Cancer incidence among adolescents and young adults in urban Shanghai, 1973-2005

Pon1 and Sult1a1 Polymorphisms and Breast Cancer Among Young Women in Brazil

Purpose: To investigate the association of genetic polymorphisms Gln192Arg and Leu55Met of Paraoxonase 1 (PON1) gene, and Arg213His of Sulfotransferase 1A1 (SUT1A1) gene with occurrence of breast cancer among young women living in Rio de Janeiro city. Methods: This is a hospital-based case-control study including 265 women aged 18-35 years, diagnosed with breast cancer at National Cancer Institute; and 277 controls in the same age group selected among women patients and companions of three general hospitals from Rio de Janeiro public health network. Polymorphisms genotyping was performed using the PCR-RFLP technique. Results: For PON1 gene, breast cancer women had a greater chance of being homozygote for Leu55Met polymorphism (ORadjusted = 1.42, 95% CI= 0.67-3.00, recessive model) and a lower chance of having at least one allele of Gln192Arg polymorphism (ORadjusted = 0.75, 95% CI = 0.50-1.13, dominant model), but without statistical significance. Accordingly, frequency of the haplotype Met55/Arg192 was lower among breast cancer women, but no statistically significant association was observed (ORadjusted = 0.85; 95% CI = 0.48-1.51). SULT1A1 His/His genotype was significantly associated with a protective effect for breast cancer (OR adjusted = 0.51, 95% CI = 0.28-0.91, recessive model). Conclusion: Arg213His polymorphism of SUT1A1 gene showed a protective effect against breast cancer among Brazilian young women. More studies with different designs are needed to understand the role of PON1 and SULT1A1 polymorphisms in breast cancer development in young Brazilian women.

Impact of the COVID-19 Lockdown on Physical Activity Levels and Health Parameters in Young Adults with Cancer

The lockdown of the COVID-19 pandemic impacted physical activity (PA) levels around the world, affecting health parameters in young adults with cancer (YAC). To our knowledge, there is no evidence of the impact of the lockdown on the Spanish YAC. To analyse the changes in PA levels before, during, and after the lockdown of the YAC and its impact on health metrics in Spain, in this study, we utilized a self-reported web survey. PA levels decreased during the lockdown, and a significant increase in PA was observed after the lockdown. Moderate PA had the largest reduction (49%). Significant increases in moderate PA were noted after the lockdown (85.2%). Participants self-reported more than 9 h of sitting per day. HQoL and fatigue levels were significantly worse during the lockdown. The impact of the COVID-19 pandemic in this cohort of Spanish YAC showed a decrease in PA levels during the lockdown, affecting sedentarism, fatigue and HQoL. After lockdown, PA levels partially recovered, while HQoL and fatigue levels remained altered. This may have long-term physical effects such as cardiovascular comorbidities associated with sedentarism and psychosocial effects. It is necessary to implement strategies such as cardio-oncology rehabilitation (CORE), an intervention that can be delivered online, potentially improving participants' health behaviours and outcomes.

Multicenter retrospective analysis of clinicopathological features and prognosis of oral tongue squamous cell carcinoma in adolescent and young adult patients

ABSTRACT

The aim of this study is to report the differences in clinicopathological features of oral tongue squamous cell carcinoma (OTSCC) and survival between adolescent and young adult (AYA) patients and elderly patients and to find the prognosticators. The medical records of 101 AYA patients and 175 control patients with OTSCC who underwent surgery were reviewed. Variables related to prognosis and their clinicopathological associations were analyzed. The 5-year overall survival (5y-OS) rates of AYA and control patients with stage I and II OTSCC were 94.4% and 89.6% (P = .353), respectively, and their 5-year disease-free survival (5y-DFS) rates were 82.0% and 76.6%, respectively (P = .476). The 5y-OS rates of patients with stages III and IV OTSCC were 83.3% and 66.7% (P = .333), respectively, and their 5y-DFS rates were 75.0% and 57.1% (P = .335), respectively. Logistic regression analysis revealed that there was no significant clinicopathological difference in AYA and control group. Furthermore, there was no significant difference in 5y-OS rates between patients who underwent elective neck dissection (END) and those who underwent therapeutic neck dissection (TND) in both group (P = 0.717 and 0.688). Overall, the present study revealed the clinicopathological features and prognosis of OTSCC were similar in AYA patients and elderly patients. Moreover, as there was no significant difference in OS between patients who underwent END and those who underwent TND in AYA and control groups, our results suggest that the indication for END in AYA patients with clinical N0 OTSCC is similar to that for elderly patients.

Vaccines for immunoprevention of cancer

The immunoprevention of cancer and cancer recurrence is an important area of concern for the scientific community and society as a whole. Researchers have been working for decades to develop vaccines with the potential to alleviate these health care and economic burdens. So far, vaccines have made more progress in preventing cancer than in eliminating already established cancer. In particular, vaccines targeting oncogenic viruses, such as the human papillomavirus and the hepatitis B virus, are exceptional examples of successful prevention of virus-associated cancers, such as cervical cancer and hepatocellular carcinoma. Cancer-preventive vaccines targeting nonviral antigens, such as tumor-associated antigens and neoantigens, are also being extensively tested. Here, we review the currently approved preventive cancer vaccines; discuss the challenges in this field by covering ongoing preclinical and clinical human trials in various cancers; and address various issues related to maximizing cancer vaccine benefit.

