Risto Sankila

Estimates of cancer incidence and mortality in Europe in 2008

Up-to-date statistics on cancer occurrence and outcome are essential for the planning and evaluation of programmes for cancer control. Since the relevant information for 2008 is not generally available as yet, we used statistical models to estimate incidence and mortality data for 25 cancers in 40 European countries (grouped and individually) in 2008. The calculations are based on published data. If not collected, national rates were estimated from national mortality data and incidence and mortality data provided by local cancer registries of the same or neighbouring country. The estimated 2008 rates were applied to the corresponding country population estimates for 2008 to obtain an estimate of the numbers of cancer cases and deaths in Europe in 2008. There were an estimated 3.2 million new cases of cancer and 1.7 million deaths from cancer in 2008. The most common cancers were colorectal cancers (436,000 cases, 13.6% of the total), breast cancer (421,000, 13.1%), lung cancer (391,000, 12.2%) and prostate cancer (382,000, 11.9%). The most common causes of death from cancer were lung cancer (342,000 deaths, 19.9% of the total), colorectal cancer (212,000 deaths, 12.3%), breast cancer (129,000, 7.5%) and stomach cancer (117,000, 6.8%).

Breast cancer incidence and mortality trends in 16 European countries.

Trends in the incidence of and mortality from breast cancer result from a variety of influences including screening programmes, such as those introduced in several European countries in the late 1980s. Incidence and mortality rates for 16 European countries are analysed. Incidence increased in all countries. The estimated annual percent change (EAPC) varied from 0.8 to 2.8% in prescreening years in 6 screened countries and from 1.2 to 3.0% in 10 non-screened countries. Screening related temporary increases were visible. Earlier mortality trends were maintained in the most recent decade in Estonia (EAPC +1.8%) and Sweden (-1.2%). In other countries, previously increasing trends changed. Trends flattened in Finland, Denmark, France, Italy and Norway (EAPC 0.0 to -0.3%), while they declined in England and Wales (-3.1%), Scotland (-2.0%), and The Netherlands (-1.0%), all of which have national screening programmes, and in Slovakia (-1.1%), Spain (-0.7%), and Switzerland (-1.1%). In some countries with screening programmes, declines in mortality started before screening was introduced, and declines also occurred in non-screened age groups and in some countries without national screening programmes. This suggests that the major determinants of the observed trends vary among the countries and may include earlier detection through screening in countries where this has been introduced, but also improvements in therapy, in countries with or without screening.

incidence and Survival of Mucinous Adenocarcinoma of the Colorectum: A Population-based Study From an Asian Country

PURPOSE:nPrevious studies have shown conflicting results on the prognosis of mucinous adenocarcinoma of the colorectum. This could be because of heavy bias on patient selection. Furthermore, little data are available from Asian populations. This study was designed to examine incident and prognostic characteristics of mucinous adenocarcinoma of the colorectum based on data obtained from a population-based, Asian, cancer registry.nMETHODS:nA total of 627 of 15,762 were mucinous adenocarcinoma cases from invasive colorectal cancer patients registered in the Singapore Registry from 1968 to 1997. Age-standardized incidence rate was used to describe the incident pattern of mucinous adenocarcinoma of colon and rectum during a period of time. Survival of patients with mucinous adenocarcinoma or ordinary adenocarcinoma was compared using relative survival and proportional hazards model.nRESULTS:nAge-standardized incidence rate of mucinous adenocarcinoma of the colon and rectum were almost unchanged in males, rising slightly in females during the study periods from 1968 to 1972 to 1993 to 1997. The proportion of mucinous adenocarcinoma cases was similar among genders and calendar-year periods but was higher in younger age groups, Malays and Indians, in advanced stages of the disease, and proximal colon. Five-year relative survival rate of patients with mucinous adenocarcinoma were similar in the colon but were lower in the rectum.nCONCLUSIONS:nColorectal mucinous adenocarcinoma as a different etiologic entity from other histologic types of colorectal cancer was suggested. Possibly greater aggressiveness of mucinous adenocarcinoma occurring in the rectum requires confirmation but suggests that mucin is important in the pathogenesis of mucinous adenocarcinoma.n

Survival of breast cancer patients in BRCA1, BRCA2, and non‐BRCA1/2 breast cancer families: A relative survival analysis from Finland

