Catherine S. Thomson

Sunbed use in children aged 11-17 in England: face to face quota sampling surveys in the National Prevalence Study and Six Cities Study

Objectives To quantify the use of sunbeds in young people across England, identify geographical variation, and explore patterns of use, including supervision. Design Two random location sampling surveys. Setting National Prevalence Study in England; Six Cities Study in Liverpool, Stoke/Stafford, Sunderland, Bath/Gloucester, Oxford/Cambridge, and Southampton. Participants 3101 children aged 11-17 in the National Prevalence study and 6209 in the Six Cities study. Results In the National Prevalence Study 6.0% (95% confidence interval 5.1% to 6.8%) of those aged 11-17 had used a sunbed. Use was higher in girls than in boys (8.6% (7.2% to 10.0%) v 3.5% (2.6% to 4.4%), respectively), in those aged 15-17 compared with those aged 11-14 (11.2% (9.5% to 12.9%) v 1.8% (1.2% to 2.4%), respectively), and in those from lower rather than higher social grades (7.6% (5.7% to 9.5%) v 5.4% (4.5% to 6.3%), respectively). Sunbed use was higher in the “north” (11.0%, 8.9% to 13.0%) than in the “midlands” (4.2%, 2.5% to 5.8%) and the “south” (4.2%, 3.3% to 5.2%). In the Six Cities Study, sunbed use was highest in Liverpool and Sunderland (20.0% (17.5% to 22.4%) and 18.0% (15.6% to 20.3%), respectively), with rates especially high in girls, those aged 15-17, or from lower social grades. Mean age of first use was 14, and 38.4% (34.7% to 42.1%) of children used a sunbed at least once a week. Nearly a quarter (23.0%, 19.8% to 26.1%) of children had used a sunbed at home (including home of friends/relatives), and 24.7% (21.0% to 28.4%) said they had used sunbeds unsupervised in a tanning/beauty salon or gym/leisure centre. Conclusions Sunbed use by children is widespread in England, is often inadequately supervised, and is a health risk. National legislation is needed to control sunbed outlets.

Colorectal cancer survival in the Nordic countries and the United Kingdom: excess mortality risk analysis of 5 year relative period survival in the period 1999 to 2000.

A deficit in colorectal cancer survival in Denmark and in the UK compared to Sweden, Norway and Finland was found in the EUROCARE studies. We set out to explore if these differences still exist. Patients diagnosed with colorectal cancer as their first invasive cancer at age 15–89 in the period 1994–2000 were identified using data from 11 cancer registries in the UK and from four Nordic countries. Five‐year relative period survival using deaths in 1999–2000 following cancers diagnosed in 1994–2000 was analysed with excess mortality risk modelling. Follow‐up time since diagnosis with age as an effect‐modifier in the first half year was the most important factor with the highest excess risk of death immediately after diagnosis and with higher age and decreasing with length of follow‐up. Variations between countries were bigger in the first half year following diagnosis than in the interval 0.5–5 years with about 30% higher risk in UK and Denmark. The differences between countries are still substantial and the order has not changed, even if the five year relative survival has improved since the EUROCARE studies. Patient management, diagnostics, and comorbidity likely explain the excess deaths in UK and Denmark during the first 6 months. The effect of stage and quality of management and treatment should be examined in population based studies with detailed patient information. Use of more detailed age‐intervals than conventionally applied in survival studies proved to be important in statistical modelling and is recommended for future studies.

Patients with prostate cancer are less likely to develop oesophageal adenocarcinoma: could androgens have a role in the aetiology of oesophageal adenocarcinoma?

Oesophageal adenocarcinoma (OAC) is more common in men. Androgens may therefore contribute to the pathogenesis of OAC. Prostate cancer (PC), an androgen sensitive tumor with a long natural history, may allow insights into this putative association. West Midlands Cancer Intelligence Unit data from 1977 to 2004 were examined to identify patients with a first malignant primary of PC. Patients were followed until diagnosis of a second primary cancer, death or end of the time period. Age- and period-adjusted standardized incidence ratios (SIR) were calculated as an estimate of the relative risk of a second malignant primary of the oesophagus. Between 1977 and 2004, 44,819 men within the West Midlands developed PC as a first primary malignancy. After exclusion for lack of follow-up, 38,627 men were eligible, providing 143,526 person years at risk for analysis. 86 second primary oesophageal cancers were observed, compared with 110 expected, resulting in an SIR of 0.78 (95% CI 0.62–0.96). There was a reduced risk of OAC 0.7 (0.5–0.95) but not of oesophageal squamous cell carcinoma (OSCC) 1.03 (0.69–1.47). The risk of developing OAC, but not OSCC, is lower than expected in patients with PC. A diagnosis of PC may be associated with aetiological factors that are negatively associated with OAC, or anti-androgen therapy may influence the development of OAC.

Descriptive epidemiology of cancer of unknown primary site in Scotland, 1961-2010.

