Spatial variation and temporal trends of testicular cancer in Great Britain

Comparing spatial patterns of 11 common cancers in Mainland China

BACKGROUND

A stronger spatial clustering of cancer burden indicates stronger environmental and human behavioral effects. However, which common cancers in China have stronger spatial clustering and knowledge gaps regarding the environmental and human behavioral effects have yet to be investigated. This study aimed to compare the spatial clustering degree and hotspot patterns of 11 common cancers in mainland China and discuss the potential environmental and behavioral risks underlying the patterns.

METHODS

Cancer incidence data recorded at 339 registries in 2014 was obtained from the "China Cancer Registry Annual Report 2017". We calculated the spatial clustering degree of the common cancers using the global Moran's Index and identified the hotspot patterns using the hotspot analysis.

RESULTS

We found that esophagus, stomach and liver cancer have a significantly higher spatial clustering degree ([Formula: see text]) than others. When by sex, female esophagus, male stomach, male esophagus, male liver and female lung cancer had significantly higher spatial clustering degree ([Formula: see text]). The spatial clustering degree of male liver was significantly higher than that of female liver cancer ([Formula: see text]), whereas the spatial clustering degree of female lung was significantly higher than that of male lung cancer ([Formula: see text]). The high-risk areas of esophagus and stomach cancer were mainly in North China, Huai River Basin, Yangtze River Delta and Shaanxi Province. The hotspots for liver and male liver cancer were mainly in Southeast China and south Hunan. Hotspots of female lung cancer were mainly located in the Pearl River Delta, Shandong, North and Northeast China. The Yangtze River Delta and the Pearl River Delta were high-risk areas for multiple cancers.

CONCLUSIONS

The top highly clustered cancer types in mainland China included esophagus, stomach and liver cancer and, by sex, female esophagus, male stomach, male esophagus, male liver and female lung cancer. Among them, knowledge of their spatial patterns and environmental and behavioral risk factors is generally limited. Potential factors such as unhealthy diets, water pollution and climate factors have been suggested, and further investigation and validation are urgently needed, particularly for male liver cancer. This study identified the knowledge gap in understanding the spatial pattern of cancer burdens in China and offered insights into targeted cancer monitoring and control.

Smart Intravenous Infusion Dosing System

Intravenous (IV) infusion therapy allows the infusion fluid to be inserted directly into the patient’s vein. It is used to place medications directly into the bloodstream or for blood transfusions. The probability that a hospitalized patient will receive some kind of infusion therapy, intravenously, is 60–80%. The paper presents a smart IV infusion dosing system for detection, signaling, and monitoring of liquid in an IV bottle at a remote location. It consists of (i) the sensing and computation layer—a system for detection and signaling of fluid levels in the IV bottle and a system for regulation and closing of infusion flow, (ii) the communication layer—a wireless exchange of information between the hardware part of the system and the client, and (iii) the user layer—monitoring and visualization of IV therapy reception at a remote location in real time. All layers are modular, allowing upgrades of the entire system. The proposed system alerts medical staff to continuous and timely changes of IV bottles, which can have positive effects on increasing the success of IV therapy, especially in oncology patients. The prescribed drip time of IV chemotherapy for the full effect of cytostatics should be imperative.

Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies

Background

Since the end of the previous century, there has not been a comprehensive review of European studies on socioeconomic inequality in cancer incidence. In view of recent advances in data source linkage and analytical methods, we aimed to update the knowledge base on associations between location-specific cancer incidence and individual or area-level measures of socio-economic status (SES) among European adults.

Materials and methods

We systematically searched three databases (PubMed, Scopus and Web of Science) for articles on cancer incidence and SES. Qualitative synthesis was performed on the 91 included English language studies, published between 2000 and 2019 in Europe, which focused on adults, relied on cancer registry data and reported on relative risk (RR) estimates.

Results

Adults with low SES have increased risk of head and neck, oesophagogastric, liver and gallbladder, pancreatic, lung, kidney, bladder, penile and cervical cancers (highest RRs for lung, head and neck, stomach and cervix). Conversely, high SES is linked with increased risk of thyroid, breast, prostate and skin cancers. Central nervous system and haematological cancers are not associated with SES. The positive gap in testicular cancer has narrowed, while colorectal cancer shows a varying pattern in different countries. Negative associations are generally stronger for men compared to women.

