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Peirelinck H, Schulpen M, Hoogendijk R, Van Damme A, Pieters R, Henau K, Van Damme N, Karim-Kos HE. Incidence, survival, and mortality of cancer in children and young adolescents in Belgium and the Netherlands in 2004-2015: A comparative population-based study. Int J Cancer 2024; 155:226-239. [PMID: 38478912 DOI: 10.1002/ijc.34918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 01/16/2024] [Accepted: 02/14/2024] [Indexed: 05/16/2024]
Abstract
International comparisons of cancer surveillance measures may provide insight into inequalities in registration practices, etiological factors, and treatment strategies. This study aimed to compare incidence, survival, and mortality of cancer in children and young adolescents between Belgium and the Netherlands. All children (0-14 years) and young adolescents (15-17 years) diagnosed with cancer between 2004 and 2015 were selected from the population-based cancer registries of Belgium (N = 4739) and the Netherlands (N = 7322). Differences in incidence and mortality were expressed as standardized rate ratios (SRR; BE/NL). Five-year observed survival was calculated using the Kaplan-Meier method. During 2004-2015, the overall cancer incidence among children and young adolescents was similar in both countries. Incidence of neuroblastoma was significantly higher in Belgian children (2010-2015: SRR = 1.3, 95% CI 1.0-1.6). Five-year survival of all malignant cancers was comparable in 2010-2015, exceeding 80% in both age groups. Remarkable differences in survival existed in children for malignant central nervous system (CNS) tumors in 2004-2009 (BE = 62%, NL = 45%), for acute myeloid leukemia (BE = 68%, NL = 78%) and rhabdomyosarcomas (BE = 60%, NL = 79%) in 2010-2015, and for neuroblastoma in both periods (2004-2009: BE = 76%, NL = 64%; 2010-2015: BE = 82%, NL = 64%). Overall cancer mortality in children decreased by approximately 3 percent-points annually in both countries, but was slightly lower in Belgium in 2004-2009 (SRR = 0.9, 95% CI 0.7-1.0). Despite differences for specific cancer types, overall cancer incidence, survival, and mortality were comparable between Dutch and Belgian children and young adolescents in 2010-2015. Variability in screening, diagnosis, and registration practices probably explains the observed differences in incidence and survival of neuroblastoma and malignant CNS tumors.
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Affiliation(s)
| | - Maya Schulpen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Raoull Hoogendijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - An Van Damme
- Department of Pediatric Hematology and Oncology, Saint Luc University Hospital, Brussels, Belgium
| | - Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kris Henau
- Belgian Cancer Registry, Brussels, Belgium
| | | | - Henrike E Karim-Kos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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Vahl JM, Nagel G, Abou Kors T, Brand M, von Witzleben A, Sonntag M, Grages A, Theodoraki MN, Greve J, Denkinger M, Dallmeier D, Idel C, Stilgenbauer S, Hoffmann TK, Laban S. Regional outcome disparities in German head and neck cancer patients: Shorter survival in Eastern Germany. Cancer Med 2023; 12:21426-21435. [PMID: 38037808 PMCID: PMC10726835 DOI: 10.1002/cam4.6690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Demographics are important prognostic factors in malignant diseases. A nationwide analysis concerning the prognostic impact of demographics in head and neck cancer (HNC) patients (HNCP) has not been performed previously. METHODS A retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) and the Federal Statistical Office (Destatis) between 2002 and 2017 was performed. A total of 212'920 HNCP were included. Incidence, tumor stage, age development, sex distribution, age-, residence-, and diagnosis-time-specific survival were examined. RESULTS Mean age of HNCP increased more rapidly than in the general population (slope coefficient: 0.29 vs. 0.20; p < 0.0001). Higher age and male sex were associated with a worse prognosis. Whereas overall survival (OS) increased from the early to the later observation period for HNCP <70 years, no OS improvement for HNCP >70 years was found. Furthermore, an OS disadvantage was observed for East Germany compared to West Germany (median 47 vs. 60 months; p < 0.0001). This disparity was associated with a disproportionately high ratio of men in East Germany (men/women: 4.4 vs. 3.1; p < 0.0001) and a lower mean age (61 vs. 63 years; p < 0.0001). In addition to stage, age and sex, residence in East Germany were confirmed as an independent factor for OS in a multivariate analysis. CONCLUSION Finally, three decades after the German reunion, a survival disadvantage for patients in East Germany still exists. This discrepancy may be a result of socioeconomic disparities.
