Cancer Epidemiology最新文献

Background

Tobacco smoking is still frequent in Italy and a major cause of cancer globally. We estimated the burden of smoking-related cancer in Italy.

Methods

To calculate the population attributable fraction (PAF), we adopted a counterfactual scenario for which all individuals never smoked. The PAF of current and former smoking and second-hand smoke (SHS) was estimated for cancers associated with these habits according to the International Agency for Research on Cancer. Relative risk estimates and prevalence of exposure were derived from large-scale studies and national surveys, respectively. A 20-year latency period between exposure and cancer was considered. Cancer incidence data for 2020 and mortality data for 2017 were obtained from the Italian Association of Cancer Registries.

Results

Tobacco smoking caused, in men and women respectively, 90.0 % and 58.3 % of lung; 67.8 % and 53.5 % of pharyngeal; 47.0 % and 32.2 % of bladder; 45.9 % and 31.7 % of oral; 36.6 % and 23.6 % of esophageal; 23.0 % and 14.0 % of pancreatic cancer and lower percentages of cancers at other sites. Tobacco smoking accounted for 23.9 % and 7.7 % of new cancer cases in 2020, and 32.1 % and 11.3 % of cancer deaths in 2017 in men and women, respectively, corresponding to 17.3 % of cases and 24.5 % of cancer deaths overall. The PAF of lung cancer due to SHS in never smoking women married with smokers was 13.0 %.

Conclusions

Tobacco smoking is a primary cause of cancer in Italy in both sexes. Tobacco control policies are warranted.

Background

Breast cancer is the most common cancer diagnosed among women globally and in the United States (US); however, its incidence in the six US-Affiliated Pacific Islands (USAPI) remains less characterized.

Methods

We analyzed data from a population-based cancer registry using different population estimates to calculate incidence rates for breast cancer among women aged >20 years in the USAPI. Rate ratios and 95 % confidence intervals (CI) were calculated to compare incidence rates between the USAPI and the US (50 states and the District of Columbia).

Results

From 2007–2020, 1118 new cases of breast cancer were diagnosed in the USAPI, with 66.3 % (n = 741) of cases reported in Guam. Age-standardized incidence rates ranged from 66.4 to 68.7 per 100,000 women in USAPI and 101.1–110.5 per 100,000 women in Guam. Compared to the US, incidence rates were lower in USAPI, with rate ratios ranging from 0.38 (95 % CI: 0.36, 0.40) to 0.39 (95 % CI: 0.37, 0.42). The proportion of late-stage cancer was significantly higher in the USAPI (48.7 %) than in the US (34.0 %), particularly in the Federated States of Micronesia (78.7 %) and Palau (73.1 %).

Conclusions

Breast cancer incidence rates were lower in the USAPI than in the US; however, late-stage diagnoses were disproportionately higher. Low incidence and late-stage cancers may signal challenges in screening, cancer surveillance, and health care access and resources. Expanding access to timely breast cancer screening, diagnosis, and treatment could reduce the proportion of late-stage cancers and improve survival in the USAPI.

Background

Hepatocellular carcinoma accounts for approximately 80 % of liver neoplasms. Globally, hepatocellular carcinoma ranks as the third most lethal cancer, with the number of deaths expected to further increase by 2040. In adults, disparities in incidence and survival are well described while pediatric epidemiology is not well characterized. We describe incidence and survival for pediatric (ages 0–19 years) hepatocellular carcinoma cases and compare these measures to adults (ages ≥ 20 years) diagnosed with hepatocellular carcinoma.

Methods

We assessed incidence data from the US Cancer Statistics database during 2003–2020 and 5-year survival from the National Program of Cancer Registries during 2001–2019. Incidence trends were determined by annual percent change (APC) and average APC (AAPC) using joinpoint regression. Five-year survival was evaluated by relative survival, and all-cause survival was estimated using multivariate Cox modeling. Corresponding 95 % confidence intervals (CI) were calculated for all analyses.