Conclusions

In Europe, cancers in almost all common locations are associated with SES and the inequalities can be explained to a varying degree by known life-style related factors, most notably smoking. Independent effects of many individual and area SES measures which capture different aspects of SES can also be observed.

Correlations between Mortality-to-Incidence Ratios and Health Care Disparities in Testicular Cancer

The mortality-to-incidence ratio (MIR) is associated with the clinical outcomes of different types of cancer as well as the ranking of health care systems. However, the association between MIRs for testicular cancer and health care disparities, including differences in expenditures and health system rankings, has not yet been reported. We used the Spearman’s rank correlation coefficient (CC) to analyze the correlation between testicular cancer MIRs and both total expenditures on health/gross domestic product (e/GDP) and the World Health Organization’s (WHO) health system rankings. After screening the data for quality and missing information, 57 countries were chosen for analysis. Generally, developed countries and regions had relatively high rates of incidence/mortality, but with a favorable MIR. Among the continents, Europe had the highest incidence rates, whereas the highest MIRs were in Africa. Globally, favorable testicular cancer MIRs were observed in countries with both a high e/GDP and a good WHO ranking (R² = 0.325, p < 0.001 and CC = −0.568, p < 0.001; R² = 0.367, p < 0.001 and CC = 0.655, p < 0.001, respectively). In conclusion, the MIR for testicular cancer varies in countries and regions based on both their total health expenditure and their health care system ranking.

Application of SCM with Bayesian B-Spline to Spatio-Temporal Analysis of Hypertension in China

Most previous research on the disparities of hypertension risk has neither simultaneously explored the spatio-temporal disparities nor considered the spatial information contained in the samples, thus the estimated results may be unreliable. Our study was based on the China Health and Nutrition Survey (CHNS), including residents over 12 years old in seven provinces from 1991 to 2011. Bayesian B-spline was used in the extended shared component model (SCM) for fitting temporal-related variation to explore spatio-temporal distribution in the odds ratio (OR) of hypertension, reveal gender variation, and explore latent risk factors. Our results revealed that the prevalence of hypertension increased from 14.09% in 1991 to 32.37% in 2011, with men experiencing a more obvious change than women. From a spatial perspective, a standardized prevalence ratio (SPR) remaining at a high level was found in Henan and Shandong for both men and women. Meanwhile, before 1997, the temporal distribution of hypertension risk for both men and women remained low. After that, notably since 2004, the OR of hypertension in each province increased to a relatively high level, especially in Northern China. Notably, the OR of hypertension in Shandong and Jiangsu, which was over 1.2, continuously stood out after 2004 for males, while that in Shandong and Guangxi was relatively high for females. The findings suggested that obvious spatial-temporal patterns for hypertension exist in the regions under research and this pattern was quite different between men and women.

Space-time analysis of testicular cancer clusters using residential histories: a case-control study in Denmark

Though the etiology is largely unknown, testicular cancer incidence has seen recent significant increases in northern Europe and throughout many Western regions. The most common cancer in males under age 40, age period cohort models have posited exposures in the in utero environment or in early childhood as possible causes of increased risk of testicular cancer. Some of these factors may be tied to geography through being associated with behavioral, cultural, sociodemographic or built environment characteristics. If so, this could result in detectable geographic clusters of cases that could lead to hypotheses regarding environmental targets for intervention. Given a latency period between exposure to an environmental carcinogen and testicular cancer diagnosis, mobility histories are beneficial for spatial cluster analyses. Nearest-neighbor based Q-statistics allow for the incorporation of changes in residency in spatial disease cluster detection. Using these methods, a space-time cluster analysis was conducted on a population-wide case-control population selected from the Danish Cancer Registry with mobility histories since 1971 extracted from the Danish Civil Registration System. Cases (N=3297) were diagnosed between 1991 and 2003, and two sets of controls (N=3297 for each set) matched on sex and date of birth were included in the study. We also examined spatial patterns in maternal residential history for those cases and controls born in 1971 or later (N= 589 case-control pairs). Several small clusters were detected when aligning individuals by year prior to diagnosis, age at diagnosis and calendar year of diagnosis. However, the largest of these clusters contained only 2 statistically significant individuals at their center, and were not replicated in SaTScan spatial-only analyses which are less susceptible to multiple testing bias. We found little evidence of local clusters in residential histories of testicular cancer cases in this Danish population.

Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma

BACKGROUND

Patients with stage I testicular seminoma are typically diagnosed at a young age and treatment is associated with low relapse and mortality rates. The long-term risks of adjuvant radiotherapy in this patient group are therefore particularly relevant.

METHODS

We identified patients and obtained treatment details from 12 cancer centres (11 United Kingdom, 1 Norway) and ascertained second cancers and mortality through national registries. Data from 2629 seminoma patients treated with radiotherapy between 1960 and 1992 were available, contributing 51,151 person-years of follow-up.

RESULTS

Four hundred and sixty-eight second cancers (excluding non-melanoma skin cancers) were identified. The standardised incidence ratio (SIR) was 1.61 (95% confidence interval (CI): 1.47-1.76, P<0.0001). The SIR was 1.53 (95% CI: 1.39-1.68, P<0.0001) when the 32 second testicular cancers were also excluded. This increase was largely due to an excess risk to organs in the radiation field; for pelvic-abdominal sites the SIR was 1.62 (95% CI: 1.43-1.83), with no significant elevated risk of cancers in organs elsewhere. There was no overall increase in mortality with a standardised mortality ratio (SMR) of 1.06 (95% CI: 0.98-1.14), despite an increase in the cancer-specific mortality (excluding testicular cancer deaths) SMR of 1.46 (95% CI: 1.30-1.65, P<0.0001).

CONCLUSION

The prognosis of stage I seminoma is excellent and it is important to avoid conferring long-term increased risk of iatrogenic disease such as radiation-associated second cancers.

Minimizing toxicity in early-stage testicular cancer treatment

Testicular cancer is the paradigm of a curable malignancy, with 10-year survival rates exceeding 95%. Cisplatin-based regimes offer a survival gain of several decades of life; however, measures of outcomes in testicular cancer are evolving. Survivorship issues are becoming increasingly important in this young adult population. Long-term risks of second malignancy and cardiovascular disease secondary to chemotherapy and radiotherapy have been extensively documented, leading to an increased uptake of surveillance. However, the optimal surveillance schedule is not universally agreed upon. Research into modalities to detect relapse and frequency is ongoing. Reducing the treatment burden with fewer cycles of chemotherapy (one cycle of bleomycin, cisplatin and etoposide instead of two for stage I high-risk nonseminomatous tumors) or less toxic alternatives (carboplatin instead of radiotherapy for stage I seminomas) is currently being explored. This article details the toxicities associated with the diagnosis and treatments of early-stage testicular cancer and current strategies used to minimize toxicity while retaining the excellent cure rates.

Ethnic and socioeconomic trends in testicular cancer incidence in New Zealand

Ethnic differences in testicular cancer incidence within countries are often sizeable, with white populations consistently having the highest ethnic-specific rates. Many studies have found that high socioeconomic status is a risk factor for testicular cancer. The objectives of this article are to test whether trends in testicular cancer incidence have varied by ethnicity and socioeconomic position in New Zealand between 1981 and 2004. Five cohorts of the entire New Zealand population for 1981-1986, 1986-1991, 1991-1996, 1996-2001 and 2001-2004 were created, and probabilistically linked to cancer registry records, allowing direct determination of ethnic and household income trends in testicular cancer incidence. There were more than 2,000 cases of testicular cancer over the study period. We found increasing rates of testicular cancer for all ethnic and income groups since 1990s. Maori had higher rates, and Pacific and Asian lower rates than European/other men with rate ratios pooled over time of 1.51 (95% CI 1.31-1.74), 0.40 (95% CI 0.26-0.61) and 0.54 (95% CI 0.31-0.94), respectively. Overall, men with low incomes had higher risk of testicular cancer than those with high incomes (pooled rate ratio for lowest to highest income groups = 1.23; 95% CI 1.05-1.44). There was no strong evidence that disparities in testicular cancer incidence have varied by ethnicity or household income over time. Given the lack of understanding of the etiology of testicular cancer, the unusual patterns identified in the New Zealand context may provide some etiological clues for future novel research.

