Pub Date : 2025-12-01Epub Date: 2025-09-11DOI: 10.1016/j.canep.2025.102903
Matthew E. Barclay , Sean McPhail , Shane A. Johnson , Ruth Swann , John Butler , Christian J. Finley , Andriana Barisic , Damien Bennett , Oliver Bucher , Nicola Creighton , Cheryl A. Denny , Ron A. Dewar , David W. Donnelly , Laura Downie , Norah Finn , Steven Habbous , Dyfed W. Huws , Leon May , Bjørn Møller , David S. Morrison , Georgios Lyratzopoulos
Objective
To describe use of chemotherapy in patients with ovarian cancer in national or sub-national populations of Australia, Canada, Norway and the UK.
Methods
Linked population-based data sources were used to describe use and time to chemotherapy initiation in ovarian cancer patients diagnosed in study periods during 2012–2017. Random-effects meta-analysis characterised the size of interjurisdictional variation.
Results
Among 39,879 patients, chemotherapy use ranged from 49 % (Wales) to 75 % (Manitoba). Across jurisdictions, chemotherapy use was higher in advanced disease (79 %, 95 %CI: 74 %–83 %), and lower for stages 1–2 or localised/regional disease (54 %, 95 %CI: 48 %–60 %). Within jurisdictions, chemotherapy use was similar in patients aged 15–64 and 65–74 and then decreased sharply with increasing age. There was large interjurisdictional variation in chemotherapy use in patients aged 85–99 years with advanced disease, being, for example, 23 % (95 %CI: 20 %–25 %) in England and 61 % (95 %CI: 51 %–70 %) in Ontario. However, jurisdictions with the highest chemotherapy use in recorded advanced stage, including Ontario, tended to have higher percentage of missing stage information. Overall, time from diagnosis to chemotherapy initiation was shorter in New South Wales and Victoria and longer in Scotland and Wales. In patients with advanced disease, interjurisdictional variation in time-to-treatment was limited.
Conclusions
Even within the same age groups and stage strata, use of chemotherapy varied substantially between jurisdictions during the mid-2010s. Future work should examine use of surgery in combination with chemotherapy. The reasons for the international variation in chemotherapy use and its contribution to international variation in survival should be established.
{"title":"Chemotherapy use in ovarian cancer patients diagnosed 2012–2017 in Australia, Canada, Norway and the UK: An International Cancer Benchmarking Partnership (ICBP) population-based study","authors":"Matthew E. Barclay , Sean McPhail , Shane A. Johnson , Ruth Swann , John Butler , Christian J. Finley , Andriana Barisic , Damien Bennett , Oliver Bucher , Nicola Creighton , Cheryl A. Denny , Ron A. Dewar , David W. Donnelly , Laura Downie , Norah Finn , Steven Habbous , Dyfed W. Huws , Leon May , Bjørn Møller , David S. Morrison , Georgios Lyratzopoulos","doi":"10.1016/j.canep.2025.102903","DOIUrl":"10.1016/j.canep.2025.102903","url":null,"abstract":"<div><h3>Objective</h3><div>To describe use of chemotherapy in patients with ovarian cancer in national or sub-national populations of Australia, Canada, Norway and the UK.</div></div><div><h3>Methods</h3><div>Linked population-based data sources were used to describe use and time to chemotherapy initiation in ovarian cancer patients diagnosed in study periods during 2012–2017. Random-effects meta-analysis characterised the size of interjurisdictional variation.</div></div><div><h3>Results</h3><div>Among 39,879 patients, chemotherapy use ranged from 49 % (Wales) to 75 % (Manitoba). Across jurisdictions, chemotherapy use was higher in advanced disease (79 %, 95 %CI: 74 %–83 %), and lower for stages 1–2 or localised/regional disease (54 %, 95 %CI: 48 %–60 %). Within jurisdictions, chemotherapy use was similar in patients aged 15–64 and 65–74 and then decreased sharply with increasing age. There was large interjurisdictional variation in chemotherapy use in patients aged 85–99 years with advanced disease, being, for example, 23 % (95 %CI: 20 %–25 %) in England and 61 % (95 %CI: 51 %–70 %) in Ontario. However, jurisdictions with the highest chemotherapy use in recorded advanced stage, including Ontario, tended to have higher percentage of missing stage information. Overall, time from diagnosis to chemotherapy initiation was shorter in New South Wales and Victoria and longer in Scotland and Wales. In patients with advanced disease, interjurisdictional variation in time-to-treatment was limited.</div></div><div><h3>Conclusions</h3><div>Even within the same age groups and stage strata, use of chemotherapy varied substantially between jurisdictions during the mid-2010s. Future work should examine use of surgery in combination with chemotherapy. The reasons for the international variation in chemotherapy use and its contribution to international variation in survival should be established.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102903"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-15DOI: 10.1016/j.canep.2025.102942
Sarah R. Haile , Miriam Wanner , Dimitri Korol , Sabine Rohrmann
Background
We aimed to compare various common approaches for handling missing vital status or follow-up time. As a case study for application of these methods, we estimated incidence of metachronous contralateral breast cancer (CBC).