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Affiliation(s)
- Julius M. Vahl
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Gabriele Nagel
- Department of Epidemiology and Medical BiometryUniversity Medical Center UlmUlmGermany
| | - Tsima Abou Kors
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Matthias Brand
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Adrian von Witzleben
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Michael Sonntag
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Ayla Grages
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Marie N. Theodoraki
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Jens Greve
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Michael Denkinger
- Agaplesion Bethesda UlmInstitute of Geriatric Research at Ulm University Medical Center and Geriatric CenterUlmGermany
| | - Dhayana Dallmeier
- Agaplesion Bethesda UlmInstitute of Geriatric Research at Ulm University Medical Center and Geriatric CenterUlmGermany
| | - Christian Idel
- Department of OtorhinolaryngologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | | | - Thomas K. Hoffmann
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Simon Laban
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
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Liang LA, Tseng YJ, Tanaka LF, Klug SJ. Second primary cancer among 217702 colorectal cancer survivors: An analysis of national German cancer registry data. Int J Cancer 2023; 153:1459-1471. [PMID: 37392091 DOI: 10.1002/ijc.34638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/02/2023]
Abstract
With improvements in survival after colorectal cancer (CRC), more survivors are at risk of developing a second cancer, particularly in younger populations where CRC incidence is increasing. We estimated the incidence of second primary cancer (SPC) in CRC survivors and its potential risk factors. We identified CRC cases diagnosed between 1990 and 2011 and SPCs until 2013 from nine German cancer registries. Standardized incidence ratios (SIR) and absolute excess risk (AER) per 10 000 person-years were calculated and were stratified by index site: colon cancer (CC) and rectal cancer (RC), age and sex. Cox regression assessed potential SPC risk factors, including primary tumor-related therapy considering death as a competing risk. We included 217 202 primary CRC cases. SPC occurred in 18 751 CRC survivors (8.6%; median age: 69 years). Risk of cancer was significantly higher in CRC survivors than in the general population (SIR males 1.14, 95% confidence interval [CI] 1.12-1.17, AER = 24.7; SIR females 1.20, 95% CI 1.17-1.23, AER = 22.8). Increased risks of SPCs were observed for the digestive system, urinary system and female and male reproductive organs. CRC incidence increased in younger persons (<50 years) and SPC incidence was 4-fold in this group (SIR males 4.51, 95% CI 4.04-5.01, AER = 64.2; SIR females 4.03, 95% CI 3.62-4.48, AER = 77.0). Primary tumor-related factors associated with SPC risk were right-sided cancer and smaller primary tumor size. Treatment and risk of SPC differed for CC (no effect) and RC (lower risk after chemotherapy). CRC survivors have excess risk of developing SPC, with particular characteristics that could guide targeted surveillance.
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Affiliation(s)
- Linda A Liang
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ying-Ju Tseng
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Luana F Tanaka
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Giusti F, Martos C, Trama A, Bettio M, Sanvisens A, Audisio R, Arndt V, Francisci S, Dochez C, Ribes J, Fernández LP, Gavin A, Gatta G, Marcos-Gragera R, Lievens Y, Allemani C, De Angelis R, Visser O, Van Eycken L. Cancer treatment data available in European cancer registries: Where are we and where are we going? Front Oncol 2023; 13:1109978. [PMID: 36845700 PMCID: PMC9944949 DOI: 10.3389/fonc.2023.1109978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
Population-based cancer registries are responsible for collecting incidence and survival data on all reportable neoplasms within a defined geographical area. During the last decades, the role of cancer registries has evolved beyond monitoring epidemiological indicators, as they are expanding their activities to studies on cancer aetiology, prevention, and quality of care. This expansion relies also on the collection of additional clinical data, such as stage at diagnosis and cancer treatment. While the collection of data on stage, according to international reference classification, is consolidated almost everywhere, data collection on treatment is still very heterogeneous in Europe. This article combines data from a literature review and conference proceedings together with data from 125 European cancer registries contributing to the 2015 ENCR-JRC data call to provide an overview of the status of using and reporting treatment data in population-based cancer registries. The literature review shows that there is an increase in published data on cancer treatment by population-based cancer registries over the years. In addition, the review indicates that treatment data are most often collected for breast cancer, the most frequent cancer in women in Europe, followed by colorectal, prostate and lung cancers, which are also more common. Treatment data are increasingly being reported by cancer registries, though further improvements are required to ensure their complete and harmonised collection. Sufficient financial and human resources are needed to collect and analyse treatment data. Clear registration guidelines are to be made available to increase the availability of real-world treatment data in a harmonised way across Europe.