Public perceptions of the harms and benefits of testicular cancer education: a qualitative study

BACKGROUND

The value of testicular cancer (TC) education, and in particular advice on testicular self-examination (TSE), has been widely debated by health professionals. One concern centres on its potential to cause unnecessary anxiety among the target population. Views outside the health professional community about TC education's potential benefits and harms have not previously been described. The objective of this study was to investigate the range of views expressed by specific groups thought to have an interest in provision of TC education.

METHODS

One-to-one, in-depth interviews with 37 men and women were completed. Participants included TC patients, men with no prior diagnosis of TC, and parents and teachers of adolescent boys. Verbatim transcripts were analysed using the Framework approach to produce a thematic description of views expressed.

RESULTS

Participants were unanimously in favour of TC education. Key perceived benefits included earlier cancer detection through increasing knowledge of symptoms leading to better treatment outcomes, and motivating help-seeking by reducing emotional barriers such as fear of cancer or embarrassment. Anxiety was acknowledged as a possible harm but was not expected to be widespread or serious.

CONCLUSION

TC education is viewed favourably by members of the public likely to be interested in its provision. Education's potential to cause anxiety was not considered a disincentive to promoting disease awareness.

Epidemiology of testicular cancer

Testicular cancer is of interest and importance because its incidence has been increasing in most countries over the past four decades. Although it remains an uncommon malignancy overall accounting for 1-2% of all tumours in men, testicular cancer is the most common malignancy in young men. There is marked geographical variation in the incidence of testicular cancer, with the highest incidence among men in Nordic countries and lowest incidence among men in the Middle East and Asia. The association between some risk factors, including cryptorchidism, a previous history of testicular cancer and a family history of testicular cancer, and the incidence of testicular cancer has been widely reported. We reviewed published reports and present the evidence to support or refute the association between the well-established and the less well-established risk factors and the incidence of testicular cancer.

Time trends in the incidence of testicular cancer in childhood and young adulthood

BACKGROUND

There has been a steep increase in the incidence of adult testicular cancer in many populations, but in spite of numerous studies, the etiology of testicular cancer remains elusive. The time trends of childhood testicular tumors are less clear and have been studied in a few populations. To further evaluate whether or not adult and childhood cancers share trend determinants and whether future adult testicular cancer incidences can be predicted through childhood testicular cancer incidences, their rates were compared.

METHOD

Data on testicular cancer incidence in childhood and in young adulthood were extracted from the IARC Cancer Incidence in the Five Continents Database limited to two 10-year time periods (1967-1976 and from 1987-1996) to allow for truncation-free analyses within the same birth cohort.

RESULTS

Childhood testicular cancer incidence varied 3- to 4-fold, whereas adult testicular cancer incidence varied 10- to 11-fold between the studied populations. No positive correlation between childhood and adulthood incidence of testicular cancer was found.

CONCLUSION

These data indicate that the incidence of testicular cancer in adulthood is influenced by factors, either prenatal or postnatal exposures different than those determining the trends among children.

Temporal trends in bull semen quality: a comparative model for human health?

INTRODUCTION

A decline in human semen quality over the past 30-60 years has been reported in numerous epidemiological studies from the United States and Europe. We evaluated temporal trends in semen quality parameters in dairy bulls. The long-term management of dairy bulls for artificial insemination presented a unique opportunity to evaluate temporal trends in semen quality and explore this relationship as a potential animal model for reproductive abnormalities in humans.

MATERIALS AND METHODS

Bull semen analysis data from 1965 through 1995 were collected from a large artificial insemination organization. Semen analyses from 12- to 18-month-old Holstein dairy bulls were included in the study and consisted of daily sperm concentration, daily ejaculate volume, total daily sperm output, percentage of sperm with normal morphology, and percentage of sperm with normal post-thaw motility. Multiple regression analysis, logistic regression, and general linear modeling were used to determine temporal trends over the 30-year period.

