Laura Esteban

The influence of alcohol consumption and hepatitis B and C infections on the risk of liver cancer in Europe

BACKGROUND/AIMS To assess the variability of liver cancer (LC) risk associated with hepatitis B (HBV) and hepatitis C (HCV) viruses and alcohol intake in 2002 throughout Europe. METHODS Incidence data were obtained from population-based cancer registries whereas mortality, HBV, HCV and alcohol exposures were obtained from the WHO databases. Relative risk of LC and their posterior probabilities to be >1 were obtained and plotted in maps through a Bayesian random effects model. RESULTS HBV prevalence >2% increased the risk of developing LC a 15% in men and 21% in women; HCV prevalence >2%, 54% in men and 33% in women and, pure alcohol intake >11l, 26% and 14%, respectively (all of them statistically significant). These risk factors played a similar role in the risk of dying from LC among men, whereas HBV and alcohol were not statistically significant among women. Significant high LC risk, after HBV/HCV and alcohol adjustment were observed for both sexes in: Hungary, Moldova, Romania, Croatia, Greece, Italy, Spain, France and Austria. CONCLUSIONS South-North and East-West decreasing gradients for LC risk were observed in Europe. HBV, alcohol and, mainly, HCV are independent risk factors that could explain this geographical pattern.

Colorectal cancer mortality in Spain: trends and projections for 1985-2019.

Background and aim To describe colorectal cancer (CRC) mortality trends during 1985–2004 and to estimate CRC mortality projections for the period 2005–2019 in Spain. Material and methods A Bayesian age-period-cohort analysis has been carried out to investigate the effect of the age, period, and birth cohort on CRC mortality in Spain. Mortality projections until 2019 were based on the age-period-cohort model. Results During 1985–1994, CRC mortality increased in both sexes (3.9% yearly in men and 1.5% in women). After 1995, CRC mortality increased in men (1.6%) and leveled off in women (−0.6%). Colon cancer mortality increased for the whole period in men, this increase being lower in the second decade (1985–1994: 5.0%; 1995–2004: 1.8%). In women, colon cancer mortality increased in the first decade (2.8%) and leveled off during the second decade (−0.1%). Rectal cancer mortality increased in men (1.2%) and decreased in women (−1.1%) during the whole study period. Projections showed an increase in the number of CRC deaths in men older than 60 years and a level off in women. Conclusion Although mass screening for CRC in Spain has not been available, the favorable recent changes in CRC mortality trends observed after 1995 could be related to progress in diagnosis and treatment. The projected number of deaths could be used as reference scenario for assessing future impact of new treatments as well as the potential impact of future population-based screening when introduced.

Tendencias de la mortalidad por cáncer en Cataluña, 1985-2004

Fundamento y objetivo Tanto la situacion epidemiologica como asistencial del cancer en las ultimas 2 decadas ha experimentado grandes cambios y esto ha influido en la mortalidad por esta enfermedad. El objetivo es analizar las tendencias de la mortalidad por cancer en Cataluna, durante los ultimos 20 anos y compararlas con Europa. Sujetos y metodo Los datos de las defunciones ocurridas en Cataluna proceden del registro de mortalidad del Departamento de Salud y estan codificados segun la Clasificacion Internacional de Enfermedades (CIE) (novena revision de 1985-1998 y decima de 1999 a 2004). La poblacion corresponde a la intercensal (1985-2000), censal (2001) y poscensal (2002-2004) del Instituto de Estadistica de Cataluna. Se han calculado las tasas ajustadas por edad (TA) mediante el metodo directo (poblacion estandar mundial de 1960) y las tasas acumuladas (Tac) de 0 a 74 anos. Para evaluar la tendencia se ha ajustado un modelo de Poisson a las TA y se ha estimado el porcentaje de cambio anual (PCA) para los decenios 1985-1994 y 1995-2004 y el global para 1985-2004. Resultados El riesgo de morir por cancer (Tac) ha pasado en los varones del 18,54 al 17,49% y en las mujeres, del 9,24 al 7,69% de 1985 a 2002. En estos anos ha disminuido la mortalidad (PCA) por los canceres de laringe (−2,52%), prostata (−1,11%) y estomago (−2,89%) en varones y estomago (−3,64%) en mujeres. Mostraron cambios de tendencia en los varones el cancer colorrectal (aumento del 2,8% hasta 1994 y estabilizacion posterior), pulmon (crecio el 1,36% hasta 1994 y despues descendio) e higado (aumento no significativo hasta 1994 y luego descenso de -3,13%). En las mujeres la mortalidad por cancer de mama primero aumento (1,48%) y despues disminuyo (−2,72%) significativamente y el de pulmon aumento en todo el periodo, aunque solo en la ultima decada (4,81%) fue estadisticamente significativo. Conclusiones La mortalidad por cancer en las ultimas 2 decadas ha mostrado una tendencia general decreciente, aunque algunas localizaciones aumentan. Comparada con otros paises, Cataluna se encuentra en una situacion mas favorable en el caso de las mujeres que en el de los varones, aunque la evolucion de los ultimos anos ha sido parecida a la de los paises que se encuentran en situacion mas ventajosa.