Reports on the prognosis of familial breast cancer patients have been contradictory. True differences in survival, if they exist, would have important implications for genetic counselling and in treatment of hereditary breast cancer. We assessed the survival rates of 359 familial breast cancer patients (32 patients from BRCA1‐positive families, 43 patients from BRCA2‐positive families and 284 patients from BRCA1/2‐negative breast cancer families) and compared them with those of all other breast cancer patients diagnosed in Finland from 1953 to 1995 (n = 59,517). Cumulative relative survival rates (RSR) were calculated by dividing the observed survival rates by the expected ones. The expected survival rates were derived from the sex, age and calendar year specific life‐tables of the general population in Finland. Regression model was used to calculate relative excess risk of death (RR) and to adjust for confounding factors. The overall 5‐year RSR of the patients in the BRCA1 families, BRCA2 families, non‐BRCA1/2 families and among sporadic cases was 67%, 77%, 86% and 78%, respectively. However, we found no significant differences in the RR adjusted for age, stage and year of diagnosis between the different familial patient groups or the general breast cancer population. In the BRCA1 families the RR tended to be higher [RR 1.30, 95% confidence interval (CI) 0.63–2.70] and in the BRCA2 families lower (RR 0.78, 95% CI 0.39–1.57) than among the general breast cancer patient population. The RR among patients in the non‐BRCA1/2 families did not differ from that of the general patient population.

Do younger female breast cancer patients have a poorer prognosis? Results from a population-based survival analysis.

Younger women who develop breast cancer are hypothesized to have poorer survival rates than women who develop it at a later stage in life. Several studies have suggested that differences in biologic characteristics of breast cancer in younger (premenopausal) and older (postmenopausal) women may account for the prognostic variation. This population‐based cohort study reports on survival rates of breast cancer in Singapore and examines the hypothesis that younger breast cancer patients have a poorer prognosis. A total of 6,397 breast cancer patients diagnosed from 1968 to 1992 were identified from the population‐based cancer registry and followed up through 1997. Outcome measures were relative survival rates (RSRs) calculated using Hakulinens method and excess hazards ratios (HRs) derived from a regression model based on relative survival. The 2‐, 5‐ and 10‐year RSRs were worse among those aged > 75 (65%, 48% and 39%, respectively). The best survival rates were seen among those aged 40–44 (84%, 67% and 56%). Patients younger than 35 years faired reasonably well (79%, 60% and 50%). When the data were stratified according to clinical stage and calendar year, the highest risk of excess deaths was found in women ≥ 75 years old. In patients with localized cancer and/or regional metastases, those in the 35–39 age group had the lowest excess risk. In patients with distant metastases, those younger than 35 years of age had the lowest excess risk of death. At the population level, younger women (< 45 years) with breast cancer in Singapore have higher relative survival rates.

Risk of cancer in BRCA1 and BRCA2 mutation-positive and -negative breast cancer families (Finland)

AbstractObjectives: To compare the risk of cancer between BRCA1 or BRCA2 mutation-positive and -negative families.nMethods: We assessed standardized incidence ratios (SIR) in 107 Finnish breast cancer families (12 BRCA1, 11 BRCA2, 84 non-BRCA1/2) with confirmed genealogy. The observed numbers of cancer cases were compared to the expected ones; both numbers were based on the population-based Finnish Cancer Registry.nResults: Risk of ovarian cancer for first-degree relatives was high in BRCA1 (SIR 29, 95% confidence interval 9.4–68) and in BRCA2 families (SIR 18, 8.3–35), but not increased for non-BRCA1/2 families (SIR 1.0, 0.2–2.9). The SIR for subsequent ovarian cancer among breast cancer patients was 61 (20–142), 38 (11–98), and 0 (0–4.2), respectively. The risk of subsequent new breast cancer among breast cancer patients was equally high in BRCA1 families (SIR 11, 3.6–26) and in BRCA2 families (SIR 10, 3.3–24) and somewhat lower in mutation-negative families (SIR 3.7, 2.1–6.1). The risk of breast cancer among relatives was markedly increased in all three groups. The only elevated SIR, besides breast and ovarian, was that for prostate cancer in BRCA2 families (SIR 4.9, 1.8–11).nConclusions: The excess risk of breast cancer in non-BRCA1/2 families suggests the existence of another predisposition gene which seems not to be linked with increased risk of ovarian cancer.