Methods
For 1980–2016, incidence of metachronous CBC with follow-up through 2024 was estimated using Poisson regression with overdispersion, by age at incidence, year of incidence, histology and follow-up period. Missing follow-up time was ignored in the naive approach, simulated once using the average hazard derived from published Swiss cancer registry data, or multiply imputed using 3 different imputation models.
Results
24,612 women aged 20–84 had unilateral breast cancer between 1980 and 2016 in the Swiss cantons of Zurich and Zug. Of those, 5 % (n = 1264) were lost to follow-up. Over 291,463 person-years, 1145 contralateral breast malignancies were diagnosed, corresponding to 393 per 100,000 person-years (95 % CI 353–438). Incidence rates have been decreasing over time to 238 (171−333) for the incidence period 2010–2016. The same overall pattern was observed regardless of how we handled missing follow-up times. However, using a single imputation generally produced lower incidence rates compared to the naive approach, with multiple imputation giving higher estimates. The most complex multiple imputation model gave incidence estimates that were very similar to those from the naive approach.
Conclusion
Different methods to handle missing follow-up times yielded similar results: that CBC incidence has declined in recent decades. Multiple imputation is likely an appropriate method to handle missing follow-up data, enabling researchers to include all eligible individuals in the analysis.
背景:我们的目的是比较各种常见的方法来处理遗漏的生命状态或随访时间。作为应用这些方法的一个案例研究,我们估计了异时性对侧乳腺癌(CBC)的发病率。方法:对1980-2016年随访至2024年的异时性CBC发病率,采用过分散泊松回归,按发病年龄、发病年份、组织学和随访时间进行估计。在幼稚的方法中忽略了随访时间的缺失,使用从瑞士癌症登记数据中得出的平均风险进行一次模拟,或使用3种不同的估算模型进行多次估算。结果:1980年至2016年间,瑞士苏黎世和楚格州有24,612名年龄在20-84岁之间的女性患有单侧乳腺癌。其中5 % (n = 1264)失访。在291,463人/年中,诊断出1145例对侧乳腺恶性肿瘤,相当于每10万人/年393例(95 % CI 353-438)。随着时间的推移,发病率一直在下降,2010-2016年发病率为238(171-333)。无论我们如何处理缺失的随访时间,观察到的总体模式都是一样的。然而,与单纯的方法相比,使用单一输入通常产生较低的发病率,而多次输入则给出较高的估计值。最复杂的多重imputation模型给出的发生率估计与朴素方法非常相似。结论:不同方法处理缺失随访时间的结果相似:近几十年来,CBC发病率有所下降。多重输入可能是处理缺失的随访数据的合适方法,使研究人员能够在分析中包括所有符合条件的个体。
{"title":"Approaches to handle missing follow-up time: A comparative analysis of contralateral breast cancer incidence","authors":"Sarah R. Haile , Miriam Wanner , Dimitri Korol , Sabine Rohrmann","doi":"10.1016/j.canep.2025.102942","DOIUrl":"10.1016/j.canep.2025.102942","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to compare various common approaches for handling missing vital status or follow-up time. As a case study for application of these methods, we estimated incidence of metachronous contralateral breast cancer (CBC).</div></div><div><h3>Methods</h3><div>For 1980–2016, incidence of metachronous CBC with follow-up through 2024 was estimated using Poisson regression with overdispersion, by age at incidence, year of incidence, histology and follow-up period. Missing follow-up time was ignored in the naive approach, simulated once using the average hazard derived from published Swiss cancer registry data, or multiply imputed using 3 different imputation models.