Clara Castro

Patterns and trends in esophageal cancer mortality and incidence in Europe (1980–2011) and predictions to 2015

BACKGROUND Over the last few decades, esophageal cancer incidence and mortality trends varied substantially across Europe, with important differences between sexes and the two main histological subtypes, squamous cell carcinoma (ESCC) and adenocarcinoma (EAC). PATIENTS AND METHODS To monitor recent esophageal cancer mortality trends and to compute short-term predictions in the European Union (EU) and selected European countries, we analyzed data provided by the World Health Organization (WHO) for 1980-2011. We also analyzed incidence trends and relative weights of ESCC and EAC across Europe using data from Cancer Incidence in Five Continents. RESULTS Long-term decreasing trends were observed for male esophageal cancer mortality in several southern and western European countries, whereas in central Europe mortality increased until the mid-1990s and started to stabilize or decline over the last years. In some eastern and northern countries, the rates were still increasing. Mortality among European women remained comparatively low and showed stable or decreasing trends in most countries. Between 2000-2004 and 2005-2009, esophageal cancer mortality declined by 7% (from 5.34 to 4.99/100 000) in EU men, and by 3% (from 1.12 to 1.09/100 000) in EU women. Predictions to 2015 show persistent declines in mortality rates for men in the EU overall, and stable rates for EU women, with rates for 2015 of 4.5/100 000 men (about 22 300 deaths) and 1.1/100 000 women (about 7400 deaths). In northern Europe, EAC is now the predominant histological type among men, while for European women ESCC is more common and corresponding rates are still increasing in several countries. CONCLUSION(S) The observed trends reflect the variations in alcohol drinking, tobacco smoking and overweight across European countries.

Trends in alcohol consumption in Europe and their impact on major alcohol-related cancers.

Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche ‘Mario Negri’, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy and North Region Cancer Registry (RORENO), Portuguese Oncology Institute, Porto, Portugal Correspondence to Carlo La Vecchia, MD, Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche ‘Mario Negri’, Via G. La Masa, 19-20156 Milan, Italy Tel: + 39 0239014527; fax: + 39 0233200231; e-mail: carlo.lavecchia@marionegri.it

Model-based patterns in prostate cancer mortality worldwide.

Background:Prostate cancer mortality has been decreasing in several high income countries and previous studies analysed the trends mostly according to geographical criteria. We aimed to identify patterns in the time trends of prostate cancer mortality across countries using a model-based approach.Methods:Model-based clustering was used to identify patterns of variation in prostate cancer mortality (1980–2010) across 37 European, five non-European high-income countries and four leading emerging economies. We characterised the patterns observed regarding the geographical distribution and gross national income of the countries, as well as the trends observed in mortality/incidence ratios.Results:We identified three clusters of countries with similar variation in prostate cancer mortality: pattern 1 (‘no mortality decline’), characterised by a continued increase throughout the whole period; patterns 2 (‘later mortality decline’) and 3 (‘earlier mortality decline’) depict mortality declines, starting in the late and early 1990s, respectively. These clusters are also homogeneous regarding the variation in the prostate cancer mortality/incidence ratios, while are heterogeneous with reference to the geographical region of the countries and distribution of the gross national income.Conclusion:We provide a general model for the description and interpretation of the trends in prostate cancer mortality worldwide, based on three main patterns.

Trends in gastric cancer mortality and in the prevalence of Helicobacter pylori infection in Portugal.

Portugal has the highest gastric cancer mortality rates in Western Europe, along with high prevalences of Helicobacter pylori infection. Monitoring their trends is essential to predict the burden of this cancer. We aimed to quantify time trends in gastric cancer mortality in Portugal and in each administrative region, and to compute short-term predictions, as well as to describe the prevalence of H. pylori infection, through a systematic review. Joinpoint analyses were used to identify significant changes in sex-specific trends in gastric cancer age-standardized mortality rates (ASMR) and to estimate annual percent changes (APC). The most recent trends were considered to compute estimates up to 2020 by adjusting Poisson regression models. We searched PubMed and IndexRMP to identify studies carried out in Portugal reporting the prevalence of H. pylori. Gastric cancer mortality has been decreasing in Portugal since 1971 in men (from ASMR=55.3/100 000; APC=−2.4, 95% confidence interval: −2.5 to −2.3) and since 1970 in women (from ASMR=28.0/100 000; APC=−2.8, 95% confidence interval: −2.9 to −2.7), although large regional differences were observed. Predicted ASMR for 2015 and 2020 were 18.8/100 000 and 16.7/100 000 for men and 8.5/100 000 and 7.4/100 000 for women, respectively. The prevalence of H. pylori varied from almost 5% at 0.5–2 years to just over 90% at 70 years or more. No consistent variation was observed since the 1990s. The downward trends in mortality rates are expected to remain in the next decades. The high prevalence of H. pylori infection across age groups and studies from different periods shows a large potential for decrease in the burden of gastric cancer in Portugal.

