37 research outputs found
Prostate cancer treatment in Europe at the end of 1990s
No full textBACKGROUND:
There is wide variation in prostate cancer incidence and survival across Europe. In many countries incidence is rising sharply in relation to the introduction of prostate-specific antigen assay, and there is concern that patients may not be treated appropriately. We therefore aimed to characterize treatment for prostate cancer across Europe.
METHODS:
We performed a high resolution population-based study, collecting information on the treatment of 3 486 prostate cancer cases diagnosed in 1995-1999 in 11 cancer registries from six European countries.
RESULTS:
Overall, about one in three patients received radical treatment (prostatectomy 23% or radiotherapy 14%); about 60% of younger patients (<70 years) received radical treatment, while a similar proportion of older patients (> or =70 years) received palliation (transurethral prostatectomy or hormone treatment only). A considerable proportion (61%) of patients with apparently high-risk disease were treated radically within a year of diagnosis, with large variation between regions: >70% in Calvados, Haut-Rhin, Tarn and Eindhoven and <50% in Slovakia and Cracow. Overall 34% of patients with apparently low-risk disease received radical treatment, varying from 17% and 22% in Bas-Rhin and Granada, to 52% and 56% in Calvados and Eindhoven.
CONCLUSIONS:
Our data indicate wide variation in the treatment for prostate cancer even among patients with apparently similar disease, and further suggest a non-negligible proportion may be receiving inappropriate radical treatment for apparently low-risk disease. Current guidelines indicate active surveillance should become the main means of managing low-risk disease
Describing the association between socioeconomic inequalities and cancer survival: methodological guidelines and illustration with population-based data
No full textAurélien Belot,1-3 Laurent Remontet,3,4 Bernard Rachet,1 Olivier Dejardin,5,6 Hadrien Charvat,7 Simona Bara,8 Anne-Valérie Guizard,5,9 Laurent Roche,3,4 Guy Launoy,5,6 Nadine Bossard3,4 1Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; 2Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France; 3Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France; 4UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France; 5National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France; 6Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France; 7Prevention Division, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; 8Manche General Cancer Registry, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France; 9Calvados General Cancer Registry, Centre François Baclesse, Caen, France Background: Describing the relationship between socioeconomic inequalities and cancer survival is important but methodologically challenging. We propose guidelines for addressing these challenges and illustrate their implementation on French population-based data. Methods: We analyzed 17 cancers. Socioeconomic deprivation was measured by an ecological measure, the European Deprivation Index (EDI). The Excess Mortality Hazard (EMH), ie, the mortality hazard among cancer patients after accounting for other causes of death, was modeled using a flexible parametric model, allowing for nonlinear and/or time-dependent association between the EDI and the EMH. The model included a cluster-specific random effect to deal with the hierarchical structure of the data. Results: We reported the conventional age-standardized net survival (ASNS) and described the changes of the EMH over the time since diagnosis at different levels of deprivation. We illustrated nonlinear and/or time-dependent associations between the EDI and the EMH by plotting the excess hazard ratio according to EDI values at different times after diagnosis. The median excess hazard ratio quantified the general contextual effect. Lip–oral cavity–pharynx cancer in men showed the widest deprivation gap, with 5-year ASNS at 41% and 29% for deprivation quintiles 1 and 5, respectively, and we found a nonlinear association between the EDI and the EMH. The EDI accounted for a substantial part of the general contextual effect on the EMH. The association between the EDI and the EMH was time dependent in stomach and pancreas cancers in men and in cervix cancer. Conclusion: The methodological guidelines proved efficient in describing the way socioeconomic inequalities influence cancer survival. Their use would allow comparisons between different health care systems. Keywords: cancer net survival, socioeconomic inequalities, European Deprivation Index, excess mortality hazard, flexible parametric mode