</div></div><div><h3>Results</h3><div>24,612 women aged 20–84 had unilateral breast cancer between 1980 and 2016 in the Swiss cantons of Zurich and Zug. Of those, 5 % (n = 1264) were lost to follow-up. Over 291,463 person-years, 1145 contralateral breast malignancies were diagnosed, corresponding to 393 per 100,000 person-years (95 % CI 353–438). Incidence rates have been decreasing over time to 238 (171−333) for the incidence period 2010–2016. The same overall pattern was observed regardless of how we handled missing follow-up times. However, using a single imputation generally produced lower incidence rates compared to the naive approach, with multiple imputation giving higher estimates. The most complex multiple imputation model gave incidence estimates that were very similar to those from the naive approach.</div></div><div><h3>Conclusion</h3><div>Different methods to handle missing follow-up times yielded similar results: that CBC incidence has declined in recent decades. Multiple imputation is likely an appropriate method to handle missing follow-up data, enabling researchers to include all eligible individuals in the analysis.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102942"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-12DOI: 10.1016/j.canep.2025.102931
Ana Clara Cruz Santos de Santana , Ellen Sabrina Ramos Santos , Jefferson Felipe Calazans Batista , Alex Rodrigues Moura , Simone Soraia Silva Sardeiro , Brenda Evelin Barreto da Silva , Carlos Anselmo Lima
Background
Prostate cancer incidence and mortality exhibit regional variation often linked to disparities in healthcare access and disease management. This study aimed to analyze temporal trends and spatial distribution of prostate cancer incidence (1996–2017) and mortality (1996–2022) in Sergipe, Brazil, to support targeted cancer control strategies.
Methods
We analyzed prostate cancer data from the Aracaju Cancer Registry and the Mortality Information System. Age-standardized incidence and mortality rates were calculated using the World Standard Population. Joinpoint regression estimated Annual Percent Change (APC) and Average Annual Percent Change (AAPC) to assess trends. The Mortality-to-Incidence Ratio (MIR) and its complement (1–MIR) were used as proxies for survival. Spatial distribution was examined using Empirical Bayesian Kriging and local empirical Bayes smoothing in QGIS and TerraView.
Results
Between 1996 and 2017, 10,133 incident prostate cancer cases were recorded. Incidence increased until 2007 (APC=11.9 %; p < 0.001), then declined (APC=–2.0 %; p = 0.027, with peaks in men aged ≥55. Mortality increased from 1996 to 2007 (APC=12.2 %; p < 0.001) and subsequently stabilised between 2007 and 2022 (APC=–0.8 %; p = 0.228), resulting in an overall AAPC of 2.4 % (p = 0.002) for the entire study period. By age group, mortality rose among men ≥ 75 years (AAPC=3.2 %; p = 0.001) but declined in those aged 15–54 (AAPC=–2.4 %; p = 0.004). The MIR remained flat over time, but estimated survival dropped substantially among men aged ≥ 75 years, from 63 % to 38 %. Spatial analysis revealed higher incidence in central/coastal municipalities, while elevated mortality clustered in southern/coastal areas.
Conclusions
Despite improvements in incidence rates, prostate cancer remains a significant burden in Sergipe, with persistent regional disparities in outcomes. Spatial and temporal analyses highlight the need for targeted public health interventions to improve early detection and access to care, especially in areas of high social vulnerability and among older men.