RESULTS AND DISCUSSION

Semen quality appears to have declined from 1970 to 1980 or 1985 as manifested by declines in daily ejaculate volume, daily sperm concentration, and total daily sperm output. In contrast, sperm morphology and motility improved over the same period. In approximately 1980 or 1985, depending on the parameter, ejaculate volume, sperm concentration, total sperm, and motility improved. However, normal morphology began to deteriorate during this same period. Methodological inconsistencies over time introduce uncertainty in analyses of temporal trends in semen quality in this and previous human studies. However, changes in technology do not appear to be solely responsible for the temporal trends observed. The source of the decline in semen quality in the bulls studied is unknown. If the decline in semen quality were due to exposure to endocrine disrupting chemicals, then a continued decline or a leveling-off would be expected. Instead, a rise in semen quality was observed during the latter portion of the observation period.

Sex-specific incidence and temporal trends in solid tumours in young people from Northern England, 1968-2005

BACKGROUND

This study examined sex-specific patterns and temporal trends in the incidence of solid tumours in the Northern Region of England from 1968 to 2005. This updates earlier analyses from the region where sex was not considered in depth. Sex-specific analyses were carried out to determine whether sex differences might provide clues to aetiology.

METHODS

Details of 3576 cases, aged 0-24 years, were obtained from a specialist population-based cancer registry. There were 1843 males (886 aged 0-14 years and 957 aged 15-24 years) and 1733 females (791 aged 0-14 years and 942 aged 15-24 years). Age-standardized incidence rates (per million population) were calculated. Linear regression was used to analyze temporal trends in incidence and annual percentage changes were estimated. Analyses were stratified by sex and by age-group.

RESULTS

There were marked differences in incidence patterns and trends between males and females and also between age-groups. For males central nervous system (CNS) tumours formed the largest proportion of under-15 cases and germ cell tumours was the largest group in the 15-24's, whilst for females CNS tumours dominated in the under-15's and carcinomas in the older group. For 0-14 year olds there were male-specific increases in the incidence of rhabdomyosarcoma (2.4% per annum; 95% CI: 0.2%-4.5%) and non-melanotic skin cancer (9.6%; 95% CI: 0.0%-19.2%) and female-specific increases for sympathetic nervous system tumours (2.2%; 95% CI: 0.4%-3.9%), gonadal germ cell tumours (8.6%; 95% CI: 4.3%-12.9%) and non-gonadal germ cell tumours (5.4%; 95% CI: 2.8%-7.9%). For 15-24 year olds, there were male-specific increases in gonadal germ cell tumours (1.9%; 95% CI: 0.3%-3.4%), non-gonadal germ cell tumours (4.4%; 95% CI: 1.1%-7.7%) and non-melanotic skin cancer (4.7%; 95% CI: 0.5%-8.9%) and female-specific increases for osteosarcoma (3.5%; 95% CI: 0.5%-6.5%), thyroid cancer (2.8%; 95% CI: 0.1%-5.6%) and melanoma (4.6%; 95% CI: 2.2%-7.1%).

CONCLUSION

This study has highlighted notable differences between the sexes in incidence patterns and trends for solid tumours. Some of these sex-specific differences could have been obscured if males and females had been analysed together. Furthermore, they suggest aetiological differences or differential susceptibility to environmental factors between males and females.

Doubling of testicular cancer incidence rate over the last 20 years in southern France

In recent decades, testicular cancer incidence has considerably increased in a majority of industrialized countries. In France, short reports suggested that the testicular cancer incidence rate has also risen, especially in north-eastern regions. In Europe, geographical variation of incidence rates has been observed in Baltic countries and a clear birth cohort effect has been revealed. This study aimed to assess temporal trends in testicular cancer incidence in southern France. We examined incidence rates over a 20-year time period in a series of 506 consecutive cases of testicular cancer recorded from 1980 to 1999 in the Midi-Pyrenees region of France. Age, calendar period, and birth cohort effects were examined simultaneously using Poisson regression models. Our analysis found a significant rise in the overall incidence rate of testicular germ cell tumors from 1.27 to 3.04 per 100,000 between 1980-1984 and 1995-1999, an annual increase of 5.70%. These results, the first obtained in a large series in southern Europe, show a twofold increase in incidence rate of testicular cancer in the Midi-Pyrenees region, which is very similar to that observed in all European countries, more or less doubling in the last 20 years. Interestingly, this major jump and the apparent testicular cancer gradient between northern and southern Europe suggest considerable geographical heterogeneity in incidence, but low geographical variation in temporal trends.