Results

Incidence rate per 100,000 persons was 0.056 (95 %CI:0.052–0.060) for pediatric cases and 7.793 (7.767–7.819) for adults. Incidence was stable in the pediatric population (0.3 AAPC, − 1.1 to 1.7). In contrast, after periods of increase, incidence declined in adults after 2015 (-1.5 APC). Relative survival increased over time for both pediatric and adult ages and was higher for children and adolescents (46.4 %, 95 %CI:42.4–50.3) than adults (20.7 %, 95 %CI:20.5–20.9). Regression modeling showed that non-Hispanic Black race and ethnicity was associated with higher risk of death in children and adolescents (1.48, 95 %CI:1.07–2.05) and adults (1.11, 95 %CI:1.09–1.12) compared to non-Hispanic white race and ethnicity.

Conclusions

Between 2003 and 2020 in the United States, pediatric incidence was stable while incidence in adults began to decline after 2015. Survival was higher across all stages for children and adolescents compared to adults. Non-Hispanic Black race and ethnicity showed a higher risk of death for both age groups. Further studies could explore the factors that influence these outcome disparities.

“Very hot beverage” (>65°C) consumption is an IARC probable carcinogen and may contribute to the African esophageal cancer burden. We conducted community cross-sectional exposure studies of hot beverage consumption in Kenya and Malawi during 2018–2019, aiming to: (i) implement a detailed measurement protocol incorporating three measurements of sip temperature and volume so as to predict each sip’s intra-esophageal liquid temperature (IELT); (ii) examine variations by seasonality, drinking venue and age, including children. 246 participants were included, of whom 236 had drink measurements (52 children and 183 adults). Among adults, mean (SD) temperatures at first sip were 67 (9) and 68 (7) °C in Kenya and Malawi respectively, i.e. 58 and almost 70 % of first sips were > 65 °C. In both countries, adults exhibited a protective habit of smaller sips at higher temperatures (mean 11 mL at first sip), whereas the larger middle sip (20 mL) had the highest IELT (45 °C). The highest temperatures were observed in men and for drinks taken in social settings, whereas we did not detect seasonality or associations with other esophageal cancer risk factors. Measurements were difficult to make for 20 % (8/43) of Kenyan children whose drink was cooled by pouring between cups (‘poesha’). Where poesha was not practiced, IELTs were lower in children (especially < 10 years) than in adults, owing to a mean of 8 °C cooler first sip temperature, however 20 % of first sips were > 65 °C. If very hot beverage consumption is an esophageal carcinogen, lowering sip temperatures and volumes in East Africa would form important prevention avenues.

Background

Despite their frequency and potential impact on prognosis, cancers diagnosed via self-referral to the emergency department are poorly documented. We conducted a detailed analysis of cancer patients diagnosed following emergency self-referral and compared them with those diagnosed following emergency referral from primary care. Given the challenges associated with measuring intervals in the emergency self-referral pathway, we also aimed to provide a definition of the diagnostic interval for these cancers.

Methods

A retrospective observational analysis was performed on patients diagnosed with 13 cancers, either following emergency self-referral or emergency referral from primary care. We analysed demographics, tumour stage, clinical data (including 28 presenting symptoms categorised by body systems), and diagnostic intervals by cancer site, then testing for differences between pathways.

Results

Out of 3624 patients, 37 % were diagnosed following emergency self-referral and 63 % via emergency referral from primary care. Emergency self-referrals were associated with a higher likelihood of being diagnosed with cancers manifesting with localising symptoms (e.g., breast and endometrial cancer), whereas the likelihood of being diagnosed with cancers featuring nonspecific symptoms and abdominal pain (e.g., pancreatic and ovarian cancer) was higher among patients referred from primary care. Diagnostic intervals in self-referred patients were half as long as those in patients referred from primary care, with most significant differences for pancreatic cancer (28 [95 % CI −34 to −23] days shorter, respectively).

Conclusion

These findings enrich the best available evidence on cancer diagnosis through emergency self-referral and showed that, compared with the emergency referral pathway from primary care, these patients had a significantly increased likelihood of presenting with symptoms that are strongly predictive of cancer. Since the starting point for the diagnostic interval in these patients is their emergency presentation, comparing it with that of those referred from primary care as an emergency is likely to result in biased data.

Background

Air pollution has been classified as a human carcinogen based largely on findings for respiratory cancers. Emerging, but limited, evidence suggests that it increases the risk of breast cancer, particularly among younger women. We characterized associations between residential exposure to ambient fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) and breast cancer. Analyses were performed using data collected in the Ontario Environmental Health Study (OEHS).