{"title":"Temporal trends and spatial distribution of prostate cancer incidence and mortality in a northeastern Brazilian state","authors":"Ana Clara Cruz Santos de Santana , Ellen Sabrina Ramos Santos , Jefferson Felipe Calazans Batista , Alex Rodrigues Moura , Simone Soraia Silva Sardeiro , Brenda Evelin Barreto da Silva , Carlos Anselmo Lima","doi":"10.1016/j.canep.2025.102931","DOIUrl":"10.1016/j.canep.2025.102931","url":null,"abstract":"<div><h3>Background</h3><div>Prostate cancer incidence and mortality exhibit regional variation often linked to disparities in healthcare access and disease management. This study aimed to analyze temporal trends and spatial distribution of prostate cancer incidence (1996–2017) and mortality (1996–2022) in Sergipe, Brazil, to support targeted cancer control strategies.</div></div><div><h3>Methods</h3><div>We analyzed prostate cancer data from the Aracaju Cancer Registry and the Mortality Information System. Age-standardized incidence and mortality rates were calculated using the World Standard Population. Joinpoint regression estimated Annual Percent Change (APC) and Average Annual Percent Change (AAPC) to assess trends. The Mortality-to-Incidence Ratio (MIR) and its complement (1–MIR) were used as proxies for survival. Spatial distribution was examined using Empirical Bayesian Kriging and local empirical Bayes smoothing in QGIS and TerraView.</div></div><div><h3>Results</h3><div>Between 1996 and 2017, 10,133 incident prostate cancer cases were recorded. Incidence increased until 2007 (APC=11.9 %; p < 0.001), then declined (APC=–2.0 %; p = 0.027, with peaks in men aged ≥55. Mortality increased from 1996 to 2007 (APC=12.2 %; p < 0.001) and subsequently stabilised between 2007 and 2022 (APC=–0.8 %; p = 0.228), resulting in an overall AAPC of 2.4 % (p = 0.002) for the entire study period. By age group, mortality rose among men ≥ 75 years (AAPC=3.2 %; p = 0.001) but declined in those aged 15–54 (AAPC=–2.4 %; p = 0.004). The MIR remained flat over time, but estimated survival dropped substantially among men aged ≥ 75 years, from 63 % to 38 %. Spatial analysis revealed higher incidence in central/coastal municipalities, while elevated mortality clustered in southern/coastal areas.</div></div><div><h3>Conclusions</h3><div>Despite improvements in incidence rates, prostate cancer remains a significant burden in Sergipe, with persistent regional disparities in outcomes. Spatial and temporal analyses highlight the need for targeted public health interventions to improve early detection and access to care, especially in areas of high social vulnerability and among older men.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102931"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-11DOI: 10.1016/j.canep.2025.102940
Danny Styvens Cardona , Juan Pablo Valencia-Arango , Juan Pablo Gallo , Catalina Andrea Bustamante , Richard Orlando Salazar , Carlos Andrés Carmona , Melisa Naranjo Vanegas , Carolina Jaramillo Jaramillo , Juliana Espinosa Moncada , Harvy Mauricio Velasco , Natalia Gallego Lopera
Introduction
The global impact of cancer, driven by both acquired and hereditary mutations, underscores the necessity for extensive research efforts. Despite the increasing volume of genetic data, significant gaps remain in data science research, particularly in Latinos and admixed populations. This study utilizes advanced data science techniques to integrate genetic and clinical data, aiming to improve the understanding of hereditary cancer in Colombia and demonstrating the transformative potential of data-driven approaches in cancer research.
Methods
This observational study analyzed healthcare databases from four regions and 11 cities in Colombia. Genetic data were extracted from PDF reports within SURA Colombia's Electronic Health Records (a Latin American health insurance provider) for individuals referred for hereditary cancer testing between October 2019 and November 2021. Variants in 30 genes, aligned with NCCN guidelines, were examined using Next-Generation Sequencing (NGS). Data extraction was automated using Python and R, followed by integration and analysis of genetic, clinical, and sociodemographic data using advanced data science tools hosted on Azure infrastructure. These tools enabled predictive modeling and cross-referencing to explore correlations between genetic variants and clinical outcomes.
Results
The study included 1377 patients, with a predominance of women (92.81 %) and 63 % from the northwestern region of Colombia. The largest age group (40.37 %) was between 31 and 44 years, and 95.35 % had a personal cancer history, primarily breast cancer (75.86 %). Hereditary cancer testing revealed 145 positive results and 587 uncertain outcomes. Data science-driven analysis identified higher positivity rates in patients aged 31–44 and over 50, particularly in the northeast and central regions. Among positive results, 42.6 % included variants of uncertain significance, with 95.9 % of these patients having a personal cancer history.
Conclusion
This study highlights the significant role of data science in analyzing hereditary cancer data. Advanced computational techniques can aid in genetic variant reclassification, uncover patterns in underrepresented populations, and inform personalized interventions for hereditary cancer management in Latin America.