Cancer incidence predictions in the North of Portugal: keeping population-based cancer registration up to date.

Decision making towards cancer prevention and control requires monitoring of trends in cancer incidence and accurate estimation of its burden in different settings. We aimed to estimate the number of incident cases in northern Portugal for 2015 and 2020 (all cancers except nonmelanoma skin and for the 15 most frequent tumours). Cancer cases diagnosed in 1994–2009 were collected by the North Region Cancer Registry of Portugal (RORENO) and corresponding population figures were obtained from Statistics Portugal. JoinPoint regression was used to analyse incidence trends. Population projections until 2020 were derived by RORENO. Predictions were performed using the Poisson regression models proposed by Dyba and Hakulinen. The number of incident cases is expected to increase by 18.7% in 2015 and by 37.6% in 2020, with lower increments among men than among women. For most cancers considered, the number of cases will keep rising up to 2020, although decreasing trends of age-standardized rates are expected for some tumours. Cervix was the only cancer with a decreasing number of incident cases in the entire period. Thyroid and lung cancers were among those with the steepest increases in the number of incident cases expected for 2020, especially among women. In 2020, the top five cancers are expected to account for 82 and 62% of all cases diagnosed in men and women, respectively. This study contributes to a broader understanding of cancer burden in the north of Portugal and provides the basis for keeping population-based incidence estimates up to date.

Assessing the completeness of cancer registration using suboptimal death certificate information.

The completeness of cancer registration depends on the probability of cases being identified by the registries at different time after diagnosis (Montanaro et al., 2006), and therefore varies with the type of cancer, and between and within registries (Shin et al., 2009). The understanding of the cancer-specific patterns of completeness in each registry is essential for a proper interpretation of the measures of cancer burden, and for a valid appraisal of its variation with time and across registries.

Paravertebral block for management of acute postoperative pain and intercostobrachial neuralgia in major breast surgery

BACKGROUND Several locoregional techniques have been described for the management of acute and chronic pain after breast surgery. The optimal technique should be easy to perform, reproducible, with little discomfort to the patient, little complications, allowing good control of acute pain and a decreased incidence of chronic pain, namely intercostobrachial neuralgia for being the most frequent entity. OBJECTIVES The aim of this study was to evaluate the paravertebral block with preoperative single needle prick for major breast surgery and assess initially the control of postoperative nausea and vomiting (PONV) and acute pain in the first 24h and secondly the incidence of neuropathic pain in the intercostobrachial nerve region six months after surgery. METHODS The study included 80 female patients, ASA I-II, aged 18-70 years, undergoing major breast surgery, under general anesthesia, stratified into 2 groups: general anesthesia (inhalation anesthesia with opioids, according to hemodynamic response) and paravertebral (paravertebral block with single needle prick in T4 with 0.5% ropivacaine+adrenaline 3μgmL(-1) with a volume of 0.3mLkg(-1) preoperatively and subsequent induction and maintenance with general inhalational anesthesia). In the early postoperative period, patient-controlled analgesia (PCA) was placed with morphine set for bolus on demand for 24h. Intraoperative fentanyl, postoperative morphine consumption, technique-related complications, pain at rest and during movement were recorded at 0h, 1h, 6h and 24h, as well as episodes of PONV. All variables identified as factors contributing to pain chronicity age, type of surgery, anxiety according to the Hospital Anxiety and Depression Scale (HADS), preoperative pain, monitoring at home; body mass index (BMI) and adjuvant chemotherapy/radiation therapy were analyzed, checking the homogeneity of the samples. Six months after surgery, the incidence of neuropathic pain in the intercostobrachial nerve was assessed using the DN4 scale. RESULTS The Visual Analog Scale (VAS) values of paravertebral group at rest were lower throughout the 24h of study 0h 1.90 (±2.59) versus 0.88 (±1.5) 1h 2.23 (±2.2) versus 1.53 (±1.8) 6h 1.15 (±1.3) versus 0.35 (±0.8); 24h 0.55 (±0.9) versus 0.25 (±0.8) with statistical significance at 0h and 6h. Regarding movement, paravertebral group had VAS values lower and statistically significant in all four time points: 0h 2.95 (±3.1) versus 1.55 (±2.1); 1h 3.90 (±2.7) versus 2.43 (±1.9) 6h 2.75 (±2.2) versus 1.68 (±1.5); 24h 2.43 (±2.4) versus 1.00 (±1.4). The paravertebral group consumed less postoperative fentanyl (2.38±0.81μgkg(-1) versus 3.51±0.81μgkg(-1)) and morphine (3.5mg±3.4 versus 7mg±6.4) with statistically significant difference. Chronic pain evaluation of at 6 months of paravertebral group found fewer cases of neuropathic pain in the intercostobrachial nerve region (3 cases versus 7 cases), although not statistically significant. CONCLUSIONS Single-injection paravertebral block allows proper control of acute pain with less intraoperative and postoperative consumption of opioids but apparently it cannot prevent pain chronicity. Further studies are needed to clarify the role of paravertebral block in pain chronicity in major breast surgery.