Incidence and survival for testicular germ cell tumor in young males: a report from the Northern Region Young Person's Malignant Disease Registry, United Kingdom

The incidence of testicular cancer has increased markedly in most developed countries, although the reasons for this are unclear. In this study, 253 patients with testicular cancer diagnosed younger than 25 years from 1968-1999 were identified from the Northern Region Young Persons' Malignant Disease Registry. The age-standardized incidence rate increased from 0.93 in 1968-1978 to 1.60 per 100,000 in 1990-1999. The increase in incidence was confined to those patients >15 years old, with the rate in younger children remaining very low. The 5-year survival increased significantly from 46% (95% confidence interval [CI] 33% to 58%) to 92% (95% CI 85% to 96%) during 1968-1999 and was significantly higher for seminoma than nonseminoma, 91% (95% CI 78% to 96%) and 77% (95% CI 70% to 82%), respectively. Although increased surveillance and public health campaigns designed to raise awareness of the disease and the advantages of self-examination should continue, further research is required into the etiology of this relatively common cancer among young males.

Space-time clustering analyses of testicular cancer amongst 15-24-year-olds in Northern England

There has been speculation that environmental exposures may be involved in the aetiology of testicular cancer in adolescent boys and young men. Indirect evidence for this hypothesis would be provided by the finding of space-time clustering. To examine this we have looked for evidence of space-time clustering using data from a population-based cancer registry from Northern England. All cases of testicular cancer diagnosed in males aged 15-24 years during the period 1968-2002 were included in the study. Tests for space-time interactions between cases were applied with fixed thresholds of close in space and close in time. Addresses at birth and diagnosis were used in the analyses. To adjust for the effect of varying population density tests were repeated replacing fixed geographical distances with nearest neighbour thresholds. A total of 257 cases of testicular cancer were identified for analysis. Overall there was no evidence for space-time clustering. However, there was statistically significant space-time clustering for 15-19-year-old based on time of birth and place of diagnosis (p<0.001). The very limited finding of space-time clustering may provide tentative evidence for an environmental, or infectious component to aetiology. However, it may well be a chance finding. A larger study based on national data is required.

Disease mapping and spatial regression with count data

In this paper, we provide critical reviews of methods suggested for the analysis of aggregate count data in the context of disease mapping and spatial regression. We introduce a new method for picking prior distributions, and propose a number of refinements of previously used models. We also consider ecological bias, mutual standardization, and choice of both spatial model and prior specification. We analyze male lip cancer incidence data collected in Scotland over the period 1975-1980, and outline a number of problems with previous analyses of these data. In disease mapping studies, hierarchical models can provide robust estimation of area-level risk parameters, though care is required in the choice of covariate model, and it is important to assess the sensitivity of estimates to the spatial model chosen, and to the prior specifications on the variance parameters. Spatial ecological regression is a far more hazardous enterprise for two reasons. First, there is always the possibility of ecological bias, and this can only be alleviated by the inclusion of individual-level data. For the Scottish data, we show that the previously used mean model has limited interpretation from an individual perspective. Second, when residual spatial dependence is modeled, and if the exposure has spatial structure, then estimates of exposure association parameters will change when compared with those obtained from the independence across space model, and the data alone cannot choose the form and extent of spatial correlation that is appropriate.

Racial disparities in testicular cancer: impact on health promotion

The present study sought to determine to what extent there was a difference in ethnicity between age and stage of testicular cancer. The sample, from National Cancer Institute data, included 7,777 men with testicular cancer. A one-way ANOVA was used for significant differences among racial groups in age and stage of tumor at diagnosis. The main research variables were race, age at diagnosis, and tumor stage. Hispanic males were found to be diagnosed at the significantly youngest age (29.8 years old) and White males at the oldest age (35.0). Even with the oldest age at diagnosis, White males were diagnosed at the significantly lowest tumor stage (M = 2.3), which was highest for Black males (2.5). Minority males are diagnosed at the earliest age, yet their tumor stage is significantly higher than that for White males. Therefore nurses need to screen all males regardless of ethnicity for testicular cancer.