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Affiliation(s)
- Francesco Giusti
- European Commission, Joint Research Centre (JRC), Ispra, Italy,Belgian Cancer Registry, Brussels, Belgium,*Correspondence: Francesco Giusti, ;
| | - Carmen Martos
- European Commission, Joint Research Centre (JRC), Ispra, Italy,Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Manola Bettio
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Arantza Sanvisens
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia; Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Riccardo Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Volker Arndt
- Epidemiological Cancer Registry Baden-Württemberg (M110) & Unit of Cancer Survivorship (C071), Division of Clinical Epidemiology and Aging Research (C070), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | - Josepa Ribes
- Catalan Cancer Plan, Department of Health of Catalonia, Hospitalet del Llobregat, Barcelona, Spain
| | - Laura Pareja Fernández
- Catalan Cancer Plan, Department of Health of Catalonia, Hospitalet del Llobregat, Barcelona, Spain
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen’s University Belfast, Belfast, Ireland
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia; Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
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Eberl M, Tanaka LF, Kraywinkel K, Klug SJ. Incidence of smoking-related second primary cancers after lung cancer in Germany: an analysis of nationwide cancer registry data. J Thorac Oncol 2021; 17:388-398. [PMID: 34902598 DOI: 10.1016/j.jtho.2021.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/18/2021] [Accepted: 11/16/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION About 80% of lung cancer cases in Germany are attributable to smoking. Patients with a lung cancer diagnosis may remain at increased risk of developing smoking-related second primary cancers (SPC). METHODS Anonymous data from 11 population-based cancer registries covering about 50% of the German population were pooled for the analysis. Included patients were diagnosed with an index lung cancer between 2002 and 2013, 30 to 99 years old at diagnosis and survived for at least 6 months. We calculated standardized incidence ratios (SIR) - stratified by age, sex, region and period - comparing the incidence of smoking-related and other SPC to the general population. RESULTS Of the 135,589 lung cancer survivors (68.2% male; mean follow-up 30.8 months) analyzed, 5,298 developed an SPC. In males the risk was particularly high for SPCs of the larynx (SIR = 3.70; 95% CI: 3.14-4.34), pharynx (3.17; 2.61-3.81) and oral cavity (2.86; 2.38-3.41). For females SIRs were notably elevated for esophagus (4.66; 3.15-6.66), oral cavity (3.14; 2.03-4.63) and urinary tract (2.68; 2.04-3.45). When combining all smoking-related cancer sites, SIR was 1.41 in males (95% CI: 1.36-1.47) and 1.81 in females (95% CI: 1.68-1.94). We observed that males had a 1.46-fold (95% CI: 1.37-1.56) and females a 1.33-fold (95% CI: 1.20-1.47) increased risk for smoking-related compared to other cancers. CONCLUSIONS Patients with primary lung cancer were at increased risk for developing a smoking-related SPC. Therefore, the advantages of increased patient surveillance and the benefits of smoking cessation strategies should be considered.
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Affiliation(s)
- Marian Eberl
- Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany.
| | - Luana F Tanaka
- Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany
| | - Klaus Kraywinkel
- German Centre for Cancer Registry Data, Robert Koch-Institut, Nordufer 20, 13353 Berlin, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany
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Peterson J, Houser SH, Flite CA, Kinnerson L, Birchfield H, Post A. Exploring Cancer Registrars' Perceptions of the Quality and Use of Cancer Registry Data for Care Coordination and Other Purposes. J Registry Manag 2021; 48:12-19. [PMID: 34170891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hospital cancer registry data are used for a variety of aspects of patient care, yet one of the lesser used purposes of cancer registry data is to improve care coordination. OBJECTIVES The purposes of this study were to assess hospital cancer registrars' perceptions of (1) the use of and quality of hospital cancer registry data for care coordination and other purposes; (2) the availability of all needed data for complete hospital cancer registry data collection; and (3) the data collection of COVID-19 effects on cancer patients. METHODS A survey was sent to hospital-based members of Cancer Registrars of Illinois between April and June 2020. Survey questions focused on current use and quality of hospital cancer registry data for care coordination as well as items related to COVID-19's effect on cancer patients. The focus of this study was hospital-based registrars, as they are the individuals collecting data directly from primary patient records. RESULTS While hospital cancer registry data are being used for many purposes including continuity of care, this study found that providers are not using hospital cancer registry data to its fullest extent. It was also found that hospital cancer registrars have collected valuable data on the impact that COVID-19 has had on cancer patients. CONCLUSION Care coordination between providers is especially important for cancer patients who may see multiple providers and visit several facilities. This study found that the hospital cancer registry database contains extremely useful data for cancer patients and practitioners. Further, it was found that the hospital cancer registry is a source of valuable information regarding the impact that COVID-19 has had on cancer patients.
