Lydia Voti

Cervical cancer screening policies and coverage in Europe.

The aim of the study was to compare current policy, organisation and coverage of cervical cancer screening programmes in the European Union (EU) member states with European and other international recommendations. According to the questionnaire-based survey, there are large variations in cervical cancer screening policies and inadequacies in the key organisational elements of the programme such as registration and monitoring required for quality-assurance and fail-safe mechanisms. Based on data from available screening registers, coverage of the screening test taken within the population-based programme was below 80% in all programmes, ranging from 10% to 79%. The screening capacity is satisfactory in most EU member states, however, and there is even over-capacity in several countries. There are also countries which do not have an acceptable capacity yet. Control of proper capacity along with education, training and communication among women, medical professionals and authorities are required, accordingly. The study indicates that, despite substantial efforts, the recommendations of the Council of the EU on organised population-based screening for cervical cancer are not yet fulfilled. Decision-makers and health service providers should consider stronger measures or incentives in order to improve cervical cancer control in Europe.

Oral cavity cancer in developed and in developing countries: population-based incidence.

The incidence of oral cavity cancer (OCC) is not well documented because it is rarely described in accord with the anatomic definition but is usually grouped with oropharyngeal subsites. We studied the incidence of OCC in developed and in developing countries.

Detecting an Association between Socioeconomic Status and Late Stage Breast Cancer Using Spatial Analysis and Area-Based Measures

Objectives: To assess the relationship between socioeconomic status (SES) and late stage breast cancer using the cluster detection software SaTScan and U.S. census–derived area-based socioeconomic measures. Materials and Methods: Floridas 18,683 women diagnosed with late stage breast cancer (regional or distant stage) between 1998 and 2002 as identified by Floridas population–based, statewide, incidence registry were analyzed by SaTScan to identify areas of higher-than-expected incidence. The relationship between SES and late stage breast cancer was assessed at the neighborhood (block group) level by combining the SaTScan results with area-based SES data. Results: SaTScan identified 767 of Floridas 9,112 block groups that had higher-than-expected incidence of late stage breast cancer. After controlling for patient level insurance status, county level mammography prevalence, and urban/rural residence in the logistic regression model, women living in neighborhoods of severe and near poverty were respectively 3.0 and 1.6 times more likely to live in areas of higher-than-expected incidence of late stage breast cancer when compared with women living in nonpoverty. Additionally, areas in the lowest quartile of mammography usage were almost seven times more likely to have higher-than-expected incidence than areas in the higher quartiles. Conclusions: In addition to confirming the importance of mammography, results from the present study suggest that “where” you live plays an important role in defining the risk of presenting with late stage breast cancer. Additional research is urgently needed to understand this risk and to leverage the strengths and resources present in all communities to lower the late stage breast cancer burden. (Cancer Epidemiol Biomarkers Prev 2007;16(4):756–62)

Treatment of local breast carcinoma in Florida: The role of the distance to radiation therapy facilities

Breast‐conserving surgery combined with radiation (BCSR) is the recommended alternative treatment to mastectomy for local breast carcinoma. However, limited access to healthcare may result in more extensive surgical treatment. The effect of distance to radiation therapy facilities on the likelihood of receiving BCSR was examined in Florida.

Cancer registration data and quality indicators in low and middle income countries: their interpretation and potential use for the improvement of cancer care

Cancer registration data plays a major role in the design and monitoring of cancer control activities and policies, and population-based cancer registries (PBCR) are the main source of information. In developed countries, the healthcare infrastructure enables the registration of quality cancer data. In low and middle Income countries (LMIC), where health care facilities are limited or scarce, cancer registration data may be of low quality. The aim of this article is to demonstrate the value of cancer incidence data for LMIC, even when quality is questionable, as well as to attempt to interpret the messages that the quality indicators convey both for cancer registration and the healthcare system. The study of data submitted to the Cancer incidence in five continents, volume nine (CI5-IX) leads to the conclusion that when PBCR from LMIC cannot provide good quality data it may indicate a deficiency that goes above and beyond the registrar ability. The quality control indicators evaluated provide insight on local conditions for cancer diagnosis and care. Low data quality not only signals lack of collaboration among reporting sources and the inability of the registrar to perform quality abstracting, but also points to specific weaknesses of the cancer care system and can guide improvement goals and efforts.