Population-based cancer survival in Singapore, 1968 to 1992: An overview

The Singapore Cancer Registry has provided comprehensive population‐based incidence data since 1968. This paper describes the population‐based survival analysis of the registry data. All invasive primary cancers diagnosed from January 1, 1968 to December 31, 1992 were passively followed up until December 31, 1997. Only 5.8% were lost to follow‐up. Cumulative and observed survival rates were calculated using Hakulinens method. Overall 5‐year relative survival rates have increased dramatically over the 25‐year period in both genders. Significant increases are seen with nasopharynx, stomach and colo‐rectum cancers, non‐Hodgkins lymphoma, leukemias and cancers of the testis, cervix, ovaries and breast. When compared with the Surveillance, Epidemiology and End Results (SEER) rates in the United States, the 5‐year relative survival rates in Singapore are generally lower. However, the rate of change between the two countries is fairly similar. On the average, the rates are 10 to 15 years behind the SEER rates and 5 to 10 years behind Finland, Switzerland and Japan, but they are close to the UK rates. The age‐standardized 5‐year survival rate for Singapore is higher for most sites compared with other developing countries like Qidong (China), Madras (India), Bombay (India) and Chiang Mai (Thailand). The 25‐year trend in cancer survival in Singapore showed two extreme groups: those showing no change and those showing significant improvements. Reducing the incidence of cancers belonging to the first group remains the only viable mode of cancer control. For cancers in the second group, improvement in survival is due to a combination of successful early detection measures and effective treatment services in Singapore.

POPULATION-BASED SURVIVAL ANALYSIS OF COLORECTAL CANCER PATIENTS IN SINGAPORE, 1968-1992

Since the 1980s, colorectal cancer incidence in Singapore has ranked second to lung in males and females. We describe a population‐based analysis of survival of colorectal cancer patients diagnosed from 1968 to 1992 in Singapore. Data of colorectal cancer patients diagnosed during 1968–1992 were retrieved from the Singapore Cancer Registry. Patients were passively followed up for death to the end of 1997. The final dataset consisted of 10,114 subjects. Observed and relative survival rates were calculated by stage (localized, regional metastases and distant metastases), age, ethnicity and calendar period for both genders. Over the study period, a significant progress in survival of colorectal cancer patients was observed. For localized cancer of the colon, the 5‐year age‐standardized relative survival (ASRS) increased from 36% in 1968–1972 to 66% in 1988–1992 for males and from 32 to 71% for females. For localized rectal cancer, the 5‐year ASRS improved from 25 to 66% for males and from 23 to 66% in females. Similarly, improvement was observed in colorectal cancer patients with regional metastases, but not in those with distant metastases. Calendar year period and clinical stage of disease were identified as major significant prognostic factors of survival for colorectal cancer. The substantially improved colorectal cancer survival rates reflected the interplay of cancer control activities in various areas, such as health promotion, early diagnosis and treatment. Our study shows a unique changing pattern of survival experience for colorectal patients from a country undergoing rapid economic development.

Nationwide cancer family ascertainment using Finnish cancer registry data on family names and places of birth for 35,761 prostate cancer patients

Identification of predisposition loci to complex diseases, such as prostate cancer, requires high‐quality family material, the ascertainment of which is often laborious, time‐consuming and inaccurate with conventional methods. Here, we describe a new method for rapid, nationwide cancer family ascertainment using Finnish Cancer Registry data on 35,761 prostate cancer cases over a 40‐year period. As members of a prostate cancer family are likely to share the same family name and place of birth, we stratified all prostate cancer cases by these 2 parameters (10,721 different names and 596 municipalities). Data were compared with the distribution of family names and places of birth for all 3.3 million Finnish men to derive standardized prevalence ratios (SPRs). A significantly elevated SPR of prostate cancer was detected for 468 (1.6%) of the 28,459 evaluable combinations of family name and place of birth. Of the 20 highest SPR values, 19 corresponded to true nuclear families, most of these having 3 or more affected cases. Two‐thirds of our 50 previously established Finnish prostate cancer families were classified among this 1.6% fraction of the highest SPR values. Finally, many of the highest SPR values originated from municipalities in southern and south‐western Finland. To explore whether such clusters could highlight local founder effects, we applied genealogical research to link together several families with elevated SPRs and identified an extended family with 20 prostate cancer cases with common ancestors in the early seventeenth century. In summary, a rapid novel method was developed and validated for identification of prostate cancer families from nationwide cancer registry data and for the identification of putative regional founder effects. Int. J. Cancer 88:307–312, 2000.