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Hellmund P, Schmitt J, Roessler M, Meier F, Schoffer O. Targeted and Checkpoint Inhibitor Therapy of Metastatic Malignant Melanoma in Germany, 2000-2016. Cancers (Basel) 2020; 12:E2354. [PMID: 32825357 DOI: 10.3390/cancers12092354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/28/2022] Open
Abstract
Targeted therapies (TT) and immune checkpoint inhibitors (ICI) have become increasingly important in the treatment of metastatic malignant melanoma in recent years. We examined implementation and effectiveness of these new therapies over time in Germany with a focus on regional differences. We analyzed data from 12 clinical cancer registries in 8 federal states in Germany over the period 2000–2016. A total of 3871 patients with malignant melanoma in Union internationale contre le cancer (UICC) stage IV at primary diagnosis (synchronous metastases) or with metachronous metastases were included. We investigated differences in survival of patients treated with new and conventional therapies by log-rank tests for Kaplan–Meier curves. Cox regression models were estimated to adjust therapy effects for demographic, regional, and prognostic factors. New systemic therapies were increasingly applied throughout Germany. TT were most frequently documented in Eastern Germany (East: 11.2%; West: 6.3%), whereas ICI therapies were more frequently used in Western Germany (East: 1.7%; West: 3.9%). TT had a relevant influence on patient survival (hazard ratio (HR) = 0.831; 95%-CI = (0.729; 0.948)). Survival was worse in Eastern Germany (HR = 1.470; 95%-CI = (1.347; 1.604)) relative to Western Germany. Treatment and survival prospects of patients with melanoma differed considerably between Western and Eastern Germany. The differences in regional medication behavior and survival require further exploration.
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Czwikla J, Urbschat I, Kieschke J, Schüssler F, Langner I, Hoffmann F. Assessing and Explaining Geographic Variations in Mammography Screening Participation and Breast Cancer Incidence. Front Oncol 2019; 9:909. [PMID: 31620366 PMCID: PMC6759661 DOI: 10.3389/fonc.2019.00909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/02/2019] [Indexed: 12/29/2022] Open
Abstract
Investigating geographic variations in mammography screening participation and breast cancer incidence help improve prevention strategies to reduce the burden of breast cancer. This study examined the suitability of health insurance claims data for assessing and explaining geographic variations in mammography screening participation and breast cancer incidence at the district level. Based on screening unit data (1,181,212 mammography screening events), cancer registry data (13,241 incident breast cancer cases) and claims data (147,325 mammography screening events; 1,778 incident breast cancer cases), screening unit and claims-based standardized participation ratios (SPR) of mammography screening as well as cancer registry and claims-based standardized incidence ratios (SIR) of breast cancer between 2011 and 2014 were estimated for the 46 districts of the German federal state of Lower Saxony. Bland-Altman analyses were performed to benchmark claims-based SPR and SIR against screening unit and cancer registry data. Determinants of district-level variations were investigated at the individual and contextual level using claims-based multilevel logistic regression analysis. In claims and benchmark data, SPR showed considerable variations and SIR hardly any. Claims-based estimates were between 0.13 below and 0.14 above (SPR), and between 0.36 below and 0.36 above (SIR) the benchmark. Given the limited suitability of health insurance claims data for assessing geographic variations in breast cancer incidence, only mammography screening participation was investigated in the multilevel analysis. At the individual level, 10 of 31 Elixhauser comorbidities were negatively and 11 positively associated with mammography screening participation. Age and comorbidities did not contribute to the explanation of geographic variations. At the contextual level, unemployment rate was negatively and the proportion of employees with an academic degree positively associated with mammography screening participation. Unemployment, income, education, foreign population and type of district explained 58.5% of geographic variations. Future studies should combine health insurance claims data with individual data on socioeconomic characteristics, lifestyle factors, psychological factors, quality of life and health literacy as well as contextual data on socioeconomic characteristics and accessibility of mammography screening. This would allow a comprehensive investigation of geographic variations in mammography screening participation and help to further improve prevention strategies for reducing the burden of breast cancer.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.,Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Iris Urbschat
- Epidemiological Cancer Registry of Lower Saxony, Registry Unit Oldenburg, Oldenburg, Germany
| | - Joachim Kieschke
- Epidemiological Cancer Registry of Lower Saxony, Registry Unit Oldenburg, Oldenburg, Germany
| | - Frank Schüssler
