Cancer Control in Central and Eastern Europe

The indirect costs of human papillomavirus-related cancer in Central and Eastern Europe: years of life lost and productivity costs

BACKGROUND

Human papilloma virus (HPV) is a common cause of several types of cancer, including head and neck (oral cavity, pharynx, oropharynx, hypopharynx, nasopharynx, and larynx), cervical, vulval, vaginal, anal, and penile cancers. As HPV vaccines are available, there is potential to prevent HPV-related disease burden and related costs.

METHOD

A model was developed for nine Central Eastern European (CEE) countries (Bulgaria, Croatia, Czechia, Hungary, Poland, Romania, Serbia, Slovakia, Slovenia). This model considered cancer patients who died from 11 HPV-related cancers (oropharynx, oral cavity, nasopharynx, hypopharynx, pharynx, anal, larynx, vulval, vaginal, cervical, and penile) in 2019. Due to data limitations, Bulgaria only included four cancer types. The model estimated the number of HPV-related deaths and years of life lost (YLL) based on published HPV-attributable fractions. YLL was adjusted with labor force participation, retirement age and then multiplied by mean annual earnings, discounted at a 3% annual rate to calculate the present value of future lost productivity (PVFLP).

RESULTS

In 2019, there were 6,832 deaths attributable to HPV cancers resulting in 107,846 YLL in the nine CEE countries. PVFLP related to HPV cancers was estimated to be €46 M in Romania, €37 M in Poland, €19 M in Hungary, €15 M in Czechia, €12 M in Croatia, €10 M in Serbia, €9 M in Slovakia, €7 M in Bulgaria and €4 M in Slovenia.

CONCLUSIONS

There is a high disease burden of HPV-related cancer-related deaths in the CEE region, with a large economic impact to society due to substantial productivity losses. It is critical to implement and reinforce public health measures with the aim to reduce the incidence of HPV-related diseases, and the subsequent premature cancer deaths. Improving HPV screening and increasing vaccination programs, in both male and female populations, could help reduce this burden.

A meta-analysis of the clinicopathological significance of the lncRNA MALAT1 in human gastric cancer

Background

Dysregulation of the long non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been linked to some oncogenic pathways that induce cancer initiation and progression. This meta-analysis was conducted to specifically summarize the most recent research on MALAT1 function in human gastric cancer (GC).

Methods

The eligible studies were first identified by searching HowNet, Web of Science, PubMed, The Cochrane Library, Embase, and Nature databases for studies published as of April 1, 2023. The meta-analysis included 14 studies assessing MALAT1 expression and presenting clinical parameters and survival outcomes.

Results

The results illustrated that high MALAT1 expression is predictive of lymph node metastasis (pooled odds ratio [OR] = 2.99, 95% confidence interval [CI] = 1.97-4.54, P < 0.001) and distant metastasis in GC (OR = 3.11, 95% CI = 1.68-5.75, P < 0.001). In addition, MALAT1 was associated with GC tumor invasion (T3/T4 vs. T1/T2: OR = 2.90, 95% CI = 1.90- 4.41, P <0.001) and TNM stage (III/IV vs I/II: OR = 2.93, 95% CI: 1.80-4.77, P <0.001). Additionally, higher MALAT-1 expression predicted poorer overall survival in patients with GC (hazard ratio = 1.64, 95% CI = 1.20-2.09, P < 0.001).

Conclusions

The current findings suggest that the high MALAT1 expression is an adverse biomarker for prognostic outcomes, lymph node metastasis, TNM stage, and distant metastasis in GC and MALAT1 could be a prognostic biomarker for GC.

Breast cancer-related mortality in Central and Eastern Europe: years of life lost and productivity costs

BACKGROUND

Breast cancer (BC) poses a public health challenge as the most commonly diagnosed cancer among women globally. While BC mortality has declined across Europe in the past three decades, an opposite trend has been reported in some transitional European countries. This analysis estimates the mortality burden and the cost of lost productivity due to BC deaths in nine Central and Eastern Europe (CEE) countries: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, and Slovenia, that have defied the favorable cancer mortality trends. These estimates may provide relevant evidence to aid decision-makers in the prioritization of BC-targeted policies.

METHODS

The human capital approach (HCA) was used to estimate years of life lost (YLL) and productivity losses due to premature death from BC (ICD-10 code: C50 Malignant neoplasm of breast). YLL and present value of future lost productivity (PVFLP) were calculated using age and gender-specific mortality, wages, and employment rates. Data were sourced from the World Health Organization (WHO), Eurostat, and the World Bank.