Trends in the surgical procedures of women with incident breast cancer in Catalonia, Spain, over a 7-year period (2005–2011)

BackgroundBreast cancer (BC) is the most frequent cancer in women, accounting for 28% of all tumors among women in Catalonia (Spain). Mastectomy has been replaced over time by breast-conserving surgery (BCS) although not as rapidly as might be expected. The aim of this study was to assess the evolution of surgical procedures in incident BC cases in Catalonia between 2005 and 2011, and to analyze variations based on patient and hospital characteristics.MethodsWe processed data from the Catalonian Health Service’s Acute Hospital Discharge database (HDD) using ASEDAT software (Analysis, Selection and Extraction of Tumor Data) to identify all invasive BC incident cases according to the codes 174.0-174.9 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that were attended for the one-year periods in 2005, 2008 and 2011. Patients were classified according to surgical procedures (BCS vs mastectomy, and immediate vs delayed reconstruction), and results were compared among periods according to age, stage, comorbidity and hospital level.ResultsBC surgical procedures were performed in more than 80% of patients. Surgical cases showed a significant increasing trend in the proportion of women aged 50–69 years, more advanced disease stages, higher comorbidity and they were attended in hospitals of less complexity level throughout the study period. Similar pattern was found for patients treated with BCS, which increased significantly from 67.9% in 2005 to 74.0% in 2011.Simple lymph node removal increased significantly (from 48.8% to 71.4% and from 63.6% to 67.8% for 2005 and 2011 in conservative and radical surgery, respectively). A slightly increase in the proportion of mastectomized young women (from 28% in 2005 to 34% in 2011) was detected, due to multiple factors. About 22% of women underwent post-mastectomy breast reconstruction, this being mostly immediate.ConclusionsThe use of HDD linked to the ASEDAT allowed us to evaluate BC surgical treatment in Catalonia. A consolidating increasing trend of BCS was observed in women aged 50–69 years, which corresponds with the pattern in most European countries. Among the mastectomized patients, immediate breast reconstructions have risen significantly over the period 2005–2011.

Cálculo de la supervivencia relativa: Comparación de métodos de estimación de la supervivencia esperada

Relative survival is the most commonly used method to determine survival in patients diagnosed with cancer. This method takes into account estimation of expected survival in cancer patients based on the observed mortality in the geographical area to which they belong. The most frequently used methods for estimation of expected survival are the Ederer (I and II) and Hakulinen methods. Survival tables for the geographical areas stratified by age and calendar year are required for these calculations. The present article presents an example of how to perform these estimations and how to choose the most appropriate method for the type of analysis to be performed. This article shows that if the follow-up of the cohort is less than 10 years, any of these methods should give similar results. However, the Hakulinen method is preferred, since it accounts for heterogeneity due to potential withdrawals.

Life expectancy and age-period-cohort effects: analysis and projections of mortality in Spain between 1977 and 2016

OBJECTIVES This study aimed to: (1) assess Spanish mortality trends between 1977 and 2001 and their impact on life expectancy; and (2) assess the differences in life expectancy between men and women for the period 2002-2016. STUDY DESIGN Time trends study using age-period-cohort (APC) analysis. METHODS A Bayesian APC model was fitted to describe Spanish mortality rates for the period 1977-2001 and to project Spanish mortality rates for 2002-2016. Life expectancy was predicted through Chiangs method using projected mortality rates. RESULTS There was a significant cohort effect for Spanish mortality, showing a slight increase in mortality among men aged 20-39 years between 1986 and 1997 (birth cohorts 1940-1970). Life expectancy is expected to increase by approximately 0.5% in men and women between 1977 and 2016 (1 year per 5-year period). Life expectancy for males born between 2012 and 2016 will be 77.15 years, compared with 84.95 years for females born during the same period. CONCLUSIONS The rising trend in mortality among the 1940-1970 cohorts may be due to the increased risk of avoidable causes of death related to acquired immunodeficiency syndrome, traffic accidents, and drug and alcohol abuse during the mid 1980s. The decline in mortality rates in recent years could lead to a mean increase in life expectancy of 1 year per 5-year period in both genders between 2002 and 2016. An increase in life expectancy for women and a levelling off for men is expected for age groups older than 79 years.