- Institute for Applied Photogrammetry and Geoinformatics, Jade University of Applied Sciences Wilhelmshaven/Oldenburg/Elsfleth, Oldenburg, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Hoebel J, Kroll LE, Fiebig J, Lampert T, Katalinic A, Barnes B, Kraywinkel K. Socioeconomic Inequalities in Total and Site-Specific Cancer Incidence in Germany: A Population-Based Registry Study. Front Oncol 2018; 8:402. [PMID: 30319967 PMCID: PMC6167637 DOI: 10.3389/fonc.2018.00402] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/03/2018] [Indexed: 12/23/2022] Open
Abstract
Most chronic diseases follow a socioeconomic gradient with higher rates in lower socioeconomic groups. A growing body of research, however, reveals cancer to be a disease group with very diverse socioeconomic patterning, even demonstrating reverse socioeconomic gradients for certain cancers. To investigate this matter at the German national level for the first time, this study examined socioeconomic inequalities in cancer incidence in Germany, both for all cancers combined as well as for common site-specific cancers. Population-based data on primary cancers newly diagnosed in 2010-2013 was obtained from the German Centre for Cancer Registry Data. Socioeconomic position was assessed at the district level using the German Index of Socioeconomic Deprivation, which is a composite index of area-based socioeconomic indicators. Absolute and relative socioeconomic inequalities in total and site-specific cancer incidence were analyzed using multilevel Poisson regression models with the logarithm of the number of residents as an offset. Among men, socioeconomic inequalities in cancer incidence with higher rates in more deprived districts were found for all cancers combined and various site-specific cancers, most pronounced for cancers of the lung, oral and upper respiratory tract, stomach, kidney, and bladder. Among women, higher rates in more deprived districts were evident for kidney, bladder, stomach, cervical, and liver cancer as well as for lymphoid/hematopoietic neoplasms, but no inequalities were evident for all cancers combined. Reverse gradients with higher rates in less deprived districts were found for malignant melanoma and thyroid cancer in both sexes, and in women additionally for female breast and ovarian cancer. Whereas in men the vast majority of all incident cancers occurred at cancer sites showing higher incidence rates in more deprived districts and cancers with a reverse socioeconomic gradient were in a clear minority, the situation was more balanced for women. This is the first national study from Germany examining socioeconomic inequalities in total and site-specific cancer incidence. The findings demonstrate that the socioeconomic patterning of cancer is diverse and follows different directions depending on the cancer site. The area-based cancer inequalities found suggest potentials for population-based cancer prevention and can help develop local strategies for cancer prevention and control.
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Affiliation(s)
- Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lars E. Kroll
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Fiebig
- German Centre for Cancer Registry Data, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Lampert
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Benjamin Barnes
- German Centre for Cancer Registry Data, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Klaus Kraywinkel
- German Centre for Cancer Registry Data, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Nakata K, Ito Y, Magadi W, Bonaventure A, Stiller CA, Katanoda K, Matsuda T, Miyashiro I, Pritchard‐Jones K, Rachet B. Childhood cancer incidence and survival in Japan and England: A population-based study (1993-2010). Cancer Sci 2018; 109:422-434. [PMID: 29178401 PMCID: PMC5797810 DOI: 10.1111/cas.13457] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 01/30/2023] Open
Abstract
The present study aimed to compare cancer incidence and trends in survival for children diagnosed in Japan and England, using population-based cancer registry data. The analysis was based on 5192 children with cancer (age 0-14 years) from 6 prefectural cancer registries in Japan and 21 295 children diagnosed in England during 1993-2010. Differences in incidence rates between the 2 countries were measured with Poisson regression models. Overall survival was estimated using the Kaplan-Meier method. Incidence rates for Hodgkin lymphoma, renal tumors and Ewing sarcomas in England were more than twice as high as those in Japan. Incidence of germ cell tumors, hepatic tumors, neuroblastoma and acute myeloid leukemia (AML) was higher in Japan than in England. Incidence of all cancers combined decreased in Japan throughout the period 1993 to 2010, which was mainly explained by a decrease in registration of neuroblastoma in infants. For many cancers, 5-year survival improved in both countries. The improvement in survival in chronic myeloid leukemia (CML) was particularly dramatic in both countries. However, 5-year survival remained less than 80% in 2005-2008 in both countries for AML, brain tumors, soft tissue sarcomas, malignant bone tumors and neuroblastoma (age 1-14 years). There were significant differences in incidence of several cancers between countries, suggesting variation in genetic susceptibility and possibly environmental factors. The decrease in incidence for all cancers combined in Japan was related to the cessation of the national screening program for neuroblastoma. The large improvement in survival in CML coincided with the introduction of effective therapy (imatinib).