High expression of ENPP1 in high-grade serous ovarian carcinoma predicts poor prognosis and as a molecular therapy target

Recent studies have shown that the expression of ENPP1 is related to differentiation, death, dissemination and chemosensitivity of tumor cells. So far, there is no research in ovarian carcinoma. This study aimed at exploring the role of ENPP1 gene in ovarian carcinoma, the relationship with prognostic indicators and chemotherapy resistance, and investigates the possibility of molecular targeted therapy. The expression of ENPP1 in 41 normal ovarian epithelial tissues, 97 ovarian serous cystadenoma and 103 HGSOC tissues was detected by IHC. In ovarian cancer tissues and ovarian cancer cell lines, mRNA and protein expression of ENPP1 was determined by qRT-PCR and Western blot. The ENPP1 expression was knockdowned by siRNA. Cell proliferation was measured with the BrdU Cell Proliferation ELISA. Cell migration and invasion were detected by Wound-Healing, Transwell migration and Matrigel invasion assay. Caspase 3 activity was determined by the CaspACE. The expression of EMT markers such as E-cadherin, N-cadherin, and Vimentin was measured, and the expression of PCNA and MMP9 was also be detected. The results showed that the expression of ENPP1 was significantly increased in high-grade ovarian serous carcinoma, the number of strong expression was 85.4% (22.3%+63.1%) and only 1.03% (1.03%+0.0%) in serous cystadenoma, but no in normal ovarian epithelium (P< 0.05). And the stronger the expression of ENPP1, the later the FIGO stage and the poorer differentiation of cells (P = 0.001 or <0.001, respectively). However, no correlation was found between the expression of ENPP1 and chemosensitivity. ENPP1 was also highly expressed in ovarian cancer tissues and in epithelial ovarian cancer cell lines (A2780, CaoV3, OVCAR3, SKOV3 and 3ao). After down-regulation of ENPP1 expression by RNA interference, the cell proliferation, migration and invasion of ovarian cancer cell decreased significantly, the expression of apoptosis related gene caspase 3 increased significantly, while the expression of PCNA and MMP9 was significantly down regulated. In addition, EMT biological characteristics of A2780 and SKOV3 cells were also inhibited. In summary, the increased expression of ENPP1 may be related to the occurrence of HGSOC, and indicate that the disease progresses rapidly and the prognosis is poor. ENPP1 may be considered as a potential molecular therapeutic target.

Global, regional and national burden of gout, 1990-2017: a systematic analysis of the Global Burden of Disease Study

OBJECTIVES

The burden of gout has been increasing globally. However, little is known about the global, regional and national distribution and time trend of this disease. We present a comprehensive analysis of the Global Burden of Disease Study 2017 on gout burden estimates for 195 countries or territories between 1990 and 2017.

METHODS

Age-standardized prevalence and disability-adjusted life-years of gout were reported between 1990 and 2017 in 195 countries and territories, and associations between these estimates and sociodemographic index (SDI) were further explored. Total and annual percent change between 1990 and 2017 were calculated to quantify the time trends of gout burden.

RESULTS

Age-standardized prevalence rates (95% uncertainty interval) per 100 000 persons were 790.90 (706.10-881.90) and 253.49 (225.69-284.02) in 2017 in males and females, respectively. The annual percent change in age-standardized prevalence (males, 0.22%; females, 0.38%) and disability-adjusted life-years (males, 0.21%; females, 0.38%) of gout increased every year from 1990 to 2017, globally. The highest increase was detected in high-SDI countries, especially in high-income North America. A non-linear association was observed between burden of gout and SDI, with the lowest estimates of gout burden when SDI value was about 0.6. High BMI was the leading risk factor for the burden of gout.

CONCLUSION

These study results suggest a globally rising trajectory of gout burden between 1990 and 2017. More effective interventions, such as detailed and intensive dietary managements and other prevention strategies for reducing obesity, should be carried out to reverse this trend, especially in females and high-SDI countries.

An epidemiology report for primary central nervous system tumors in adolescents and young adults: a nationwide population-based study in France, 2008-2013

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.

Cancer incidence and mortality trends in young adults in Metropolitan Lima young adults, 1990-2012

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.

Trends in the epidemiology of young-onset colorectal cancer: a worldwide systematic review

BACKGROUND

Recent data suggest that the risk of young-onset colorectal cancer (yCRC), in adults less than 50 years of age, is increasing. To confirm findings and identify contemporary trends worldwide, we conducted a systematic review of studies examining population-level trends in yCRC epidemiology.

METHODS

We searched MEDLINE (1946-2018), EMBASE (1974-2018), CINAHL (1982-2018), and Cochrane Database of Systematic Reviews (2005-2018) for studies that used an epidemiologic design, assessed trends in yCRC incidence or prevalence, and published in English. Extracted information included country, age cut-off for yCRC, and reported trends in incidence or prevalence (e.g. annual percent change [APC]). We pooled similarly reported trend estimates using random effects models.

RESULTS

Our search yielded 8695 articles and after applying our inclusion criteria, we identified 40 studies from 12 countries across five continents. One study assessed yCRC prevalence trends reporting an APCp of + 2.6 and + 1.8 among 20-39 and 40-49 year olds, respectively. 39 studies assessed trends in yCRC incidence but with substantial variability in reporting. Meta-analysis of the most commonly reported trend estimate yielded a pooled overall APCi of + 1.33 (95% CI, 0.97 to 1.68; p < 0.0001) that is largely driven by findings from North America and Australia. Also contributing to these trends is the increasing risk of rectal cancer as among 14 studies assessing cancer site, nine showed an increased risk of rectal cancer in adults less than 50 years with APCi up to + 4.03 (p < 0.001).

CONCLUSIONS

Our systematic review highlights increasing yCRC risk in North America and Australia driven by rising rectal cancers in younger adults over the past two decades.