{"title":"Bridging data gaps: Methodological advances in extracting and analyzing genetic information from unstructured clinical records in hereditary cancer","authors":"Danny Styvens Cardona , Juan Pablo Valencia-Arango , Juan Pablo Gallo , Catalina Andrea Bustamante , Richard Orlando Salazar , Carlos Andrés Carmona , Melisa Naranjo Vanegas , Carolina Jaramillo Jaramillo , Juliana Espinosa Moncada , Harvy Mauricio Velasco , Natalia Gallego Lopera","doi":"10.1016/j.canep.2025.102940","DOIUrl":"10.1016/j.canep.2025.102940","url":null,"abstract":"<div><h3>Introduction</h3><div>The global impact of cancer, driven by both acquired and hereditary mutations, underscores the necessity for extensive research efforts. Despite the increasing volume of genetic data, significant gaps remain in data science research, particularly in Latinos and admixed populations. This study utilizes advanced data science techniques to integrate genetic and clinical data, aiming to improve the understanding of hereditary cancer in Colombia and demonstrating the transformative potential of data-driven approaches in cancer research.</div></div><div><h3>Methods</h3><div>This observational study analyzed healthcare databases from four regions and 11 cities in Colombia. Genetic data were extracted from PDF reports within SURA Colombia's Electronic Health Records (a Latin American health insurance provider) for individuals referred for hereditary cancer testing between October 2019 and November 2021. Variants in 30 genes, aligned with NCCN guidelines, were examined using Next-Generation Sequencing (NGS). Data extraction was automated using Python and R, followed by integration and analysis of genetic, clinical, and sociodemographic data using advanced data science tools hosted on Azure infrastructure. These tools enabled predictive modeling and cross-referencing to explore correlations between genetic variants and clinical outcomes.</div></div><div><h3>Results</h3><div>The study included 1377 patients, with a predominance of women (92.81 %) and 63 % from the northwestern region of Colombia. The largest age group (40.37 %) was between 31 and 44 years, and 95.35 % had a personal cancer history, primarily breast cancer (75.86 %). Hereditary cancer testing revealed 145 positive results and 587 uncertain outcomes. Data science-driven analysis identified higher positivity rates in patients aged 31–44 and over 50, particularly in the northeast and central regions. Among positive results, 42.6 % included variants of uncertain significance, with 95.9 % of these patients having a personal cancer history.</div></div><div><h3>Conclusion</h3><div>This study highlights the significant role of data science in analyzing hereditary cancer data. Advanced computational techniques can aid in genetic variant reclassification, uncover patterns in underrepresented populations, and inform personalized interventions for hereditary cancer management in Latin America.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102940"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite global recommendations favoring breast-conserving surgery (BCS) with radiotherapy for early-stage breast cancer, there is limited long-term evidence on surgical trends and survival outcomes in low- and middle-income countries such as Iran. Understanding these patterns is crucial to improving treatment equity and patient outcomes. This study aimed to evaluate two-decade trends in surgical approach selection for breast cancer and to compare survival outcomes between BCS and mastectomy in Fars province, Iran.
Methods
Data from 10,091 women diagnosed with breast cancer between 2000 and 2022 were extracted from the Shiraz Breast Cancer Registry. Patients were categorized into four groups based on type of surgery (BCS or mastectomy) and receipt of radiotherapy. Logistic regression was used to identify factors influencing treatment selection. Survival and recurrence were analyzed using Kaplan-Meier and factors affecting survival were evaluated using the Cox regression model.
Results
Between 2000 and 2022, the proportion of patients undergoing BCS plus radiotherapy increased from 30.5 % to 73.8 %, surpassing mastectomy. The BCS plus radiotherapy group showed the most favorable outcomes, with the lowest breast cancer-specific mortality (6.2 %), recurrence rate (10.2 %), and the highest 10-year BCSS (96.01 %). These associations remained significant after multivariable adjustment.
Conclusion
This study reveals a significant shift toward BCS plus radiotherapy in southern Iran over the past two decades. BCS with radiotherapy is associated with superior survival outcomes compared to mastectomy. However, access barriers continue to prevent many women from receiving the optimal surgical approach, indicating the need for policy and health system interventions.