Il trattamento delle metastasi epatiche da cancro del coloretto
No full textIl cancro del colon-retto (CRC) è il quarto cancro più comune in Occidente e la seconda causa più comune di mortalità per cancro dopo il tumore al polmone correlati in Europa e Nord America [1,2]. Nei pazienti con cancro del colon retto il fegato è il sito più comune di metastasi a diffusione ematogena. Oltre il 50% dei pazienti con CRC svilupperà metastasi al fegato durante la loro vita [2,3]. Un quarto dei pazienti con CRC primarie si trovano ad avere secondarismi epatici sincroni [4]. Quasi la metà dei pazienti sottoposti a resezione der CRC primitivo probabilmente svilupperà secondarismi epatici metacroni [5]. Metastasi epatiche sincrone si presentano nel 15% dei pazienti, mentre il rischi complessivo di sviluppare metastasi metacrone dopo la resezione della sede primaria è del 13%[1].Questo rischio incrementa a più del 30% in pazienti che presentano linfonodi mesenterici positivi( stadio III) [6].Al centro di ogni discussione di tecniche di resezione del fegato sono le questioni legate alle indicazioni e alla resecabilità. E 'chiaro per esperienza suffragata dalle prove sopra citata (Simmonds et al, 2006; Rees et al, 2008) [13,14]. che ottimi risultati possono essere ottenuti con la resezione del fegato utilizzando criteri altamente selettivi. Inoltre, le indicazioni sono cambiati notevolmente negli ultimi anni come è stato dimostrato che buoni risultati possono essere raggiunti con una chemioterapia efficace in pazienti precedentemente incurabili (Adam et al, 2009) [32]. Il ruolo della resezione epatica come un trattamento efficace per le metastasi epatiche colorettali è stata fondata nel 1988 dal Registro delle metastasi epatiche [9].Infatti la chirurgia laparoscopica del fegato ha impiegato molto tempo per ottenere popolarità nella comunità scientifica ed anche ora essa è limitata a pochi centri di eccellenza, dove è essenzialmente utilizzata per eseguire resezioni minori. Negli ultimi anni c'è stato un grande interesse nella chirurgia epatica laparoscopica o mininvasiv
Reliability of recording uterine cancer in death certification in France and age-specific proportions of deaths from cervix and corpus uteri.
No full textFrench uterine cancer recordings in death certificates include 60% of "uterine cancer, Not Otherwise Specified (NOS)"; this hampers the estimation of mortalities from cervix and corpus uteri cancers. The aims of this work were to study the reliability of uterine cancer recordings in death certificates using a case matching with cancer registries and estimate age-specific proportions of deaths from cervix and corpus uteri cancers among all uterine cancer deaths by a statistical approach that uses incidence and survival data. Deaths from uterine cancer between 1989 and 2001 were extracted from the French National database of causes of death and case-to-case matched to women diagnosed with uterine cancer between 1989 and 1997 in 8 cancer registries. Registry data were considered as "gold-standard". Among the 1825 matched deaths, cancer registries recorded 830 cervix and 995 corpus uteri cancers. In death certificates, 5% and 40% of "true" cervix cancers were respectively coded "corpus" and "uterus, NOS" and 5% and 59% of "true" corpus cancers respectively coded "cervix" and "uterus, NOS". Miscoding cervix cancers was more frequent at advanced ages at death and in deaths at home or in small urban areas. Miscoding corpus cancers was more frequent in deaths at home or in small urban areas. From the statistical method, the estimated proportion of deaths from cervix cancer among all uterine cancer deaths was higher than 95% in women aged 30-40 years old but declined to 35% in women older than 70 years. The study clarifies the reason for poor encoding of uterus cancer mortality and refines the estimation of mortalities from cervix and corpus uteri cancers allowing future studies on the efficacy of cervical cancer screening
Cancer incidence and mortality in France over the period 1980-2005.