Global, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990-2017: results from a global burden of disease study, 2017

To provide comprehensive estimates of the global, regional, and national burden of infertility from 1990 to 2017, using findings from a 2017 study on the global burden of disease (GBD), we assessed the burden of infertility in 195 countries and territories from 1990 to 2017. DisMod-MR 2.1 is a Bayesian meta-regression method that estimates non-fatal outcomes using sparse and heterogeneous epidemiological data. Globally, the age-standardized prevalence rate of infertility increased by 0.370% per year for females and 0.291% per year for males from 1990 to 2017. Additionally, age-standardized disability-adjusted life-years (DALYs) of infertility increased by 0.396% per year for females and 0.293% per year for males during the observational period. An increasing trend to these burden estimates was observed throughout the all socio-demographic index (SDI) countries. Interestingly, we found that high SDI countries had the lowest level of prevalence and DALYs in both genders. However, the largest increasing trend was observed in high-SDI countries for females. By contrast, low-SDI countries had the largest increasing trend in males. Negative associations were observed between these burden estimates and the SDI level. The global disease burden of infertility has been increasing throughout the period from 1990 to 2017.

Trends in the prevalence of congenital hydrocephalus in 14 cities in Liaoning province, China from 2006 to 2015 in a population-based birth defect registry from the Liaoning Women and Children's Health Hospital

The aim of this study was to assess the prevalence and trends of congenital hydrocephalus (CH) using a large population-based sample with cases retrieved from the Liaoning Birth Defects Registry, which included 14 cities, over a 10-year period. CH prevalence, percent change, average change, and contribution rates of each city were calculated. Statistical analysis was performed using a Poisson regression model. There was a total of 3008 CH cases among 3,248,954 live births during the observational period (9.26 cases/10,000 live births). On average, the prevalence of CH had significantly decreased by 11.84% each year (P < 0.01). The three leading cities with the highest prevalence of CH were Chaoyang (13.73/10,000), Huludao (13.18/10,000), and Fuxin (12.71/10,000), while Yingkou (6.06/10,000), Dalian (6.27/10,000), and Anshan (6.56/10,000) had the lowest prevalence. Notably, significantly decreasing trends were observed in 10 (71.4%) of these 14 cities. In addition, the cities of Fushun, Shenyang, and Dalian had contributed to more than one-third of the decreasing trend in Liaoning province. In conclusion, this study provides evidence of the decreasing prevalence of CH over a 10-year period (2006–2015) in Liaoning province. Preventative efforts should be strengthened to further reduce the risk of CH in these high prevalence areas.

The impact of young age on the prognosis for colorectal cancer: a population-based study in Taiwan

Background

The impact of age as a prognostic factor for patients with colorectal cancer (CRC) remains controversial, possibly due to heterogeneity between studies in terms of patient numbers, percentage of patients undergoing curative resection, percentage of patients receiving neoadjuvant therapy, or failure to adjust for potential confounding factors. This study used colorectal cancer survival data from the Taiwan Cancer Registry database in order to comprehensively analyze age as a prognostic factor.

Methods

Survival data were analyzed for 62 060 CRC patients diagnosed with adenocarcinoma, mucinous adenocarcinoma, or signet-ring cell carcinoma of the colon and rectum between 1998 and 2005. The rates of all-cause mortality and CRC-related mortality were determined using Kaplan-Meier analysis, and the log-rank test was used to compare differences in survival between different age groups. The crude and adjusted hazard ratios for all-cause and CRC-related mortalities were calculated according to the estimates from the univariable and multivariable Cox proportional hazard models.

Results

Patients in the ≤40 and the 41-50 age groups had a higher proportion of mucinous adenocarcinoma (P < 0.001) and signet-ring cell carcinoma (P < 0.001) compared to the older age groups. After adjusting for gender, histology, and tumor site, patients in the ≤40 age group had a poorer overall survival (OS) and cancer-specific survival compared to patients in the 41-50 and 51-60, and 61-70 age groups (P < 0.001), but a better OS and cancer-specific survival compared to patients in the 71-80 and >80 age groups (P < 0.001).

Conclusions

Our study indicated that age is an important consideration while determining the clinical management of CRC patients.

Time trends of neonatal mortality by causes of death in Shenyang, 1997-2014

To investigate the rate and time trends of neonatal mortality from 1997 to 2014 in Shenyang, which were previously rarely reported upon by developing countries, data on 4719 neonatal deaths (0–28 days) and 970,583 live births from the Shenyang Women and Children Health Care Centre were analyzed. Neonatal mortality rates (per 1000 live births), percent change, and annual percent change (APC) were calculated. During the observation period, neonatal mortality in Shenyang significantly decreased by 7.04%, 8.33%, and 5.35% per year overall, in urban and rural areas, respectively. When grouped by category of neonatal death, the time trends of three categories showed statistically significant decreases: congenital malformations (APC = −9.97%), diseases of the perinatal period (APC = −6.04%), and diseases of the respiratory system (APC = −8.52%). Congenital malformations, diseases of the respiratory system, and diseases of the nervous system and sense organs were the three major contributors to the aforementioned decreasing trend, which accounted for 58.71% in overall areas. Among selective causes of neonatal death, the neonatal mortality rates of pneumonia, congenital heart disease, preterm birth and low birth weight, birth asphyxia, and intracranial hemorrhage of the newborn significantly decreased 7.87%, 7.32%, 2.47%, 11.04%, and 10.68% per year, respectively. In summary, neonatal mortality rates decreased in Shenyang during the 17-year study period. Future studies are warranted to further investigate the factors contributing to the neonatal mortality trends in China.

Poor prognosis of young patients with colorectal cancer: a retrospective study

PURPOSE

The present study aimed to explore the survival outcomes of patients with colorectal cancer (CRC) aged 35 years and younger.

METHODS

This retrospective cohort study included a total of 995 patients with CRC treated between January 2003 and September 2011. The patients were assorted into the young (aged 18-35 years) and older (aged 36-75 years) groups. The clinical characteristics and survival outcomes of the patients in the young group were compared with those of the patients in the older group for evaluation.