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Affiliation(s)
- Kayo Nakata
- Cancer Control CenterOsaka International Cancer InstituteOsakaJapan
- Developmental Biology and Cancer ProgrammeUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Cancer Survival GroupLondon School of Hygiene & Tropical MedicineLondonUK
| | - Yuri Ito
- Cancer Control CenterOsaka International Cancer InstituteOsakaJapan
| | - Winnie Magadi
- Cancer Survival GroupLondon School of Hygiene & Tropical MedicineLondonUK
| | - Audrey Bonaventure
- Cancer Survival GroupLondon School of Hygiene & Tropical MedicineLondonUK
| | - Charles A. Stiller
- National Cancer Registration and Analysis ServicePublic Health EnglandOxfordUK
| | - Kota Katanoda
- Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | - Tomohiro Matsuda
- Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | - Isao Miyashiro
- Cancer Control CenterOsaka International Cancer InstituteOsakaJapan
| | - Kathy Pritchard‐Jones
- Developmental Biology and Cancer ProgrammeUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Bernard Rachet
- Cancer Survival GroupLondon School of Hygiene & Tropical MedicineLondonUK
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Chihara D, Ito H, Izutsu K, Hattori M, Nishino Y, Ioka A, Matsuda T, Ito Y. Advance and stagnation in the treatment of patients with lymphoma and myeloma: Analysis using population-based cancer registry data in Japan from 1993 to 2006. Int J Cancer 2015; 137:1217-23. [PMID: 25694231 DOI: 10.1002/ijc.29477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/02/2015] [Indexed: 12/13/2022]
Abstract
There have been significant advances in the treatment of patients with lymphoma and myeloma. Although the improvements in survival outcome have been clearly addressed by clinical trials, these studies includes patients who are otherwise healthy and would be eligible for trials that the actual improvement in survival in the general patient population over time is yet to be elucidated. Therefore, we reviewed the cancer-registry data of patients with lymphoma and myeloma in Japan from 1993 to 2006 and estimated relative survival (adjusted for competing causes of death in same-age members of the general population) according to three periods of diagnosis (1993-1997, 1998-2002 and 2003-2006). We also estimated conditional 5-year relative survival (5-year survival rate of patients who have survived 5 years). A total of 26,141 patients were reviewed and analyzed. Relative survival improved in Hodgkin lymphoma (HL, N = 853, +20% improvement), diffuse large B-cell lymphoma (DLBCL, N = 4,919, +14% improvement) and follicular lymphoma (FL, N = 1,333, +13% improvement). In contrast, we found no significant improvement in survival since 1993 in peripheral T-cell lymphoma (PTCL, N = 667, +4% improvement), adult T-cell leukemia/lymphoma (ATLL, N = 2,166, -5% improvement) or multiple myeloma (MM, N = 4,914, -2% improvement). Conditional 5-year survival of HL, DLBCL, FL, PTCL, ATLL and MM was 88, 87, 79, 63, 53 and 45%, respectively. Relative survival of patients with HL, DLBCL and FL significantly improved from 1993 to 2006 in Japan; in contrast, no improvement was seen in other diseases, suggesting unmet need of novel treatment strategies.
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Affiliation(s)
- Dai Chihara
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Koji Izutsu
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Masakazu Hattori
- Department of Cancer Therapy Center, Fukui Prefectural Hospital, Fukui, Japan
| | - Yoshikazu Nishino
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Natori, Japan
| | - Akiko Ioka
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tomohiro Matsuda
- Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Osaka, Japan
| | - Yuri Ito
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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