neurosurg 2019; 125:e424-e428. [PMID: 30703591 DOI: 10.1016/j.wneu.2019.01.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To analyze the plasma cell-free DNA (Cf-DNA) in glioma patients with high throughout sequencing for a novel non-invasive method for the early diagnosis and management of glioma. METHODS Six patients with glioma were recruited from the Affiliated Hospital of Nantong University from June 2015 to September 2016. Their plasma samples were tested for Cf-DNA by whole exon sequencing and mutations were analyzed by bioinformatics. RESULTS After filtering the raw sequencing data of Cf-DNA, 33,173 mutations were obtained from 12,462 genes of which 442 genes and 655 mutation sites were identical to that in the Catalogue of Somatic Mutations in Cancer database. However, when we compared the Cf-DNA data with the glioma mutated loci in the Cancer Genome Alta database, only 4 mutations matched with the glioma sequences in the Cancer Genome Alta and did not correspond to that of the paired-tumor tissues. CONCLUSIONS There were some cancer-related somatic mutations in the Cf-DNA of glioma patients, but no identical mutations were found in the paired solid tumors. Therefore, plasma Cf-DNA mutations may not be a suitable marker for the detection of glioma.
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Affiliation(s)
- Junlong Sun
- Department of Clinic Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Wenwu Zhou
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China; Department of Clinic Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Kangcheng Mao
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Yunfeng He
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Junzhong Yao
- Department of Clinic Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Zhongyu Tang
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Mengruo Song
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Qianqian Liu
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Hui Zhu
- Department of Clinic Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Shaoqing Ju
- Department of Clinic Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Jinlong Shi
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China; Department of Clinic Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China
| | - Wei Shi
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China; Department of Clinic Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, Peoples Republic of China.
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13
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Ryzhov A, Bray F, Ferlay J, Fedorenko Z, Goulak L, Gorokh Y, Soumkina O, Znaor A. Evaluation of data quality at the National Cancer Registry of Ukraine. Cancer Epidemiol 2018; 53:156-165. [PMID: 29459256 DOI: 10.1016/j.canep.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cancer notification has been mandatory in Ukraine since 1953, with the National Cancer Registry of Ukraine (NCRU) established in 1996. The aim of this study was to provide a comprehensive evaluation of the data quality at the NCRU. METHODS Qualitative and semi-quantitative methods were used to assess the comparability, completeness, validity and timeliness of cancer incidence data from the NCRU for the period 2002-2012. RESULTS Cancer registration procedures at the NCRU are in accordance with international standards and recommendations. Semi-quantitative methods suggested the NCRU's data was reasonably complete, although decreases in age-specific incidence and mortality rates in the elderly indicated some missing cases at older ages. The proportion of microscopically-verified cases increased from 73.6% in 2002 to 82.3% in 2012, with death-certificate-only (DCO) proportions stable at around 0.1% and unknown stage recorded in 9.6% of male and 7.5% of female solid tumours. Timeliness was considered acceptable, with reporting >99% complete within a turn-around time of 15 months. CONCLUSION While timely reporting of national data reflects the advantages of a mandatory data collection system, a low DCO% and observed age-specific declines suggest possible underreporting of incidence and mortality data, particularly at older ages. Overall, the evaluation indicates that the data are reasonably comparable and thus may be used to describe the magnitude of the cancer burden in Ukraine. Given its central role in monitoring and evaluation of cancer control activities, ensuring the sustainability of NCRU operations throughout the process of healthcare system reform is of utmost importance.
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Affiliation(s)
- Anton Ryzhov
- National Cancer Registry of Ukraine, Ukrainian National Cancer Institute, Kyiv, Ukraine; Taras Shevchenko National University of Kyiv, Ukraine; Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Zoya Fedorenko
- National Cancer Registry of Ukraine, Ukrainian National Cancer Institute, Kyiv, Ukraine
| | - Liudmyla Goulak
- National Cancer Registry of Ukraine, Ukrainian National Cancer Institute, Kyiv, Ukraine
| | - Yevgeniy Gorokh
- National Cancer Registry of Ukraine, Ukrainian National Cancer Institute, Kyiv, Ukraine
| | - Olena Soumkina
- National Cancer Registry of Ukraine, Ukrainian National Cancer Institute, Kyiv, Ukraine
| | - Ariana Znaor
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France.
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Di Ciaula A. Towards 5G communication systems: Are there health implications? Int J Hyg Environ Health 2018; 221:367-375. [PMID: 29402696 DOI: 10.1016/j.ijheh.2018.01.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 02/07/2023]
Abstract
The spread of radiofrequency electromagnetic fields (RF-EMF) is rising and health effects are still under investigation. RF-EMF promote oxidative stress, a condition involved in cancer onset, in several acute and chronic diseases and in vascular homeostasis. Although some evidences are still controversial, the WHO IARC classified RF-EMF as "possible carcinogenic to humans", and more recent studies suggested reproductive, metabolic and neurologic effects of RF-EMF, which are also able to alter bacterial antibiotic resistance. In this evolving scenario, although the biological effects of 5G communication systems are very scarcely investigated, an international action plan for the development of 5G networks has started, with a forthcoming increment in devices and density of small cells, and with the future use of millimeter waves (MMW). Preliminary observations showed that MMW increase skin temperature, alter gene expression, promote cellular proliferation and synthesis of proteins linked with oxidative stress, inflammatory and metabolic processes, could generate ocular damages, affect neuro-muscular dynamics. Further studies are needed to better and independently explore the health effects of RF-EMF in general and of MMW in particular. However, available findings seem sufficient to demonstrate the existence of biomedical effects, to invoke the precautionary principle, to define exposed subjects as potentially vulnerable and to revise existing limits. An adequate knowledge of pathophysiological mechanisms linking RF-EMF exposure to health risk should also be useful in the current clinical practice, in particular in consideration of evidences pointing to extrinsic factors as heavy contributors to cancer risk and to the progressive epidemiological growth of noncommunicable diseases.
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Affiliation(s)
- Agostino Di Ciaula
- Division of Internal Medicine, Hospital of Bisceglie (ASL BAT), Bisceglie, Italy; International Society of Doctors for Environment (ISDE), Arezzo, Italy.
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