No full textBACKGROUND: The objective of this study was to provide updated estimates of national trends in cancer incidence and mortality for France for 1980-2005. METHODS: Twenty-five cancer sites were analysed. Incidence data over the 1975-2003 period were collected from 17 registries working at the department level, covering 16% of the French population. Mortality data for 1975-2004 were provided by the Inserm. National incidence estimates were based on the use of mortality as a correlate of incidence, mortality being available at both department and national levels. Observed incidence and mortality data were modelled using an age-cohort approach, including an interaction term. Short-term predictions from that model gave estimates of new cancer cases and cancer deaths in 2005 for France. RESULTS: The number of new cancer cases in 2005 was approximately 320,000. This corresponds to an 89% increase since 1980. Demographic changes were responsible for almost half of that increase. The remainder was largely explained by increases in prostate cancer incidence in men and breast cancer incidence in women. The relative increase in the world age-standardised incidence rate was 39%. The number of deaths from cancer increased from 130,000 to 146,000. This 13% increase was much lower than anticipated on the basis of demographic changes (37%). The relative decrease in the age-standardised mortality rate was 22%. This decrease was steeper over the 2000-2005 period in both men and women. Alcohol-related cancer incidence and mortality continued to decrease in men. The increasing trend of lung cancer incidence and mortality among women continued; this cancer was the second cause of cancer death among women. Breast cancer incidence increased regularly, whereas mortality has decreased slowly since the end of the 1990s. CONCLUSION: This study confirmed the divergence of cancer incidence and mortality trends in France over the 1980-2005 period. This divergence can be explained by the combined effects of a decrease in the incidence of the most aggressive cancers and an increase in the incidence of less aggressive cancers, partly due to changes in medical practices leading to earlier diagnoses
Recent trends in incidence, geographical distribution, and survival of papillary thyroid cancer in France
No full textInternational audienc
[Epidemiology of oral cavity cancers in France].
No full textINTRODUCTION: We had for objective to describe the updated epidemiology of oral cancers in France. MATERIAL AND METHODS: Estimates made from data collected from various French cancer institutions. The distribution by topography, histology, regions, mean age, and specific incidence rates were calculated from the collected data. The survival data was taken from the Francim network studies. RESULTS: Approximately 7000 oral cavity cancers were diagnosed in France in 2005. In 2007, 1746 people died of that cancer. Standardized (world population) incidence rates are respectively, in men and women, 12.3 and 3.0 cases per 100,000 person-years. These cancers have significantly decreased in men: the standardized incidence rate decreased by 43.2% between 1980 and 2005. Among women, the trend is reversed with an increased incidence of 51.7% over the same period. CONCLUSION: In France, the incidence of oral cavity cancers has been strongly decreasing in men and strongly increasing in women. This trend should be compared to the frequency of the main risk factors: alcohol and tobacco
Incidence trends for potentially human papillomavirus-related and -unrelated head and neck cancers in France using population-based cancer registries data: 1980-2012.
No full text: Human papillomavirus (HPV) has been recently recognised as a carcinogenic factor for a subset of head and neck cancers (HNC). In Europe, France has one of the highest incidence rates of HNC. The aim of this study is to explore changes in HNC incidence in France, potentially in relation with infection by HPV. HNC were classified into two anatomical groups: potentially HPV-related and HPV-unrelated. Trends over the period 1980-2012 were analysed by an age-period-cohort model based on data from eleven French cancer registries. Among men, the age-standardised incidence rate (ASR) of HNC decreased in both groups, but less so for HPV-related sites as compared to unrelated sites, especially in recent years (annual percentage change [APC] over the period 2005-2012: -3.5% vs. -5.4%). Among women, the ASR increased in both groups, but more rapidly for HPV-related as compared to unrelated sites (APC over the period 2005-2012: +1.9% vs. -0.4%). This preferential growth of HPV-related versus unrelated HNC was observed in the cohorts born from 1930 to 1935. The differences in trends between possible HPV-related and HPV-unrelated sites suggest an increasing incidence of HNC due to HPV infection. The difference was less marked in men as compared to women, most likely because of a higher contamination in the HPV-related group by cancers due to tobacco or alcohol consumption. The pattern observed is consistent with observations made in other countries, with studies of HPV prevalence in HNC and the evolution of sexual behaviour in France.<br/