BACKGROUND Cancers of unknown primary site (CUP) pose problems for diagnosis, treatment, and accurate prediction of prognosis. However, there are limited published data describing the epidemiology of this disease entity. Our aim was to describe the epidemiology of CUP in Scotland. METHODS Anonymised data, covering the period 1961-2010, were extracted from the Scottish Cancer Registry database, based on the following ICD-10 diagnostic codes: C26.0, C26.8, C26.9, C39, and C76-C80. Age-standardised incidence rates were calculated by direct standardisation to the World Standard Population. Estimates of observed survival were calculated by the Kaplan-Meier method. RESULTS Between 1961 and 2010, there were 50,941 registrations of CUP, representing 3.9% of all registrations of invasive cancers. Age-standardised rates increased to a peak in the early to mid-1990s, followed by a steeper decrease in rates. During 2001-2010, age-standardised rates of CUP were higher in the most compared with the least deprived fifth of the population. Observed survival was marginally higher in patients diagnosed during 2001-2010 (median 5.6 weeks) compared with those diagnosed in the previous two decades. During the most recent decade, survival decreased with age at diagnosis, and was higher in patients with squamous cell carcinoma and with lymph node metastases. CONCLUSION Patterns of CUP in Scotland are largely consistent with those reported from the few other countries that have published data. However, in comparing studies, it is important to note that there is heterogeneity in terms of definition of CUP, as well as calendar period of diagnosis or death. Variation in the definition of CUP between different epidemiological studies suggests that there would be merit in seeking international agreement on guidelines for the registration of CUP as well as a standard grouping of diagnostic codes for analysis.

The influence of deprivation and ethnicity on the incidence of esophageal cancer in England

The incidence of esophageal cancer (EC), particularly esophageal adenocarcinoma (EAC), has been rising dramatically. In the USA, esophageal squamous cell carcinoma (ESCC) is associated with deprivation and black ethnicity, while EAC is more common among whites. The influence of social deprivation and ethnicity has not been studied in England. West Midlands Cancer Intelligence Unit data were used to study the incidence of ESCC and EAC, and the influence of age, sex, socioeconomic status (Townsend quintiles by postcode) and ethnicity (to individual patients from Hospital Episode Statistics). From 1977 to 2004, a total of 15,138 EC were identified. Five-year directly age standardized incidence rates per 100,000 (95% CI) for men increased from 8.6 (8.0–9.1) in 1977–1981 to 13.7 (13.1–14.3) in 2000–2004 and for women from 5.0 (4.7–5.4) to 6.3 (5.9–6.6). ESCC incidence did not alter, but EAC incidence rose rapidly in males [2.1 (1.9–2.4) to 8.5 (8.1–9.0)] and in females [0.5 (0.4–0.6) to 1.7 (1.5–1.9)]. ESCC was strongly associated with the most socially deprived quintile. EAC was not associated with differences in socioeconomic status. EAC was significantly more common in white men 7.3 (6.9–7.7) and women 1.5 (1.3–1.6) when compared with black and Asian populations. In England the incidence of EAC has rapidly risen, particularly in men over the last three decades. ESCC was strongly associated with social deprivation. EAC was more common in white populations, but no association with the socioeconomic status was found.

The risk of oesophageal cancer is not affected by a diagnosis of breast cancer.

Oesophageal adenocarcinoma (OAC) is less common and develops at a later age in women compared with men. Endogenous oestrogen may therefore protect against OAC development. A cohort of women with breast cancer, a tumour commonly treated with oestrogen antagonists, was examined to identify the subsequent risk of developing OAC. Earlier studies have implicated radiotherapy in increasing oesophageal cancer (OC) risk among women with breast cancer. West Midlands Cancer Intelligence Unit data recording cancer diagnosis and treatment information was examined to identify patients with a first malignant primary breast cancer during 1977–2004. Patients were followed until diagnosis of a second primary cancer, death or end of the time period examined. Age-adjusted and period-adjusted standardized incidence ratios (SIR) were calculated as an estimate of relative risk for a second primary OC. Seventy-three thousand six hundred and thirteen women were eligible for the study, providing 486 679 person years at risk for analysis. One hundred and thirty-two second primary OCs were observed, compared with 121 expected (SIR 1.09; 95% confidence interval: 0.91–1.29). Radiotherapy treatment in 37 888 women did not affect the risk of a second primary OC (SIR 1.07; 95% confidence interval: 0.79–1.41). No difference was identified when examined by OC morphology. There was no association between breast cancer and a second primary OC. Radiotherapy that avoids deep irradiation in the treatment of breast cancer, local nodes or recurrence was not associated with an increased risk of developing a second primary OC.

Legislation is needed to stop children using sunbeds

Spence extols the joy of sunny days,1 but sunbeds raise serious issues. A recent meta-analysis showed sunbed use before the age of 35 was associated with an increased relative risk of 75% for developing malignant melanoma (absolute risks were not recorded).2 Cancer Research UK recently carried out two large, face to face surveys of sunbed use in over 9000 children aged 11-17 in England.3 …

Beware using secular trends in deaths to judge effectiveness of breast screening

At least three papers have now used comparisons of secular trends in age specific mortality in breast cancer to make inferences about the effectiveness of mammographic screening.1 2 3 4 However, Autier et al were circumspect in their interpretation, acknowledging that the “larger reduction in mortality in women <50 years old may reflect better targeting of effective treatments and response to …