RESULTS

Compared with the older group, a significantly higher number of patients in the young group had right-sided colon cancer (30.9 vs. 19.6%, P = 0.026), high histologic grade tumor (14.7 vs. 6.4%, P = 0.021), and stage III disease (50.0 vs. 35.5%, P = 0.016). In stage III disease, compared with the older group, the patients in the young group had worse survival outcome in terms of 5-year overall survival (OS, P = 0.007), cancer-specific survival (CSS, P = 0.010), and disease-free survival (DFS, P = 0.039). Multivariate analysis revealed that age ≤35 years was an independent risk factor in terms of 5-year OS (hazard ratio [HR] = 1.68; 95% confidence interval [CI]: 1.12-2.54; P = 0.012), CSS (HR = 1.74; 95% CI: 1.15-2.65; P = 0.009), and DFS (HR = 1.58; 95% CI: 1.06-2.35; P = 0.024).

CONCLUSIONS

The young patients with CRC aged 35 years and younger had worse prognosis compared with older patients, especially for stage III disease.

Incidence Trends of Cervical Cancer in Adolescents and Young Adults: Brazilian Population Based Data

PURPOSE

High incidence rates for cervical cancer in adolescents and young adults (AYAs: 15-29 years) make this the most common carcinoma in Brazil. Our aim was to analyze the incidence trends for cervical cancer (CC) and in situ neoplasia (IsN) among this age group.

METHODS

Incidence data were extracted from 21 Brazilian population-based cancer registries (PBCRs). Tumors with behavior code/3 (malignant) were classified as CC. Tumors with behavior code/2 were classified as IsN. Age-adjusted and age-specific incidence rates were calculated for individuals aged 15-19 years, 20-24 years, and 25-29 years. Incidence trends were evaluated by joinpoint regression analyses.

RESULTS

The median incidence rate of CC for AYA in Brazil was 3.63 per 100,000, with the highest rate observed in Recife (27.50 per 100,000). Significant increase in incidence for CC was identified in two PBCRs, with decreased rates for three PBCRs. The median incidence rate of IsN was 16.78 per 100,000 and was highest in Roraima (93.37 per 100,000). Increased incidence rates for IsN were identified in six PBCRs, with significant decreases in two PBCRs.

CONCLUSION

The incidence rate for CC among AYA in Brazil is high and warrants intervention in terms of both prevention and control.

Disease Severity, Presentation, and Clinical Outcomes Among Adolescents With Malignant Breast Neoplasms: A 20-Year Population-Based Outcomes Study From the SEER Database (1973-2009)

INTRODUCTION

Primary breast cancer in adolescents is extremely rare and thus is not widely studied. This study aimed to evaluate trends, characteristics, and outcomes among a cohort of adolescents with breast cancer.

PATIENTS AND METHODS

A total of 657,712 female patients with breast cancer from Surveillance Epidemiology and End Results (SEER) database (1973-2009) were analyzed, and 91 adolescents were identified. Three age groups (under 20 years, 20-50 years or premenopausal, and > 50 years or postmenopausal) were compared for tumor size, stage, receptor status, and outcomes. Categorical data were compared by chi-square (Fisher) test and continuous data with Student's t test.

RESULTS

Median age was 19 years (range, 10-20 years). A total of 52.7% (n = 48) and 5.5% (n = 5) of patients presented with invasive and in-situ cancers, respectively, and 37.3% (n = 34) with sarcomas. Median tumor size of invasive cancers was 3.2 cm (range, 0.1-12.5 cm). Sixty percent of patients presented with regional disease, and the majority (28%) of those tested were receptor negative. Mortality rates in adolescents were higher than pre- and postmenopausal patients in localized and regional stage. Overall median survival was 106 months.

CONCLUSION

Although rare, breast cancer does occur in adolescent girls and must be considered in differential of breast masses in females under 20, especially with strong breast cancer family history. Prognosis maybe worse than in older patients; however, the sample size is small. Delay in diagnosis, aggressive tumor biology, and negative receptor status may affect prognosis. Routine breast examination in high-risk older adolescents may permit early identification and avoid delay in diagnosis and treatment.

Changing trends in the prevalence of anencephaly in Liaoning province of Northeast China from 2006-2015: data from a population-based birth defects registry

The goal of this study was to assess the prevalence and trends of anencephaly on the basis of a large population-based cases identified by the Liaoning Birth Defects Registry, which included 14 cities over a 10-year period. Anencephaly prevalence, percent change, average changeand the contribution rates of each city were calculated. Statistical analysis was undertaken on the basis of a Poisson regression model. A total of 1600 anencephaly cases were collected during the observational period (4.92/10,000 live births). On average, the prevalence decreased 10.15% each year; this overall time trend was statistically significant (P<0.01). The top three leading cities were Huludao (10.33 per 10,000 live births), Chaoyang (8.56 per 10,000 live births) and Fuxin (6.36 per 10,000 live births). In contrast, Anshan (2.64 per 10,000 live births), Dalian (2.79 per 10,000 live births) and Yingkou (3.46 per 10,000 live births) were the cities with the lowest prevalence. Of note, significantly decreasing trends were observed in half of these cities (n=7). Additionally, Benxi, Yingkou and Dalian were the major cities contributing to over one third of the decreasing trend in Liaoning province. In conclusion, this study provided evidence of the decreasing prevalence of anencephaly from 2006 to 2015 in Liaoning province. In the future, prevention efforts should be strengthened to further reduce the risk of anencephaly in areas with high rates.