WAERS: an application for Web-assisted estimation of relative survival.

Net cancer survival estimation is usually performed by computing relative survival (RS), which is defined as the ratio between observed and expected survival rates. The mortality of a reference population is required in order to compute the expected survival rate, which can be performed using a variety of statistical packages. A new Web interface to compute RS, called WAERS, has been developed by the Catalan Institute of Oncology. The reference population is first selected, and then the RS of a cohort is computed. A remote server is used for this purpose. A mock example serves to illustrate the use of the tool with a hypothetical cohort, for which RS is estimated based on three different reference populations (a province of Spain, an autonomous community (Region), and the entire Spanish population). At present, only mortality tables for different areas of Spain are available. Future improvements of this application will include mortality tables of Latin American and European Union countries, and stratified (control variable) analysis. This application can be also useful for cohort mortality studies and for registries of several diseases.

Monitoring the decreasing trend of testicular cancer mortality in Spain during 2005–2019 through a Bayesian approach

PURPOSE To assess time trends of testicular cancer (TC) mortality in Spain for period 1985-2019 for age groups 15-74 years old through a Bayesian age-period-cohort (APC) analysis. METHODS A Bayesian age-drift model has been fitted to describe trends. Projections for 2005-2019 have been calculated by means of an autoregressive APC model. Prior precision for these parameters has been selected through evaluation of an adaptive precision parameter and 95% credible intervals (95% CRI) have been obtained for each model parameter. RESULTS A decrease of -2.41% (95% CRI: -3.65%; -1.13%) per year has been found for TC mortality rates in age groups 15-74 during 1985-2004, whereas mortality showed a lower annual decrease when data was restricted to age groups 15-54 (-1.18%; 95% CRI: -2.60%; -0.31%). During 2005-2019 is expected a decrease of TC mortality of 2.30% per year for men younger than 35, whereas a leveling off for TC mortality rates is expected for men older than 35. CONCLUSIONS A Bayesian approach should be recommended to describe and project time trends for those diseases with low number of cases. Through this model it has been assessed that management of TC and advances in therapy led to decreasing trend of TC mortality during the period 1985-2004, whereas a leveling off for these trends can be considered during 2005-2019 among men older than 35.

REGSTATTOOLS: freeware statistical tools for the analysis of disease population databases used in health and social studies

BackgroundThe repertoire of statistical methods dealing with the descriptive analysis of the burden of a disease has been expanded and implemented in statistical software packages during the last years. The purpose of this paper is to present a web-based tool, REGSTATTOOLShttp://regstattools.net intended to provide analysis for the burden of cancer, or other group of disease registry data. Three software applications are included in REGSTATTOOLS: SART (analysis of disease’s rates and its time trends), RiskDiff (analysis of percent changes in the rates due to demographic factors and risk of developing or dying from a disease) and WAERS (relative survival analysis).ResultsWe show a real-data application through the assessment of the burden of tobacco-related cancer incidence in two Spanish regions in the period 1995–2004. Making use of SART we show that lung cancer is the most common cancer among those cancers, with rising trends in incidence among women. We compared 2000–2004 data with that of 1995–1999 to assess percent changes in the number of cases as well as relative survival using RiskDiff and WAERS, respectively. We show that the net change increase in lung cancer cases among women was mainly attributable to an increased risk of developing lung cancer, whereas in men it is attributable to the increase in population size. Among men, lung cancer relative survival was higher in 2000–2004 than in 1995–1999, whereas it was similar among women when these time periods were compared.ConclusionsUnlike other similar applications, REGSTATTOOLS does not require local software installation and it is simple to use, fast and easy to interpret. It is a set of web-based statistical tools intended for automated calculation of population indicators that any professional in health or social sciences may require.

Relative survival computation: Comparison of methods for estimating expected survival

Relative survival is the most commonly used method to determine survival in patients diagnosed with cancer. This method takes into account estimation of expected survival in cancer patients based on the observed mortality in the geographical area to which they belong. The most frequently used methods for estimation of expected survival are the Ederer (I and II) and Hakulinen methods. Survival tables for the geographical areas stratified by age and calendar year are required for these calculations. The present article presents an example of how to perform these estimations and how to choose the most appropriate method for the type of analysis to be performed. This article shows that if the follow-up of the cohort is less than 10 years, any of these methods should give similar results. However, the Hakulinen method is preferred, since it accounts for heterogeneity due to potential withdrawals.