Primary oral melanoma: Population-based incidence

Primary oral melanoma (POM) is a rare form of melanoma, generally diagnosed at a late stage and has poor prognosis. Epidemiological information has scarcely been reported in the literature over the past 40 years. Analyzing the Cancer Incidence in Five Continents volume IX (CI5-IX) database we found a total of 124,436 oral cavity cancers reported from all population-based cancer registries and 319 cases of POM reported by 67 cancer registries. To our knowledge this is the largest number of POM cases analyzed and accounts for 0.26% of all oral cavity cancers. ASR(W) for POM do not exceed 0.01 per 100,000 persons-year in all regions. The most common anatomic sites were palate (47%) and gum (27.6%) and a detailed oral mucosa examination and biopsies of nodular or macular lesions in these sites, especially on elderly patients, is advised to be routinely performed.

The Roles of Teaching Hospitals, Insurance Status, and Race/Ethnicity in Receipt of Adjuvant Therapy for Regional-Stage Breast Cancer in Florida

OBJECTIVES We examined the roles of teaching hospitals, insurance status, and race/ ethnicity in womens receipt of adjuvant therapy for regional-stage breast cancer. METHODS Data were taken from the Florida Cancer Data System for cases diagnosed from July 1997 to December 2000. We evaluated the impact of health insurance status and hospital type on use of adjuvant therapy (after adjustment for age, race/ethnicity, and marital status). Interaction terms for hospital type, insurance status, and race/ethnicity were entered in each model. RESULTS Teaching facilities diagnosed 12.5% of the cases; however, they cared for a disproportionate percentage (21.3%) of uninsured and Medicaid-insured women. Among women who received adjuvant chemotherapy only, those diagnosed in teaching hospitals were more likely than those diagnosed in nonteaching hospitals to receive therapy regardless of insurance status or race/ethnicity. Among women who received chemotherapy with or without hormonal therapy, Hispanics were more likely than White non-Hispanic women to receive therapy, whereas women with private insurance or Medicare were less likely than uninsured and Medicaid-insured women to receive this type of therapy. CONCLUSIONS Teaching facilities play an important role in the diagnosis and treatment of regional-stage breast cancer among Hispanics, uninsured women, and women insured by Medicaid.

Cancer trends among Hispanic men in South Florida, 1981-1998

Hispanics now represent a majority of residents in Miami‐Dade County, Florida. In this report, the authors present new cancer incidence and mortality data for South Floridas Hispanic men for the period 1990–1998 and compare them with data from a previous report from the 1980s. Periodic updating of cancer incidence data, reflecting current population distribution, lifestyle, and environmental risk factors, is necessary to inform cancer prevention and control activities optimally.

Lymphoma and lymphoid leukemia incidence in Florida children

Incidence reports for pediatric lymphoma and lymphoid leukemia in Hispanic subpopulations in the United States are rare. The authors hypothesized that Floridas Hispanic children would have higher risks of lymphoma and lymphoid leukemia compared with non‐Hispanic white children.

A Feasibility Study of the Evaluation of the Florida Breast Cancer Early Detection Program Using the Statewide Cancer Registry

In Florida, a Center for Disease Control and Prevention (CDC)-funded initiative of the Florida Department of Health has targeted socio-economically disadvantaged women for breast and cervical cancer screening. Since 1995, over 12,000 women aged 50–64, within 200% of the federally defined poverty level, with no health insurance, and living in metropolitan catchment areas in Florida, have been screened by the Florida Breast and Cervical Cancer Early Detection Program (BCCEDP). This was a matched cohort cross-sectional analysis of a cohort study of Florida women with breast cancer using the Florida incident cancer registry, the Florida Cancer Data System (FCDS). The study evaluated the hypothesis that there would be no difference in the stage at diagnosis between breast cancer cases in the BCCEDP-screening program and breast cancer cases not diagnosed in the screening program. After linking the BCCEDP records with the FCDS, BCCEDP-screened cases were matched on gender, age, race, ethnicity, and other variables with five groups of FCDS breast cancer cases not screened by BCCEDP to control for demographic and socio-economic factors. Breast cancer cases diagnosed in BCCEDP were significantly more likely to be diagnosed at later stage than non-BCCEDP breast cancer cases in the five matched groups. The BCCEDP is not purely a screening program since it also caters to symptomatic women in the indigent population, therefore these finding were expected. In fact, 71% of the BCCEDP cases were symptomatic at the time of screening/diagnosis and 53% were late-stage diagnosed. These findings show that BCCEDP is indeed servicing its targeted population of medically under-served and symptomatic women in Florida. Furthermore, despite limitations, this study illustrates the potential collaboration between cancer registries and breast cancer screening programs for quality control purposes.