The management and outcome of patients with germ-cell tumours treated in the Edinburgh Cancer Centre between 1988 and 2002

AIMS

The aim of this retrospective analysis was to review the outcome of patients with germ-cell tumours treated in the Edinburgh Cancer Centre over the past 15 years, and to see whether there had been any changes over three 5-year cohorts.

MATERIALS AND METHODS

Patients referred with gonadal and extra-gonadal primary germ-cell tumours, between 1988 and 2002, were identified from the departmental database, and survival by stage and prognostic group was analysed.

RESULTS AND CONCLUSIONS

The proportion of patients with stage I seminoma has significantly increased. The good prognosis of patients with early stage disease is confirmed, with the outcome for some groups of patients being better than expected. There is a non-significant trend to improved results over the three 5-year cohorts. The outcome for patients with stage IV seminoma is worse than would be expected, but numbers are small. The poor prognosis of patients with non-seminomatous germ-cell tumours who fall into the International Germ Cell Consensus Classification (IGCCC) poor-prognostic group is confirmed. Failure of patients with metastatic non-seminomatous germ-cell tumours to achieve a complete response to initial therapy is shown to be a poor prognostic indicator.

Germ-Cell Testicular Cancer in Offspring of Finnish Immigrants to Sweden

Variation in testicular cancer incidence can be used to assist in identification of risks. Finland has a significantly lower germ-cell testicular cancer risk than Sweden. Finns who immigrate to Sweden maintain their lower risk irrespective of age at immigration. We investigated difference in risk between Finland and Sweden by examining germ-cell testicular cancer incidence in males born in Sweden to Finnish immigrant parents. Swedish general population registers were used to identify 11,662 males born in Sweden where both Finnish parents immigrated to Sweden from Finland from 1969 or afterward. All of these offspring were at least 15 years old by final follow-up in 2001. Some six offspring (all diagnosed between ages 20 and 24 years) had a diagnosis of germ-cell testicular cancer. Comparison with the Swedish population rate produced standardized incidence ratios [SIR (95% confidence interval)] of 0.85 (0.31-1.84) for all the men and 1.75 (0.64-3.81) for the 20- to 24-year age group. SIRs calculated using the Finnish population rates produced an overall SIR (95% confidence interval) of 1.11 (0.41-2.41) and 2.95 (1.08-6.42) for the 20- to 24-year age group. Although the substantially reduced risk of testicular cancer previously observed in Finnish immigrant to Sweden was not found, this study had insufficient statistical power to conclude that environmental exposures explain the difference in germ-cell testicular cancer risk between Finland and Sweden.

Current practices in spatial analysis of cancer data: data characteristics and data sources for geographic studies of cancer

The use of spatially referenced data in cancer studies is gaining in prominence, fueled by the development and availability of spatial analytic tools and the broadening recognition of the linkages between geography and health. We provide an overview of some of the unique characteristics of spatial data, followed by an account of the major types and sources of data used in the spatial analysis of cancer, including data from cancer registries, population data, health surveys, environmental data, and remote sensing data. We cite numerous examples of recent studies that have used these data, with a focus on etiological research.

Padrões espaço-temporais da mortalidade por câncer de pulmão no Sul do Brasil

As neoplasias representam a segunda causa mais comum de mortalidade no Brasil, juntamente com as chamadas causas externas. Dentre as neoplasias, o câncer de pulmão é um dos mais freqüentes, tanto em homens quanto em mulheres, e é também um dos que apresentam maior letalidade. Além disso, o risco atribuível do tabagismo como agente etiológico deste câncer é bastante alto, o que o torna potencialmente susceptível a medidas preventivas de saúde pública. O objetivo deste trabalho foi analisar os padrões espaço-temporais de câncer de pulmão em quatro Estados brasileiros (Rio Grande do Sul, Santa Catarina, Paraná e São Paulo), no período de 1996 a 2000. Os valores observados foram obtidos do Sistema de Informações de Mortalidade do Ministério da Saúde. Os valores esperados foram calculados utilizando-se a técnica de padronização indireta segundo sexo e faixa etária. As unidades geográficas utilizadas foram microrregiões definidas pelo IBGE. Foi utilizado um modelo bayesiano que permite interação espaço-temporal, ajustado através do software WinBUGS. Os resultados encontrados mostraram que no sul do Brasil existe um padrão em "U" nas razões de mortalidade por câncer de pulmão para homens, além de indicar áreas específicas que apresentaram riscos mais elevados e/ou maior ritmo de crescimento. A principal hipótese para este resultado seria diferentes incidências de tabagismo, mas a inexistência desta informação de abrangência regional impediu que esta variável fosse incluída na análise. Os resultados deste artigo podem ser utilizados para instruir políticas públicas voltadas para a redução do tabagismo e da mortalidade por câncer de pulmão.