Prevalence and time trends of spina bifida in fourteen cities located in the Liaoning province of northeast China, 2006-2015

The present study sought to assess the time trends of spina bifida on the basis of cases identified by the Liaoning Birth Defects Registry in 14 cities from 2006 to 2015. We calculated the prevalence of spina bifida, percent and average change of time trends, and contribution rates of each city. Poisson regression model was used to find the line of best fit for spina bifida prevalence by year, with year as a continuous independent variable. From 2006 to 2015, a total of 2,029 spina bifida cases were identified from 3,248,954 live births (6.25/10,000 live births). We observed statistically significant decreasing trend of overall time trend (11.57% each year). Chaoyang, Fuxin, and Huludao were the top three leading cities, with 14.30/10,000 live births, 9.70/10,000 live births, and 9.20/10,000 live births, respectively. Inversely, the bottom three cities with lowest prevalence were Anshan (2.64/10,000 live births), Dandong (3.43/10,000 live births), and Dalian (3.45/10,000 live births). Of note, we observed significant decreasing trends in over half of these cities (n = 8). In addition, the decreasing trend of overall time trend could be mainly attributed to cities of Shenyang, Fushun, and Jinzhou which accounted for nearly one third. In summary, our study suggested a decreasing time trend of spina bifida during the past decade in the Liaoning province. The findings of this study provide evidence that the nationwide folic acid supplement program has been an effective strategy to prevent spina bifida.

Decreasing prevalence and time trend of gastroschisis in 14 cities of Liaoning Province: 2006-2015

To identify trends in the prevalence of gastroschisis on the basis of a large population-based observation study with cases identified by the Liaoning Birth Defects Registry including 14 cities over the course of a 10-year period. Data were obtained from the aforementioned registry which was maintained by the Liaoning Women and Children's Health Hospital, a comprehensive care institution as well as being responsible for the women's and children's health care guidance in this province. Gastroschisis prevalence, percent change, annual percent change (APC), and contribution rates of each city were calculated. We observed 747 cases of gastroschisis among 3,248,954 live births, for a prevalence of 2.30 per 10,000 births. The gastroschisis prevalence significantly decreased by 12.63% per year in Liaoning Province. Although the decreasing trends were observed in all these 14 cities, significant results were only observed in Shenyang (APC = -16.31%), Tieling (APC = -20.23%), and Chaoyang (APC = -13.50%). Notably, Tieling, Shenyang, and Yingkou were the three major cities which contributed almost 37.17% of the decreasing trend of gastroschisis in Liaoning Province. In conclusion, our findings demonstrate that the prevalence of gastroschisis has been decreasing during the recent decade among 14 cities in Liaoning Province.

Evaluating the time trends in prevalence of exomphalos in 14 cities of Liaoning province, 2006 to 2015

To evaluate time trends of exomphalos prevalence using a large population-based study with cases identified by the Liaoning Birth Defects Registry including 14 cities over the course of a 10-year period. Exomphalos prevalence, percent change, annual percent change (APC), and contribution rates of each city were calculated. Additionally, epidemiological characteristics of this malformation were described. We observed 516 cases of exomphalos among 3,248,954 live births. Birth prevalence of exomphalos was 1.59 per 10,000 live births with non-significant change during the observational period (APC = −1.19%, P = 0.48). However, significantly decreasing trends were noticed in three cities: Fushun (APC = −9.15%, P = 0.03), Benxi (APC = −11.49%, P = 0.05), and Yingkou (APC = −16.47%, P = 0.04), contributing 62.77% of the decreasing trend of overall prevalence. The mean maternal age, gestational age, and birth weight was 28.4 years (standard deviation [SD], 6.1 years), 25.6 weeks (SD, 8.6 weeks), and 1236.2 gram (SD, 1164.4 gram). For time of diagnosis, 79.8% (n = 412) cases were diagnosed during pregnancy. In summary, the prevalence of exomphalos in Liaoning province did not change remarkably during 2006 to 2015. Future studies are warranted to investigate the risk factors and create prevention strategies for this disease.

Different extent in decline of infant mortality by region and cause in Shenyang, China

To compare the pattern of cause of death of infant mortality rates by urban/rural areas as well as to generate knowledge for potential strategies to decrease this mortality, we carried out a study by analyzing the infant mortality data from the Shenyang Women and Children Health Care Centre. From 1997 to 2014, 970,583 live births and 6510 infant deaths were registered. Infant mortality rates, percent change, and annual percent change (APC) were calculated. The infant mortality significantly decreased by 5.92%, 7.41%, and 3.92% per year in overall, urban, and rural areas, respectively. Among the categories of causes of infant death, congenital anomalies (APC = -7.87%), asphyxia-related conditions (APC = -9.43), immaturity-related conditions (APC = -3.44%), diseases of the nervous system and sense organs (APC = -6.01%), and diseases of the respiratory system (APC = -6.29%) decreased significantly in the observational periods. Additionally, among selective causes of infant death, pneumonia, congenital heart disease, neural tube defects, preterm birth and low birth weight, birth asphyxia, and intracranial hemorrhage of the newborn significantly decreased by 5.45%, 5.45%, 16.47%, 2.18%, 10.95%, and 10.33% per year, respectively. In conclusion, infant mortality has been continuously decreased in Shenyang from 1997 to 2014, although further efforts are still needed to decrease the infant mortality in rural areas.

Incidence and Trend of Childhood and Adolescent Cancers in Yazd, Iran

BACKGROUND

Data on childhood and adolescent malignant tumors incidence are skimp in developing countries. In this study, we analyzed the incidence and trend of childhood and adolescent cancers in Yazd city, center of Iran between Jan 2004 and Dec 2013.

MATERIAL AND METHODS

The various types of malignant tumors were grouped pursuant to the International Classification for Cancer in Children. To analyze the data, descriptive and illative statistical methods were used.