{"title":"10 Years of breast cancer treatment trends in Fars Province, report of Shiraz Breast Cancer Registry","authors":"Majid Akrami , Amirhesam Moosazadeh , Mehrdad Taghva , Nastaran Tavakolian , Marzieh Karami Rad , Zahra Keumarsi , Masoumeh Ghoddusi Johari , Vahid Zangouri","doi":"10.1016/j.canep.2025.102937","DOIUrl":"10.1016/j.canep.2025.102937","url":null,"abstract":"<div><h3>Background</h3><div>Despite global recommendations favoring breast-conserving surgery (BCS) with radiotherapy for early-stage breast cancer, there is limited long-term evidence on surgical trends and survival outcomes in low- and middle-income countries such as Iran. Understanding these patterns is crucial to improving treatment equity and patient outcomes. This study aimed to evaluate two-decade trends in surgical approach selection for breast cancer and to compare survival outcomes between BCS and mastectomy in Fars province, Iran.</div></div><div><h3>Methods</h3><div>Data from 10,091 women diagnosed with breast cancer between 2000 and 2022 were extracted from the Shiraz Breast Cancer Registry. Patients were categorized into four groups based on type of surgery (BCS or mastectomy) and receipt of radiotherapy. Logistic regression was used to identify factors influencing treatment selection. Survival and recurrence were analyzed using Kaplan-Meier and factors affecting survival were evaluated using the Cox regression model.</div></div><div><h3>Results</h3><div>Between 2000 and 2022, the proportion of patients undergoing BCS plus radiotherapy increased from 30.5 % to 73.8 %, surpassing mastectomy. The BCS plus radiotherapy group showed the most favorable outcomes, with the lowest breast cancer-specific mortality (6.2 %), recurrence rate (10.2 %), and the highest 10-year BCSS (96.01 %). These associations remained significant after multivariable adjustment.</div></div><div><h3>Conclusion</h3><div>This study reveals a significant shift toward BCS plus radiotherapy in southern Iran over the past two decades. BCS with radiotherapy is associated with superior survival outcomes compared to mastectomy. However, access barriers continue to prevent many women from receiving the optimal surgical approach, indicating the need for policy and health system interventions.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102937"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-11DOI: 10.1016/j.canep.2025.102929
Kuan-Fu Liao, Shih-Wei Lai
{"title":"Aspirin use associated with a decreased risk of gastric cancer","authors":"Kuan-Fu Liao, Shih-Wei Lai","doi":"10.1016/j.canep.2025.102929","DOIUrl":"10.1016/j.canep.2025.102929","url":null,"abstract":"","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102929"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-31DOI: 10.1016/j.canep.2025.102954
Lena Friederike Kopplin, Isabelle Kaiser
The number of melanoma cases has been rising over the past decades. Hence, screening is essential to provide early and effective patient management. However, screening for risk factors binds medical resources and may be conducted by patients. To evaluate the quality and validity of such a self-assessment, a systematic review of patient-expert agreement in dermatologic examinations is presented. A systematic review of studies examining participant-expert agreement on melanoma risk factors that were published until May 2025 was conducted. Included sources were retrieved from PubMed, the Web of Science Core Collection, and Scopus. Publications in languages other than English were excluded from the analysis. Of the 3562 records identified, 29 were eligible for evaluation. Six melanoma risk factors dominated the results: Typical and atypical nevi, skin phototype, freckles, hair and eye color., with typical nevi being the most frequently assessed risk factor (22 studies). Agreement is highly heterogeneous, ranging from predominantly weaker to scarcely reported substantial agreement, casting doubts on whether individuals should be tasked with self-assessment. Individual self-assessment may currently serve as a first indication of elevated melanoma risk but cannot substitute for dermatologic screening.