RESULTS

In 2019, there were 19,726 BC deaths in the nine CEE countries. This study estimated BC deaths resulted in 267,184 YLL. Annual PVFLP was estimated to be €85 M in Poland, €46 M in Romania, €39 M in Hungary, €21 M in Slovakia, €18 M in Serbia, €16 M in Czech Republic, €15 M in Bulgaria, €13 M in Croatia, and €7 M in Slovenia.

CONCLUSION

Premature death from BC leads to substantial YLL and productivity losses. Lost productivity costs due to premature BC-related mortality exceeded €259 million in 2019 alone. The data modeled provide important evidence toward resource allocation priorities for BC prevention, screening, and treatment that could potentially decrease productivity losses. Careful consideration should be given to BC-specific policies, such as surveillance programs and the availability of new treatments in CEE countries to decrease the medical and financial burden of the disease.

Spatial Cluster Analysis of Stomach Neoplasms in the Center of Iran Based on a Population-Based Study, 2009-2014: Application of the Poisson-Based Probability Model

Background

A better understanding of the spatial pattern of stomach cancer can be helpful in the implementation of preventive strategies. This study is one of the first studies to establish a study unit based on the smallest possible size for cluster analysis. This study includes a novel evaluation of spatial differences in different geographical areas of Arak. The present study seeks to discover the spatial clusters of stomach cancer from 2009 to 2014 in Arak.

Methods

All of the addresses of the stomach cancer cases were geocoded. After that, the number of stomach cancer cases in each census block was calculated to be entered in the SaTScan software. A discrete Poisson-based probability model was used to analyze this cluster.

Results

In Arak, there are 5502 census blocks with a population of about 526,182. The number of identified and registered stomach cancer cases with an acceptable residence address was 392. Totally, 11 stomach cancer clusters were established in the area of Arak, from these; two clusters were detected statistically significant. Relative risks of the first and second clusters were 1.75 (P = 0.01) and 17.60 (P = 0.04) and those are located within the radius of 1.73 and 0.085 km, respectively.

Conclusions

Our results have confirmed that two areas are at a higher risk than others. However, based on the results of this study, community-based interventions in certain geographical areas can be designed to reduce and control the incidence of stomach cancer.

Global, regional, and national burden of ovarian cancer and the attributable risk factors in all 194 countries and territories during 2007-2017: A systematic analysis of the Global Burden of Disease Study 2017

BACKGROUND

We estimated the global burden of ovarian cancer (OC) in 194 countries and territories between 2007 and 2017.

METHODS

Data were extracted from the Global Burden of Disease (GBD), Injuries, and Risk Factors 2017 study.

RESULTS

Globally, 286 126.80 (95% UI = 278 075.38-295 311.41) incident cases, 4.67 million (4.53-4.83) disability-adjusted life-years (DALYs), and 175 981.99 (171 384.15-181 198.43) deaths were reported in 2017. The age-standardized incidence and DALY rates increased by 2.05% and 1.34% during 2007-2017, respectively, while the age-standardized mortality rate decreased by -0.14%. The age-standardized incidence, DALY, and mortality rates in 2017 were the highest in the high socio-demographic index (SDI) quintile, but the largest percentage increase during 2007-2017 was in the low-SDI quintile. Among regions, Central Europe showed the highest 2017 age-standardized incidence, DALY, and mortality rates, whereas South Asia and East Asia showed the largest percentage increases in both rates during 2007-2017. Among countries, India showed the largest percentage increase in age-standardized incidence and DALY rates, whereas Iran showed the largest percentage increase in age-standardized mortality rates. Globally, the largest percentage increase in risk-attributable DALYs was associated with metabolic risk factors (e.g., high fasting plasma glucose levels).

CONCLUSION

The global age-standardized incidence, DALYs, and mortality rates of OC remain stable during 2007-2017. However, the low SDI quintile and the greatest burden in South and East Asia, India, and Iran suggested that more targeted strategies should be performed in those regions and countries.

Association of MALAT1 expression in gastric carcinoma and the significance of its clinicopathologic features in an Iranian patient

AIM

The aim of this study was to evaluate the expression of MALAT1 and the relationship between its expression with clinical characteristics in an Iranian gastric cancer patient.

BACKGROUND

Long non-coding RNAs (LncRNAs) play critical roles in the initiation and development of gastric cancer. Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) is a highly conserved lncRNA and plays key roles in various types of human cancer. However, our understanding of the role of lncRNAs in the occurrence and development of gastric cancer is not fully clear.