RESULTS

Two hundred twenty-two patients with a malignancy aged less than 18 years were studied with a male to female ratio of 1.36.The mean age of patients was 9.88 (±5.7) years. Leukemia with the frequency of 84 (37.8%) and after that lymphoid malignancies with the frequency of 49 (22.1%) were the most common cancers. There was a low range of oscillation in the incidence rate of malignancies during this period of time (P value= 0.081). Malignancies were mostly in males (P value=0.057) but the whole process of malignancy incidence had gone toward the higher rate of incidence in females. Incidence rate of cancers types was steady. Malignancy incidence was 3-7 cases in hundred of thousands except a year of which this incidence rate was estimated 13.4.

CONCLUSION

Leukemias and lymphomas were the main cancers in the center of Iran. Childhood and adolescent malignancies may be considerably under-recorded in our province .A childhood and adolescent cancer registry is necessary for exact analysis of these types of malignancies.

Years of potential life lost due to breast and cervical cancer: a challenge for Brazilian public policy

BACKGROUND

The purpose of the article was to analyze the years of potential life lost (YPLL) of women who died from breast and cervical cancer in the State of Parana, Southern Brazil. This was a temporal trend study (2000 to 2010) about the coefficients of mortality and the years of potential life lost in women aged 20 to 70 years.

MATERIALS AND METHODS

Data were obtained through the database of the Department of the Unified Health System (DATASUS) and the National Mortality Information System.

RESULTS

There was a loss of 125.075 YPLL due to breast cancer, with an average of 11.370 YPLL. Regarding cervical cancer, the figure obtained was 91.625 YPLL from 2000 to 2010, with an average of 8.329 YPLL. Increased risk of death from breast cancer was observed for women aged 50 to 59 years, with a significant increase among those in the age group from 40 to 49 years. There was an increased rate of cervical cancer among women 40 to 69 years.

CONCLUSIONS

The risk of death grows with increasing age, being higher from 40 years. Prevention is paramount for both cancers. Thus, preventive measures are required and a reassessment of political strategies should be adopted.

Adolescent and young adult patients with cancer: a milieu of unique features

Adolescent and young adult (AYA) patients with cancer are a unique category of patients who, depending on age at time of diagnosis, might receive treatment from oncologists specializing either in the treatment of children or adults. In the USA, AYA oncology generally encompasses patients 15-39 years of age. AYA patients with cancer typically present with diseases that span the spectrum from 'paediatric' cancers (such as acute lymphoblastic leukaemia [ALL] and brain tumours) to 'adult' tumours (such as breast cancer and melanoma), as well as cancers that are largely unique to their age group (such as testicular cancer and bone tumours). Research indicates that outcomes of AYA patients with cancer are influenced not only by the treatment provided, but also by factors related to 'host' biology. In addition to the potential biological and cancer-specific differences between AYAs and other patients with cancer, AYA patients also often have disparate access to clinical trials and suffer from a lack of age-appropriate psychosocial support services and health services, which might influence survival as well as overall quality of life. In this Review, these issues are discussed, with a focus on two types of AYA cancer--ALL and melanoma--highlighting findings arising from the use of emerging technologies, such as whole-genome sequencing.

Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year follow-up of the Qidong hepatitis B intervention study: a cluster randomized controlled trial

BACKGROUND

Neonatal hepatitis B vaccination has been implemented worldwide to prevent hepatitis B virus (HBV) infections. Its long-term protective efficacy on primary liver cancer (PLC) and other liver diseases has not been fully examined.

METHODS AND FINDINGS

The Qidong Hepatitis B Intervention Study, a population-based, cluster randomized, controlled trial between 1985 and 1990 in Qidong, China, included 39,292 newborns who were randomly assigned to the vaccination group in which 38,366 participants completed the HBV vaccination series and 34,441 newborns who were randomly assigned to the control group in which the participants received neither a vaccine nor a placebo. However, 23,368 (67.8%) participants in the control group received catch-up vaccination at age 10-14 years. By December 2013, a total of 3,895 (10.2%) in the vaccination group and 3,898 (11.3%) in the control group were lost to follow-up. Information on PLC incidence and liver disease mortality were collected through linkage of all remaining cohort members to a well-established population-based tumor registry until December 31, 2013. Two cross-sectional surveys on HBV surface antigen (HBsAg) seroprevalence were conducted in 1996-2000 and 2008-2012. The participation rates of the two surveys were 57.5% (21,770) and 50.7% (17,204) in the vaccination group and 36.3% (12,184) and 58.6% (17,395) in the control group, respectively. Using intention-to-treat analysis, we found that the incidence rate of PLC and the mortality rates of severe end-stage liver diseases and infant fulminant hepatitis were significantly lower in the vaccination group than the control group with efficacies of 84% (95% CI 23%-97%), 70% (95% CI 15%-89%), and 69% (95% CI 34%-85%), respectively. The estimated efficacy of catch-up vaccination on HBsAg seroprevalence in early adulthood was 21% (95% CI 10%-30%), substantially weaker than that of the neonatal vaccination (72%, 95% CI 68%-75%). Receiving a booster at age 10-14 years decreased HBsAg seroprevalence if participants were born to HBsAg-positive mothers (hazard ratio [HR]  = 0.68, 95% CI 0.47-0.97). Limitations to consider in interpreting the study results include the small number of individuals with PLC, participants lost to follow-up, and the large proportion of participants who did not provide serum samples at follow-up.

CONCLUSIONS

Neonatal HBV vaccination was found to significantly decrease HBsAg seroprevalence in childhood through young adulthood and subsequently reduce the risk of PLC and other liver diseases in young adults in rural China. The findings underscore the importance of neonatal HBV vaccination. Our results also suggest that an adolescence booster should be considered in individuals born to HBsAg-positive mothers and who have completed the HBV neonatal vaccination series. Please see later in the article for the Editors' Summary.