在过去的几十年里,黑色素瘤病例的数量一直在上升。因此,筛查对于提供早期和有效的患者管理至关重要。然而,筛查危险因素限制了医疗资源,可能由患者进行。为了评估这种自我评估的质量和有效性,提出了皮肤病检查中患者-专家协议的系统综述。对截至2025年5月发表的关于黑色素瘤风险因素的参与者-专家共识的研究进行了系统回顾。纳入的来源检索自PubMed、Web of Science Core Collection和Scopus。以英文以外语文出版的出版物不包括在分析之内。在确定的3562个记录中,有29个有资格进行评估。结果显示,6个黑色素瘤风险因素占主导地位:典型和非典型痣、皮肤光型、雀斑、头发和眼睛颜色。典型痣是最常被评估的风险因素(22项研究)。共识是高度异质的,从明显较弱到几乎没有报道的实质性共识,这让人怀疑个人是否应该承担自我评估的任务。个体自我评估目前可以作为黑色素瘤风险升高的第一个指标,但不能代替皮肤科筛查。
{"title":"Self-assessment of melanoma risk factors versus expert assessment: A systematic review of agreement","authors":"Lena Friederike Kopplin, Isabelle Kaiser","doi":"10.1016/j.canep.2025.102954","DOIUrl":"10.1016/j.canep.2025.102954","url":null,"abstract":"<div><div>The number of melanoma cases has been rising over the past decades. Hence, screening is essential to provide early and effective patient management. However, screening for risk factors binds medical resources and may be conducted by patients. To evaluate the quality and validity of such a self-assessment, a systematic review of patient-expert agreement in dermatologic examinations is presented. A systematic review of studies examining participant-expert agreement on melanoma risk factors that were published until May 2025 was conducted. Included sources were retrieved from PubMed, the Web of Science Core Collection, and Scopus. Publications in languages other than English were excluded from the analysis. Of the 3562 records identified, 29 were eligible for evaluation. Six melanoma risk factors dominated the results: Typical and atypical nevi, skin phototype, freckles, hair and eye color., with typical nevi being the most frequently assessed risk factor (22 studies). Agreement is highly heterogeneous, ranging from predominantly weaker to scarcely reported substantial agreement, casting doubts on whether individuals should be tasked with self-assessment. Individual self-assessment may currently serve as a first indication of elevated melanoma risk but cannot substitute for dermatologic screening.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102954"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-29DOI: 10.1016/j.canep.2025.102928
Shan Zhang , Hongwei Wang , Jingjing Ji, Ruiyu Chai, Shiyi Song, Jikang Shi, Siyu Liu
This document is the authors' response to the received comments for manuscript CANEP-D-25–00912.
本文是作者对CANEP-D-25-00912稿件评论的回复。
{"title":"Response to ‘reverse causality’ comment","authors":"Shan Zhang , Hongwei Wang , Jingjing Ji, Ruiyu Chai, Shiyi Song, Jikang Shi, Siyu Liu","doi":"10.1016/j.canep.2025.102928","DOIUrl":"10.1016/j.canep.2025.102928","url":null,"abstract":"<div><div>This document is the authors' response to the received comments for manuscript CANEP-D-25–00912.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102928"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Occupational benzene exposure is a known carcinogen; however, the dose-response relationship with cancers of the nervous system, particularly glioma, requires clarification. Based on the systematic review by Mangiaterra et al., this paper conducted a secondary analysis of the results and utilized original supplementary data to assess risk ratios (RRs) for high, medium, and low benzene exposure levels. This aimed to evaluate both linear and non-linear dose-response relationships. We observed a significantly increased risk for nervous system cancers only at high exposure levels. Risks associated with moderate and low exposure levels showed no significant increase. Both dose-response curves indicated no clear upward trend with increasing exposure. Limitations include the frequent lack of confounder adjustment in source estimates, potential publication bias, and limited original data, all of which impact the heterogeneity and accuracy of the findings. While high-concentration benzene exposure may pose a risk for nervous system cancers and potentially exhibit dose-dependency, these limitations constrain the robustness of the dose-response assessment. Future research should validate this association using high-quality, multi-level exposure data with adequate confounder adjustment. Such studies are crucial to provide a scientific basis for occupational health protection measures.
{"title":"Further dose-response association exploration could enhance the causal inference between benzene exposure and risk of nervous system cancers","authors":"Yachen Liang, Jingya Chen, Tianyou Chen, Xiao Li, Junjie Fang, Lefu Wu","doi":"10.1016/j.canep.2025.102892","DOIUrl":"10.1016/j.canep.2025.102892","url":null,"abstract":"<div><div>Occupational benzene exposure is a known carcinogen; however, the dose-response relationship with cancers of the nervous system, particularly glioma, requires clarification. Based on the systematic review by Mangiaterra et al., this paper conducted a secondary analysis of the results and utilized original supplementary data to assess risk ratios (RRs) for high, medium, and low benzene exposure levels. This aimed to evaluate both linear and non-linear dose-response relationships. We observed a significantly increased risk for nervous system cancers only at high exposure levels. Risks associated with moderate and low exposure levels showed no significant increase. Both dose-response curves indicated no clear upward trend with increasing exposure. Limitations include the frequent lack of confounder adjustment in source estimates, potential publication bias, and limited original data, all of which impact the heterogeneity and accuracy of the findings. While high-concentration benzene exposure may pose a risk for nervous system cancers and potentially exhibit dose-dependency, these limitations constrain the robustness of the dose-response assessment. Future research should validate this association using high-quality, multi-level exposure data with adequate confounder adjustment. Such studies are crucial to provide a scientific basis for occupational health protection measures.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102892"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}