Methods

The OEHS, a population-based case-control study, identified incident cases of breast cancer in Ontario, Canada among women aged 18–45 between 2013 and 2015. A total of 465 pathologically confirmed primary breast cancer cases were identified from the Ontario Cancer Registry, while 242 population-based controls were recruited using random-digit dialing. Self-reported questionnaires were used to collect risk factor data and residential histories. Land-use regression and remote-sensing estimates of NO₂ and PM_2.5, respectively, were assigned to the residential addresses at interview, five years earlier, and at menarche. Logistic regression was used to estimate odds ratios (OR) and their 95 % confidence intervals (CI) in relation to an interquartile range (IQR) increase in air pollution, adjusting for possible confounders.

Results

PM_2.5 and NO₂ were positively correlated with each other (r = 0.57). An IQR increase of PM_2.5 (1.9 µg/m³) and NO₂ (6.6 ppb) at interview residence were associated with higher odds of breast cancer and the adjusted ORs and 95 % CIs were 1.37 (95 % CI = 0.98–1.91) and 2.33 (95 % CI = 1.53–3.53), respectively. An increased odds of breast cancer was observed with an IQR increase in NO₂ at residence five years earlier (OR = 2.16, 95 % CI: 1.41–3.31), while no association was observed with PM_2.5 (OR = 0.96, 95 % CI 0.64–1.42).

Conclusions

Our findings support the hypothesis that exposure to ambient air pollution, especially those from traffic sources (i.e., NO₂), increases the risk of breast cancer in young women.

Background

Predictive modelling using pre-epidemic data have long been used to guide public health responses to communicable disease outbreaks and other health disruptions. In this study, cancer registry and related health data available 2–3 months from diagnosis were used to predict changes in cancer detection that otherwise would not have been identified until full registry processing was completed about 18–24 months later. A key question was whether these earlier data could be used to predict cancer incidence ahead of full processing by the cancer registry as a guide to more timely health responses. The setting was the Australian State of New South Wales, covering 31 % of the Australian population. The study year was 2020, the year of emergence of the COVID-19 pandemic.

Methods

Cancer detection in 2020 was modelled using data available 2–3 months after diagnosis. This was compared with data from full registry processing available from 2022. Data from pre-pandemic 2018 were used for exploratory model building. Models were tested using pre-pandemic 2019 data. Candidate predictor variables included pathology, surgery and radiation therapy reports, numbers of breast screens, colonoscopies, PSA tests, and melanoma excisions recorded by the universal Medical Benefits Schedule (MBS). Data were analysed for all cancers collectively and 5 leading types.

Results

Compared with full registry processing, modelled data for 2020 had a >95 % accuracy overall, indicating key points of inflexion of cancer detection over the COVID-disrupted 2020 period. These findings highlight the potential of predictive modelling of cancer-related data soon after diagnosis to reveal changes in cancer detection during epidemics and other health disruptions.

Conclusions

Data available 2–3 months from diagnosis in the pandemic year indicated changes in cancer detection that were ultimately confirmed by fully-processed cancer registry data about 24 months later. This indicates the potential utility of using these early data in an early-warning system.

Background

COVID-19 disrupted consulting behaviour, healthcare delivery and cancer diagnostic services. This study quantifies the cancer incidence coded in UK general practice electronic health records and deviations from historical trends after the March 2020 national lockdown. For comparison, we study the coded incidence of type-2 diabetes mellitus, which is diagnosed almost entirely within primary care.

Methods

Poisson interrupted time series models investigated the coded incidence of diagnoses in adults aged ≥ 18 years in the Clinical Practice Research Datalink before (01/03/2017–29/02/2020) and after (01/03/2020–28/02/2022) the first lockdown. Datasets were stratified by age, sex, and general practice per 28-day aggregation period. Models captured incidence changes associated with lockdown, both immediately and over time based on historical trends.