Next-generation sequencing of colorectal cancers in chinese: identification of a recurrent frame-shift and gain-of-function Indel mutation in the TFDP1 gene

Abstract Re-sequencing of target genes is a highly effective approach for identifying mutations in cancers. Mutations, including indels (insertions, deletions, and the combination of the two), play important roles in carcinogenesis. Combining genomic DNA capture using high-density oligonucleotide microarrays (NimbleGen, Inc.) with next-generation high-throughput sequencing, we identified approximately 1600 indels for colorectal cancers in the Chinese population. Among them, 5 indels were localized to exonic regions of genes, including the TFDP1 (transcription factor Dp-1) gene. TFDP1 is an important transcription factor that coordinates with E2F proteins, thereby promoting transcription of E2F target genes and regulating the cell cycle and differentiation. We report here the identification of a recurrent frame-shift indel mutation (named indel84) in the TFDP1 gene in colorectal cancers by next-generation sequencing. We found in a validation set that TFDP1 indel84 is present in 70% of colorectal cancer (CRC) tissues. Wild-type TFDP1 encodes a protein of 410 amino acids with a potential DNA binding site at its N-terminal followed by several functional protein domains. The TFDP1 indel cDNA would generate an alternative TFDP1 protein missing the first 120 amino acids and potentially affecting the DNA binding domain. We further demonstrated that the TFDP1 indel84 mutation generated a gain-of-function phenotype by increasing cell proliferation, migration, and invasion of CRC cells. Our study identified a key molecular event for CRC that might have great diagnostic and therapeutic potentials.

Breast cancer incidence and mortality in women under 50 years of age in Brazil

Many countries have reported an increase in breast cancer incidence in young women. The current study's objective was to explore breast cancer distribution in women less than 50 years of age in Brazil. A descriptive study on breast cancer incidence (selected cities) and mortality (Brazil and selected cities) in 2002-2004 was carried out, and the results were compared with those from other countries. The study also analyzed the trend in hospital morbidity and incidence rates for breast cancer. Porto Alegre (Rio Grande do Sul State) showed the highest incidence rates (17.9 and 165.5/100,000 in the 15-39 and 40-49-year age strata, respectively). Regarding mortality, Belo Horizonte (Minas Gerais State) showed the highest rate in the 15-39-year group and Porto Alegre in the 40-49-year group (2.8 and 25.5/100,000). Hospital admissions and incidence rates for breast cancer suggest a change in epidemiological distribution. The results reveal an epidemiological pattern of breast cancer in young Brazilian women with regional distribution characteristics.

Malignant tumours of the central nervous system in Kazakhstan--incidence trends from 2004-2011

In the article were observed the epidemiological aspects of malignant tumors of the central nervous system (MT CNS) in Kazakhstan in a retrospective study for the years 2004-2011. The material of the study was consolidated accounting data of oncology centers on patients with MT CNS (C70-72) with first time established diagnosis. Calculated were crude, age, standardized (world standard), aligned and predicted incidence of MT CNS among both male and female populations. It was found that over the studied period, there were 4,604 cases of MT CNS. The average annual crude incidence rate of MT CNS in total population was 3.7±0.10/0000. Trends in aligned incidence rates in the whole country had a tendency to increase (T=+0.9%). Defined levels of morbidity MT CNS in the whole population in different regions of Kazakhstan: low up to 2.870/0000, the average from 2.87 to 4.450/0000 and high from 4.450/0000 and above on the basis of which was given the space-time estimate. Age and sex differences in MT CNS incidence were also clearly established.

Managing the changing burden of cancer in Asia

Asia accounts for 60% of the world population and half the global burden of cancer. The incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030, due to ageing and growing populations, lifestyle and socioeconomic changes. Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions. The existing and emerging cancer patterns and burden in different regions of Asia call for political recognition of cancer as an important public health problem and for balanced investments in public and professional awareness. Prevention as well as early detection of cancers leads to both better health outcomes and considerable savings in treatment costs. Cancer health services are still evolving, and require substantial investment to ensure equitable access to cancer care for all sections of the population. In this review, we discuss the changing burden of cancer in Asia, along with appropriate management strategies. Strategies should promote healthy ageing via healthy lifestyles, tobacco and alcohol control measures, hepatitis B virus (HBV) and human papillomavirus (HPV) vaccination, cancer screening services, and vertical investments in strengthening cancer healthcare infrastructure to improve equitable access to services.

Incidence trends of urinary bladder and kidney cancers in urban Shanghai, 1973-2005

Objectives

We examined the incidence trends of bladder and kidney cancers using a population-based cancer registration data.

Methods

Age-standardized incidence rates were analyzed using data from the Shanghai Cancer Registry during 1973 to 2005. Annual percentage changes and 95% confidence intervals were calculated to evaluate the incidence changes. Age-period-cohort analysis was further implemented to assess the contributions of age, period and cohort effects to the trends using the intrinsic estimator method.

Results

In total, 12,676 bladder and 5,811 kidney cancer patients were registered in urban Shanghai. The age-standardized rates of bladder cancer in males increased from 6.39 to 7.66 per 100,000, or 0.62% per year, whereas the rates in females increased from 1.95 to 2.09 per 100,000, or 0.33% per year. For kidney cancer, the age-standardized rates in males increased from 1.20 to 5.64 per 100,000, or 6.98% per year. Similarly in females, the rates increased from 0.85 to 3.33 per 100,000, or 5.93% per year. Age-period-cohort analysis showed increasing curves of age and period effects but generally decreasing cohort effects for bladder and kidney cancers.

Conclusions

Our results show increasing incidence trends of bladder and kidney cancers in Chinese men and women, especially for kidney cancer.

Clinical characteristics and prognosis of young patients with colorectal cancer in Eastern China

AIM: To explore the clinical characteristics and prognosis of young patients with colorectal cancer patients in Eastern China.

