Incidence of pancreatic cancer in Greenland 2000-2010

Access to radiotherapy among circumpolar Inuit populations

Cancer is a substantial health burden for Inuit populations, an Indigenous peoples who primarily inhabit the circumpolar regions of Alaska, Canada, Greenland, and Russia. Access to radiotherapy is lacking or absent in many of these regions, despite it being an essential component of cancer treatment. This Review presents an overview of factors influencing radiotherapy delivery in each of the four circumpolar Inuit regions, which include population and geography, health-systems infrastructure, and cancer epidemiology. This Review also provides insight into the complex patient pathways needed to access radiotherapy, and on radiotherapy use. The unique challenges in delivering radiotherapy to circumpolar Inuit populations are discussed, which, notably, include geographical and cultural barriers. Recommendations include models of care that have successfully addressed these barriers, and highlight the need for increased collaboration between circumpolar referral centres in Alaska, Canada, Greenland, and Russia to ultimately allow for better delivery of cancer treatment.

Global incidence and mortality rates in pancreatic cancer and the association with the Human Development Index: decomposition approach

OBJECTIVES

Pancreatic cancer has a lower morbidity yet higher case fatality rates (CFRs) compared with other gastrointestinal cancers. The effects of socio-economic components on pancreatic cancer rates have been acknowledged; however, the effects of the Human Development Index (HDI) inequality are not. In this study, we aimed to determine the contribution of important socio-economic components on pancreatic cancer rates using a decomposition approach.

STUDY DESIGN

Global ecological study.

METHODS

Incidence and mortality rates of pancreatic cancer were obtained for 172 countries from GLOBOCAN and the United Nations Development Program. The World Bank database was also used to obtain the HDI and its gradient for 169 countries. Inequality in pancreatic cancer age-specific incidence and mortality rates was calculated according to the HDI using the concentration index (CI). We decomposed the CI to determine main contributors of the inequality.

RESULTS

The CI for incidence and mortality of pancreatic cancer in both genders according to the HDI was 0.26 (95% confidence interval: 0.21-0.30) and 0.25 (95% confidence interval: 0.21-0.30), respectively, which indicated more concentrated inequality in advantaged countries. About 80% of the inequality sources were predicted by socio-economic component in both rates of pancreatic cancer. The main contributors to inequality were the mean years of schooling, life expectancy at birth, expected years of schooling, and urbanization.

CONCLUSION

Global inequalities exist in pancreatic cancer incidence and mortality rates according to the HDI; in addition, inequality was more concentrated in countries with higher score of HDI.

Symptoms and health-related quality of life in patients with advanced cancer - A population-based study in Greenland

PURPOSE

The aims were to describe symptoms and health-related quality of life (HRQoL) in Greenlandic patients with advanced cancer and to assess the applicability and internal consistency of the Greenlandic version of the EORTC-QLQ-C30 core version 3.0.

METHODS

A Greenlandic version of the EORTC QLQ-C30 v.3.0 was developed. The translation process included independent forward translation, reconciliation and independent back translation by native Greenlandic-speaking translators who were fluent in English. After pilot testing, a population-based cross-sectional study of patients with advanced cancer receiving palliative treatment was conducted. Internal consistency was examined by calculating Cronbach's alpha coefficients for five function scales and three symptom scales.

RESULTS

Of the 58 patients who participated in the study, 47% had reduced social functioning, 36% had reduced physical and role functioning and 19% had reduced emotional and cognitive functioning. Furthermore, 48% reported fatigue, and 33% reported financial problems. The Greenlandic version of the EORTC had good applicability in the assessment of symptoms and quality of life. Acceptable Cronbach's alpha coefficients (above 0.70) were observed for the physical, role and social functioning scales, the fatigue scale and the global health status scale.

CONCLUSIONS

Patients with undergoing palliative treatment in Greenland for advanced cancer reported high levels of social and financial problems and reduced physical functioning. This indicates a potential for improving palliative care service and increasing the focus on symptom management. The Greenlandic version of the EORTC-QLQ-C30 represents an applicable and reliable tool to describe symptoms and health-related quality of life among Greenlandic patients with advanced cancer.

Health effects associated with measured levels of contaminants in the Arctic

The Human Health Assessment Group has over the past decade recommended that effect studies be conducted in the circumpolar area. Such studies examine the association between contaminant exposure in the Arctic populations and health effects. Because foetuses and young children are the most vulnerable, effect studies are often prospective child cohort studies. The emphasis in this article is on a description of the effects associated with contaminant exposure in the Arctic. The main topics addressed are neurobehavioural, immunological, reproductive, cardiovascular, endocrine and carcinogenic effect. For each topic, the association between exposure and effects is described, and some results are reported for similar studies outside the Arctic.

Health of Indigenous Circumpolar Populations

Indigenous circumpolar populations have experienced profound transitions in lifeways over the past half-century as a result of economic development. Although there have been positive aspects of this social transformation, most circumpolar groups today have a triple burden of disease, with a modestly elevated infectious disease level, an elevated and increasing burden of chronic conditions such as obesity and cardiovascular disease, and high rates of mental health–related challenges. The health of contemporary circumpolar populations is not easily characterized because of dramatic regional differences that stem from socioeconomic disparities among nonindigenous groups, individual population histories, lifestyle factors, environmental pollution, and underlying biological variation. Overall health and well-being range from excellent among the Sami of Sweden and Norway to extremely poor among marginalized native populations in northern Russia. Circumpolar groups today are not only threatened by continued regional economic development and pollution, but also uniquely vulnerable to global climate change.

Incidence of pancreatic cancer in Greenland 2000-2010

Background

Inuit people are known to be at an increased risk of cancers usually uncommon to the western world such as cancers of the nasopharynx and salivary glands. But what is the trend regarding pancreatic cancer?

Objective

To determine the incidence of pancreatic cancer (PC) in Greenland compared with Denmark in the period 2000–2010.

Study design

Retrospective register-based study. Cases were retrieved from The Danish Cancer Register and The Greenlandic Patient Register and stratified in 5-year age intervals for each year. Age-standardized incidence ratios (SIR) for each year for Greenland compared with Denmark were calculated using the number of cases and the number of inhabitants in each 5-year age interval and in each country. The average SIR for the entire period was calculated using a weighted average.

Results

The study revealed a SIR of 2.38 (95% CI: 1.97–2.86; p<0.0001) indicating a significantly increased incidence of PC in Greenland compared with Denmark. A linear regression analysis showed no significant change in the SIR over time (p for trend 0.25) as well as no significant change isolated in Greenland (p for trend 0.8). Furthermore, the Inuit were significantly younger at the time of diagnosis (mean 62.7 vs. 70.0; p<0.0001).

Conclusions

The age-standardized incidence of PC is 138% higher in Greenland than in Denmark. A part of this could be explained by a higher prevalence of smoking and DM-2. However, the impact of genetic factors cannot be disregarded and should be subjected to further investigation.