Results

We studied 189,457 incident cancer and 191,915 incident diabetes records in 1480 general practices over 52,374,197 person-years at risk. During 01/03/2020–28/02/2022, there were fewer incident records of cancer (n = 22,199, 10.49 %, 10.44–10.53 %) and diabetes (n = 15,709, 7.57 %, 7.53–7.61 %) than expected. Within cancers, impacts ranged from no effect (e.g. unknown primary, pancreas, and ovary), to small effects for lung (n = 773, 3.11 %, 3.09–3.13 % fewer records) and female breast (n = 2686, 6.77 %, 6.73–6.81 %), to the greatest effect for bladder (n = 2874, 31.15 %, 31.00–31.31 %). Diabetes and cancer records recovered maximally to 86 % (95 %CI 80.3–92.7 %) and 74 % (95 %CI 70.3–78.6 %) in July 2021 and May 2021, respectively, of their expected values, declining again until the study end.

Conclusion

The “missing” cancer and diabetes diagnoses in primary care may comprise delayed or missed diagnoses, reduced incidence associated with excess deaths from COVID-19, and potentially increased non-coded recording of diagnoses. Future validation studies must quantify the concordance between primary care and National Cancer Registration Data and Hospital Episode Statistics over the pandemic era.

Introduction

Data on social inequalities in cancer mortality are sparse, especially in low- and middle-income countries. We aimed to analyze the socioeconomic inequalities in cancer mortality in Costa Rica between 2010 and 2018.

Methods

We linked 9-years of data from the National Electoral Rolls, National Birth Index and National Death Index to classify deaths due to cancer and socioeconomic characteristics of the district of residence, as measured by levels of urbanicity and wealth. We analyzed the fifteen most frequent cancer sites in Costa Rica among the 2.7 million inhabitants aged 20 years and older. We used a parametric survival model based on a Gompertz distribution.

Results

Compared to urban areas, mixed and rural area residents had lower mortality from pancreas, lung, breast, prostate, kidney, and bladder cancers, and higher mortality from stomach cancer. Mortality from stomach, lung and cervical cancer was higher, and mortality from colorectal cancer, non-Hodgkin lymphoma and leukemia was lower in the most disadvantaged districts, compared to the wealthiest ones.

Conclusion

We observed marked disparities in cancer mortality in Costa Rica in particular from infection- and lifestyle- related cancers. There are important opportunities to reduce disparities in cancer mortality by targeting cancer prevention, early detection and opportune treatment, mainly in urban and disadvantaged districts.

Background

Oral cavity cancers (OCCs) are the sixth most prevalent cancers in the world. There are strong evidences showing the risk of the cigarette smoking, alcohol use, poor oral hygiene and some types of diets in OCCs; however, few studies explored the relationship between opium and its derivatives (O&D) use and OCCs incidence. The aim of this study was to investigate the relationship between consumption of O&D and the incidence of OCCs.

Methods

In a case-control; 133 patients with OCCs and 266 healthy controls matched by age, sex, and place of residence were included. Data, including cigarette smoking, O&D, alcohol and others tobacco (Nass, pipe and hookah) use and diet, were collected using a structured questionnaire. The relation between the use of O&D and OCCs was evaluated using conditional logistic regression.

Results

Opium ever-use was associated with an increased risk of OCCs (Adjusted Odds Ratio (AOR) =2.36, 95 % CI: 1.16–4.78). A dose-response relation was observed between the amount of daily O&D use and OCCs; and the relation was stronger in high users (AOR for low users = 1.38, 95 %CI: 0.58–3.24 and AOR for high users = 4.85, 95 % CI:1.79–13.11). Those who used opium for more than 18 years were highly at risk of OCCs (AOR= 5.04, 95 % CI, 2.00–12.68). Also, OCCs was higher among subjects starting the use of O&D at younger ages (≤ 50 years old vs never users AOR = 3.32, 95 % CI: 1.19–9.23). The smoking method of consuming O&D increased the odds of getting OCCs more than twice (AOR= 2.02, 95 % CI, 1.03–3.94), and using both smoking and oral consumption simultaneously, increased the odds of getting OCCs more than 8 times (AOR= 8.57, 95 % CI, 1.68–43.70). Also, the use of other tobacco products (Nass, pipe and hookah) increases the odds of getting OCCs by 4 times (AOR= 3.90, 95 % CI, 1.12–13.57)

Conclusions

The results showed that opium use is probably a dose related risk factor for oral cavity cancers. Therefore, it is necessary to implement preventive policies to control the use of opioids.