METHODS: A total of 1335 patients with colorectal cancer treated from December 1985 to December 2005 at the Second Affiliated Hospital of Zhejiang University School of Medicine were studied retrospectively. The patients were divided into two groups, a younger group (aged ≤ 30 years) and an older group (aged > 30 years), and comparison was made in the clinical characteristics and prognosis between the two groups. Chi-square test was used for data analysis of all categorical variables, and overall survival (OS) was calculated by the Kaplan-Meier method. A multivariate analysis was performed using the Cox model.

RESULTS: There were 42 (3.1%) and 1293 (96.9%) cases in the younger group and older group, respectively. Univariate analysis showed that the 5- and 10-year OS in the younger group were 33.9% and 26.1%, respectively, and those in the older group were 60.1% and 52.2%, respectively. Younger group had poor survival (χ² = 14.146, P = 0.000). Multivariate analysis revealed that age was not a dependent factor for prognosis (OR = 0.866, 95%CI: 0.592-1.269, P = 0.461). Stratified analysis indicated that in stage III and IV disease, the 5- and 10-year OS were 24.6% and 14.8% in the younger group, and 40.4% and 33.3% in the older group, respectively, with a significant difference between the two groups (χ² = 5.101, P = 0.024). In the subgroup of radical surgery, the 5- and 10-year OS were 44.3% and 34.2% in the younger group, and 69.6% and 60.5% in the older group, with a difference being significant between the two groups (χ² = 7.830, P = 0.005).

CONCLUSION: Compared with older patients, the younger patients have lower survival, especially in the subgroups of stage III and IV disease and radical surgery.

Parity and kidney cancer risk: evidence from epidemiologic studies

BACKGROUND

Observational studies have reported conflicting results between parity and kidney cancer risk. To our knowledge, a comprehensive and quantitative assessment of the association between parity and kidney cancer has not been reported. Thus, we conducted a systematic review and dose-response meta-analysis of published epidemiologic studies to summarize the evidence of this association.

METHODS

Relevant published studies of parity and kidney cancer were identified using MEDLINE (PubMed) database through end of June 2013. Two authors independently assessed eligibility and extracted data. Six prospective and eight case-control studies reported relative risk (RR) estimates and 95% confidence intervals (CI) of kidney cancer associated with parity or parity number. Fixed- or random-effects models were used to estimate summary relative risk.

RESULTS

The summary relative risk of kidney cancer for the parity versus nulliparous was 1.23 (95% CI, 1.10-1.36; Q = 12.41; P = 0.413; I(2) = 3.3%). In addition, significant association was also found for the highest versus lowest parity number, with summary RR = 1.36 (95% CI, 1.19-1.56; Q = 8.24; P = 0.766; I(2) = 0%). In the dose-response analysis, the summary per one live birth relative risk was 1.08 (95% CI: 1.05-1.10; Q = 9.34; P = 0.500; I(2) = 0%), also indicating the positive effect of parity on kidney cancer risk. No evidence of publication bias and significant heterogeneity between subgroups was detected by meta-regression analyses.

CONCLUSIONS

In summary, findings from this meta-analysis suggest that ever parity and higher parity number is significantly associated with increased risk of kidney cancer.

IMPACT

The present results suggest a positive association between parity and kidney cancer risk.

Anti-tumor effect of 4-Amino-2-Trifluoromethyl-Phenyl Retinate on human breast cancer MCF-7 cells via up-regulation of retinoid receptor-induced gene-1

4-Amino-2-Trifluoromethyl-Phenyl Retinate (ATPR) is one of the retinoid derivatives designed and synthesized in our team. In this paper, we explored the potential anti-tumor effects of ATPR in breast cancer. Here we found that ATPR showed remarkable anti-proliferative effects in a dose- and time-dependent manner, caused cell cycle arrest in the G0/G1 phase and significantly increased the expression of retinoid receptor-induced gene-1 (RRIG1). ATPR decreased the expression of phosphorylation-ERK (p-ERK) and increased the expression of estrogen receptor β (ERβ) and phosphorylation-p38 (p-p38). Following RRIG1 knockdown by RNAi interference, we found that the changes of ERβ, p-ERK and p-p38 induced by ATPR were both depressed. Our data suggest that ATPR could inhibit the proliferation and induce differentiation of MCF-7 cells via mediating the expression of RRIG1.

New insight into Ki67 expression at the invasive front in breast cancer

Purpose

To investigate the distribution of Ki67+ cells in breast cancer in relation to clinical-pathological parameters and prognosis.

Materials and Methods

Ki67 expression status was detected in 1,086 breast cancer specimens using immunohistochemistry staining and examining the relationship between the Ki67+ cells' location. Subsequently, clinical-pathological parameters and prognosis were determined.

Results

In total, Ki67 protein expression was found in 781 (71.92%) of the 1,086 breast cancer specimens. Among the 781 Ki67+ cases, 461 were defined as diffuse type and 320 were defined as borderline type. After universal correlation analysis, significant differences were observed in age, histological grade, metastatic nodes, postoperative distant metastasis, and molecular subtype between Ki67+ and Ki67− cases (P = 0.01, 0.001, 0.001, 0.001, and 0.001, respectively). After subgroup analysis, the borderline cases were found to be characterized by a high distant metastasis rate compared to the diffuse cases as well as the Ki67− cases (P = 0.001). No differences were observed between diffuse type or Ki67− cases (P = 0.105). Multivariate analysis showed that age, tumor size, histological grade, lymph node metastasis, molecular subtype, and the Ki67 distribution pattern were observed to be related to postoperative distant metastasis (all P<0.05). Furthermore, borderline type was shown to attain a significantly more distant bone and liver metastasis and worse disease-specific survival than the other types (P = 0.001). In the Cox regression test, the Ki67 distribution pattern was detected as an independent prognostic factor (P = 0.001).

Conclusion

The distribution pattern of Ki67 may be a new independent prognostic factor for breast cancer.