Cancer incidence and survival (1997-2006) among adolescents and young adults in the north of Portugal.

Cancer is the first cause of natural death among young subjects. Population-based statistics are important to evaluate the burden of disease and the effectiveness of healthcare provision. We aimed to describe cancer incidence and survival among adolescents (15–19 years) and young adults (20–24 years) in the north of Portugal. Data on the cancers diagnosed between 1997 and 2006 were obtained from the Portuguese North Region Cancer Registry, and incidence rates were computed. Vital status was determined until December 2010. Survival was estimated using the Kaplan–Meier survival function. Trends on cancer incidence were assessed using the Joinpoint regression analysis. A total of 1223 cases were diagnosed: 441 among adolescents and 782 among young adults. Overall incidence rate was 198.3 per million adolescents [95% confidence interval (95% CI): 135.7–260.9] and 306.2 per million young adults (95% CI: 262.3–350.0). The most frequent tumors were Hodgkin lymphoma (adolescents: 21.0%; young adults: 14.8%), thyroid carcinoma (adolescents: 11.5%; young adults: 16.2%), and germ cell tumors (adolescents: 11.1%; young adults: 16.3%). Cancer incidence significantly increased among young adults [annual average percent change: 3.6%, (95% CI: 1.7–5.4)], while appears to vary randomly among adolescents. Overall five-year observed survival was 77.2% (95% CI: 72.9%–80.8%) among adolescents and 81.3% (95% CI: 78.4%–83.9%) among young adults, lower in males. In conclusion, cancer incidence among adolescents and young adults is higher in the north of Portugal than in other European countries, especially of thyroid tumors. Between 1997 and 2006, the incidence increased significantly in young adults.

Prediagnosis lifestyle exposures and survival of gastric cancer patients: a cohort study from Portugal

Background:Dietary habits and smoking are recognised as important gastric cancer determinants. However, their impact on prognosis remains poorly understood. We aimed to quantify the association between lifestyles and survival of gastric cancer patients.Methods:In 2001–2006, 568 patients were recruited in the two major public hospitals in the north of Portugal. Participants were inquired about smoking and dietary habits regarding the year preceding the diagnosis. The vital status of all participants, up to 2011 (maximum follow-up: 10 years), was assessed through the North Region Cancer Registry. Cox proportional hazards regression models were used to estimate adjusted (at least for age, sex and education) hazard ratios (HR) and 95% confidence intervals (95% CI).Results:No significant differences in gastric cancer survival were observed according to smoking status (current vs never smokers, HR=1.00, 95% CI: 0.72–1.38) or alcohol intake (current vs never consumers, HR=0.87, 95% CI: 0.61–1.25). Only a dietary pattern (high consumptions of most food groups and low vegetable soup intake) was significantly associated with a better prognosis among patients with the extent of disease classified as regional spread (HR=0.45, 95% CI: 0.22–0.93).Conclusion:This study shows that prediagnosis lifestyles have a small impact in the survival of gastric cancer patients.

Trends in gastric and esophageal cancer incidence in northern Portugal (1994-2009) by subsite and histology, and predictions for 2015

Introduction Gastric cancer (GC) and esophageal cancer (EC) share risk factors, and the incidence trends reflect differences in etiology according to their subtypes. We aimed to describe the incidence trends of GC (by topography) and EC (by histological type) in northern Portugal for 1994-2009 and to estimate the incidence for 2015. We further analyzed exposure to the main risk factors for these cancers in the region over the last decades. Methods GC and EC data were obtained from the North Region Cancer Registry of Portugal (RORENO). Joinpoint regression was used to compute annual percent changes (APC) in incidence trends. Poisson regression yielded estimates for 2015. A literature review up to 2014 provided data on exposure to risk factors. Results GC rates decreased in 1994-2009 (men, APC = −1.3; women, APC = −1.6); GC, unspecified subtype, had the steepest decline since the early 2000s (men, APC = −4.9; women, APC = −6.3). The incidence for 2015 will increase for EC in men (up to ≈190 cases) and stabilize in women (≈30) and for GC (≈730 men, ≈500 women). Increasing prevalence of tobacco smoking among women and overweight/obesity, fairly stable prevalence of alcohol, fruit and vegetable consumption, and no trend for Helicobacter pylori infection were observed. Conclusions The declining incidence of GC unspecified subtype indicated an improvement in cancer registration accuracy, but precluded a sound assessment of trends by subtype. Variations in the prevalence of exposure to some risk factors were consistent with observed incidence trends, and future studies should aim to quantify their contribution to the GC and EC burden in the region.