METHODS

This cross-sectional study was performed on 41 gastric tumor tissue samples with matched normal adjacent tumor tissues. The RNA level of lncRNA MALAT1 gene was assessed using quantitative Real-time polymerase chain reaction. B2M was used as an internal control. The 2 -ΔΔCq method was adopted to determine expression fold changes.

RESULTS

A significant association was observed between the levels of MALAT1 in gastric tumor tissues compared with normal adjacent tissues (mean= 1.558, p= 0.014). In addition, clinicopathologic data on MALAT1 RNA expression levels in gastric cancer tissues was evaluated. No significant association was observed between the relative expression of MALAT1 and the stage, grade, H. pylori infection, and tumor size groups among gastric cancer patients (p= 0.82, p= 0.904, p= 0.407, and p= 0.701, respectively).

CONCLUSION

The current results showed that MALAT1 has a significant association in gastric cancer. The expression of MALAT1 may be used as a diagnostic biomarker for monitoring gastric cancer patients.

Trend of Gastric Cancer Incidence in an Area Located in the Center of Iran: 2009-2014

PURPOSE

There are remarkable differences between the incidence and mortality of gastric cancer in different places of the world. This study, for the first time, estimated the information around the incidence rates and trends of gastric cancer in the central area of Iran, Arak metropolitan.

METHODS

In this study, all cases with gastric cancer in Arak from 2009 to 2014 were included. Direct standardized method was applied to estimate age-standardized incidence rates (ASIRs) by a STATA package, with efficient interval estimation that might be preferable in the case of rare diseases, including cancer data. The obtained standard errors were used to calculate annual percent changes (APCs) by the Joinpoint analysis.

RESULTS

Annual ASIRs of gastric cancer were 23.92 (95% CI 21.62, 26.37) and 9.60 (95% CI 8.20, 11.18) for male and female, respectively. In male, APC of ASIRs was - 5.00% (95% CI - 9.32, - 0.47). In contrast, among female, it was - 2.69% (95% CI - 31.56, 38.34) that was statistically insignificant.

CONCLUSIONS

The ASIRs have significantly decreased trends in males, but not in females. The preventive strategies should be a focus on the declining of the risk factors and the quick early diagnosis of gastric cancer.

Cancer mortality in the elderly in 11 countries worldwide, 1970-2015

BACKGROUND

Population ageing results in an increasing cancer burden in the elderly. We aimed to evaluate time-trends in cancer mortality for adults aged 65 and over for 17 major cancer types and all cancers combined in 11 countries worldwide over the period 1970-2015.

MATERIALS AND METHODS

We obtained cancer death certification and population figures from the WHO and PAHO databases. We computed age-standardised (world standard population) rates for individuals aged 65 and over, and applied joinpoint regression models.

RESULTS

Age-standardised mortality rates for all cancers combined showed a heterogeneous, but widespread decline. Lung cancer mortality rates have been decreasing among men, and increasing among women. Pancreatic cancer had unfavourable trends in all countries for both sexes. Despite variability across countries, other tobacco-related cancers (except kidney) showed overall favourable trends, except in Poland and Russia. Age-standardised mortality rates from stomach cancer have been declining in all countries for both sexes. Colorectal mortality has been declining, except in Poland and Russia. Liver cancer mortality increased in all countries, except in Japan, France and Italy, which had the highest rates in the past. Breast cancer mortality decreased for most countries, except for Japan, Poland and Russia. Trends for age-standardised uterine cancer rates in the USA, Canada and the UK were increasing over the last decade. Ovarian cancer rates showed declines in most countries. With the exception of Russia, prostate cancer rates showed overall declines. Lymphoid neoplasms rates have been declining in both sexes, except in Poland and Russia.

CONCLUSION

Over the last decades, age-standardised cancer mortality in the elderly has been decreasing in major countries worldwide and for major cancer sites, with the major exception of lung and uterine cancer in women and liver, pancreatic and kidney cancers in both sexes. Cancer mortality for the elderly in central and eastern Europe remains comparatively high.