Small-Area Incidence Trends in Breast Cancer

BACKGROUND

During the past 2 decades, the observed incidence of in situ and early-stage invasive breast cancer has increased substantially as a result of increased use of mammography. Geographic variability in the increase in breast cancer incidence has been observed among large areas. Examining the variability among small areas in the incidence over time will facilitate appropriate geographic allocation of resources aimed at increasing screening.

METHODS

We examined county-specific increases in breast cancer incidence over time, specifically the variability and spatial correlation in the increase in breast cancer incidence. The analyses were based on county-level data (1973-1997) from the Iowa Surveillance, Epidemiology, and End Results program. A spatiotemporal hierarchical Bayesian model was used to examine variability in county-specific rates (intercepts, slopes, and spatial correlations) among white women at least 40 years of age.

RESULTS

Posterior values indicate there was little variability among counties in the change in breast cancer incidence over time (slope) but substantial variation among intercepts. There was considerable spatial correlation among the county-specific intercepts but a lack of a spatial correlation among the county-specific slopes. There was no correlation between the county-specific intercept and slope.

CONCLUSIONS

Breast cancer incidence increased over time, but county-specific rates increased independently relative to their neighboring counties or their initial rate.

Changes of neoplasm concentration with geographical co-ordinates

We investigated the regional differences in diversity--from another respect concentration--of causes of cancer mortality in England and Wales. Statistical analyses of published mortality data were done, using the jackknifed estimate of the Shannon index, for each region, sex and age group and year of death. In males diversity of cancer death causes is secularly increasing whilst it is decreasing in females. Latitude was negatively associated with diversity in male 45+ year age groups and longitude negatively associated with diversity in male 65+ age groups. Although, there were some significant associations in the female groups, there was no general trend across age groups as found in males. These trends remained after accounting for regional variation in past smoking behaviour. We suggest that the observed patterns may be related to prior occupational exposures and non-identified environmental and socioeconomical factors. It is concluded that techniques drawn from population ecology have a potential value in epidemiological studies of human disease. Ecological methods by themselves are likely to be of value in hypothesis generation rather than hypothesis testing.

Temporal trends in orchidopexy, Great Britain, 1992-1998

Concern has been expressed in recent years about worsening male reproductive health, possibly mediated by increasing exposures to environmental endocrine-disrupting agents. Trends suggested large increases in cryptorchidism in Britain and the United States between the 1950s and 1980s, although published data on recent trends have been scarce. We examined numbers of orchidopexy procedures, as a marker for cryptorchidism, using routine hospital admission data for England, Wales, and Scotland for fiscal years 1992-1993 through 1998-1999. Annual trends in orchidopexy rates were analyzed by age, in-patient admission versus day case, and geographical region. Orchidopexy rates were also obtained from the General Practice Research Database (GPRD) for England to cross-validate the hospital admissions data. Orchidopexy rates for boys 0-14 years old fell by 33% (from 23.5 to 15.8 per 10,000 population) between 1992 and 1998, with the steepest decline (50%) in 5-9-year-olds. The decreasing trend for 0-14-year-olds was evident in every region in England, in Wales, and in Scotland. Rates remained stable for men 15 or more years old, at 0.7 per 10,000. There was a marked shift from in-patient to day-case procedures. Rates from the GPRD showed a similar downward trend to the hospital data. Our findings could represent either an underlying decrease in the frequency of undescended testis or a fairly dramatic improvement in the diagnosis of cryptorchidism--resulting in fewer orchidopexies performed for retractile testis--in Great Britain during the 1990s, or both. Either way, our findings do not support the postulate of a recent worsening of male reproductive health of the scale suggested by some recent commentators on the endocrine disruptor hypothesis.