Mapping cancer research across Central and Eastern Europe, the Russian Federation and Central Asia: Implications for future national cancer control planning

Cancer research is an essential part of national cancer control programmes, and the emerging economies of Central and Eastern Europe (CEE) and the Russian Federation and Central Asia (R-CA) (Commonwealth of Independent States) remain relatively understudied. Here, we map the cancer research activity from the 29 countries across these regions over a 10-year period (2007-2016), using a standard scientometric approach. Research activity was compared with the countries' wealth and with the disease burden from different cancers, and analyses were also performed by the research domain (e.g. fundamental cancer biology, surgery). We found that although there was a correlation between outputs and national wealth, there were many outliers; the CEE countries publishing relatively more, and the R-CA, less. Outputs reflected cancer burdens, but there was a relative paucity of research on lung, colorectal, gastric and pancreatic cancer, as well as research domains such as screening and palliative care. Clinical trials accounted for only 3% of all research outputs from all countries, and were very international, with on average 1.5 CEE countries and 8.0 others involved in each article, and they were heavily cited (on average, 84 times in 5 years). Poland was by far the most research-active country, but significant needs and opportunities have been identified to expand the cancer research activity in all CEE and R-CA countries to enhance national cancer control planning.

Pressurized intraperitoneal aerosol chemotheprapy after misdiagnosed gastric cancer: Case report and review of the literature

We report the first application of pressurized intraperitoneal aerosol chemotherapy (PIPAC) as a rescue therapy before palliative D2 gastrectomy combined with liver metastasectomy performed in a 49-year-old woman with peritoneal carcinomatosis who was primarily diagnosed with and underwent surgery for a Krukenberg tumor. The PIPAC procedure was performed with the use of cisplatin at 7.5 mg/m² and doxorubicin at 1.5 mg/m² for 30 min at 37 °C. Eight weeks after the PIPAC procedure, the patient underwent open classic D2 gastrectomy with the creation of a Roux-en-Y anastomosis (RNY) combined with liver metastasectomy. The patient underwent the classic protocol for chemotherapy combined with Xeloda. The patient felt better and returned to her daily activities. Multicenter data should be gathered to confirm the usefulness of PIPAC as a rescue or neoadjuvant supportive therapy in a very select group of patients who have been recently qualified to undergo classic chemotherapy or standard oncologic surgical procedures.

European cancer mortality predictions for the year 2017, with focus on lung cancer

Background

We predicted cancer mortality figures in the European Union (EU) for the year 2017 using most recent available data, with a focus on lung cancer.

Materials and methods

We retrieved cancer death certification data and population figures from the World Health Organisation and Eurostat databases. Age-standardized (world standard population) rates were computed for France, Germany, Italy, Poland, Spain, the UK and the EU overall in 1970-2012. We obtained estimates for 2017 by implementing a joinpoint regression model.

Results

The predicted number of cancer deaths for 2017 in the EU is 1 373 500, compared with 1 333 400 in 2012 (+3%). Cancer mortality rates are predicted to decline in both sexes, reaching 131.8/100 000 men (-8.2% when compared with 2012) and 84.5/100 000 women (-3.6%). Mortality rates for all selected cancer sites are predicted to decline, except pancreatic cancer in both sexes and lung cancer in women. In men, pancreatic cancer rate is stable, in women it increases by 3.5%. Lung cancer mortality rate in women is predicted to rise to 14.6/100 000 in 2017 (+5.1% since 2012, corresponding to 92 300 predicted deaths), compared with 14.0/100 000 for breast cancer, corresponding to 92 600 predicted deaths. Only younger (25-44) women have favourable lung cancer trends, and rates at this age group are predicted to be similar in women (1.4/100 000) and men (1.2/100 000). In men lung cancer rates are predicted to decline by 10.7% since 2012, and falls are observed in all age groups.

Conclusion

European cancer mortality projections for 2017 confirm the overall downward trend in rates, with a stronger pattern in men. This is mainly due to different smoking prevalence trends in different generations of men and women. Lung cancer rates in young European women are comparable to those in men, confirming that smoking has the same impact on lung cancer in the two sexes.

Biomarker Testing for Personalized Therapy in Lung Cancer in Low- and Middle-Income Countries

There have been many important advances in personalized therapy for patients with lung cancer, particularly for those with advanced disease. Molecular testing is crucial for implementation of personalized therapy. Although the United States and many Western countries have come far in the implementation of personalized therapy for lung cancer, there are substantial challenges for low- and middle-income countries (LMICs). Globally, the LMICs display great heterogeneity in the pattern of implementation of molecular testing and targeted therapy. The current review presents an attempt to identify the challenges and obstacles for the implementation of molecular testing and the use of targeted therapies in these areas. Lack of infrastructure, lack of technical expertise, economic factors, and lack of access to new drugs are among the substantial barriers.