Ryoko Machii

Trends in Stomach Cancer Mortality Rates in Japan, USA, UK, France and Korea Based on the WHO Mortality Database

In order to identify the factors that influence national trends in mortality, it is essential to distinguish between period and cohort patterns. Whereas period patterns indicate immediate effects of conditions occurring for all age groups at that period, cohort patterns may reflect long-lasting effects of determinants present earlier in the individual life course, e.g. in infancy, childhood or adulthood. Mortality data, abstracted from the World Health Organization (WHO) database, are available for various countries. We used annual data on stomach cancer mortality in Japan, the United States (USA), the United Kingdom (UK), France and Korea during the period 1950–2009 by gender and 5-year age groups. We calculated age-specific stomach cancer mortality rates among individuals over 40 years of age in 9-year birth cohorts based on the mortality data grouped into 5-year intervals. Figure 1 shows an age-specific stomach cancer mortality trend by birth cohort in the five countries for males and Fig. 2 shows data for females.

Evaluation and Revision of Checklists for Screening Facilities and Municipal Governmental Programs for Gastric Cancer and Colorectal Cancer Screening in Japan

OBJECTIVE To evaluate the appropriateness of current checklists created by a governmental committee to assess screening programs run by municipal governments and service provider facilities for gastric and colorectal cancer, and to accumulate expert opinions to provide insights aimed at the next revision. METHODS We convened an expert panel that consisted of physicians nominated by regional offices of the Japanese Society for Gastrointestinal Cancer Screening and radiology technicians nominated by the technician chapter of the society. The panel rated the appropriateness of each checklist item on a scale of 1-9 (1, extremely inappropriate; 9, extremely appropriate) twice, between which they had a face-to-face discussion meeting. During the process they were allowed to propose modifications and additions to the items. RESULTS In the first round of rating, the panelists rated all 57 and 56 checklists items for gastric and colorectal cancer, respectively, as appropriate based on an acceptance rule determined a priori. During the process of the face-to-face discussion, however, the panel proposed modifications to 23 (40%) and 22 (39%) items, respectively, and the addition of 27 new items each. After integrating overlapping items and rating again for appropriateness, 66 and 64 items, respectively, were accepted as the revised checklist set. CONCLUSIONS The expert panel considered current checklists for colorectal and gastric cancer-screening programs and facilities to be suitable. Their proposals for a new set of checklist items will help further improve the checklists.

Morphological distribution of lung cancer from Cancer Incidence in Five Continents Vol. X

To compare the morphological distribution of cancer incidence worldwide, we abstracted the incidence in 2003–07 fromCancer Incidence in Five Continents Vol. X (CI5-X). The International Agency for Research on Cancer provides the CI5 detailed databases on the incidence of cancer recorded by cancer registries (regional and national) worldwide. We used the number of incidences in Japan, the Republic of Korea, the USA, Brazil, UK, Italy and Australia from the CI5 database which contains the incidence for selected cancer registries published in CI5-X for 2003–07. The Republic of Korea and the USA (NPCR: National Program of Cancer Registries) reported the cancer incidence covered by all the country; however, the remaining countries reported the cancer incidence by registry. We aggregated eight registries in Japan, two registries in Brazil, four registries in the UK, 22 registries in Italy and five registries in Australia. We compared the morphological distribution between countries for lung cancer coded as C34 (ICD10). The incidence of lung cancer was ranked in the top three for males and in the top six for females in all the countries studied. The age-standardized rates of lung cancer (including trachea cancer coded as C33) by world standard population (/100 000) were 42.7 in Japan, 49.8 in the Republic of Korea, 53.5 in the USA, 28.2 in Brazil, 44.9 in UK, 49.0 in Italy and 74.2 in Australia for males; 14.4 in Japan, 13.4 in the Republic of Korea, 36.4 in the USA, 12.9 in Brazil, 27.7 in UK, 11.6 in Italy and 19.7 in Australia for females. These rates were average values for several registries in some selected countries as described earlier. Figure 1 shows the distribution of morphology for males; Figure 2 shows these data for females. Squamous cell carcinoma (SCC), adenocarcinoma, small-cell carcinoma and large cell carcinoma made up ∼60% of all lung cancers, and 12–35% were unspecified morphology for both sexes. Sarcoma and other morphology were rarely classified. For males, adenocarcinoma was the first or the second most common morphology in all the countries. In Korea, >30% of the patients diagnosed with lung cancer had SCC. The proportion of SCC was ∼20% in other countries. The proportion of large cell carcinoma was important in Brazil, Italy and Australia and accounts for 17.9, 12.4 and 13.2%. In the USA, the UK and Australia, other specified carcinoma was common, at 20.8, 12.9 and 12.7%, respectively. For females, a wide variety of distribution of morphology was observed. In all the countries, adenocarcinoma was the predominant morphology, especially in Japan and the Republic of Korea, where it represents approximately half of all lung cancers. Adenocarcinoma was the most frequent morphology, representing ∼30% of all lung cancers in the USA, Brazil, Italy and Australia as well. In UK, adenocarcinoma was still the most frequent; however, SCC, small-cell carcinoma, and other specified carcinoma were also apparent. In the USA, UK and Australia, SCC and other specified carcinoma were often observed, at 10–14% and 12–20%, respectively.

Worldwide Relative Burden of Cancer Death in 2008 Extrapolated from the WHO Mortality Database

In order to compare the burden of cancer mortality worldwide, we abstracted the crude mortality rate in 2008 from the WHO mortality database. We used a crude mortality rate by cancer sites in Japan, the Philippines, the USA, Brazil, the UK, Poland and Australia. However, the most recent published mortality rate in Australia is from 2006. We selected five cancer sites with the highest mortality rates in each country and compared the difference between the sites and the distribution of cancer burden. Figure 1 shows the burden of cancer mortality ranking highest for males and Figure 2 shows these data for females. For males, the burden of cancer death at five major primary sites accounted for more than half of all cancer mortalities in all countries except the USA and Australia. In the seven countries, lung cancer was the most frequent cancer in varying proportions (14.8% in Brazil, to 32.3% in Poland). In all the countries except Japan and the Philippines, prostate cancer was placed second; it was third in the Philippines and fifth in Japan. Stomach cancer was the second most common cancer reported for Japan and liver cancer for the Philippines. Colon cancer was also a common form of cancer except in Brazil. It was the third most common cancer in the USA, the UK, Poland and Australia, and the fourth most frequent in Japan and the Philippines. In Japan, liver cancer was the third most frequent. For females, the burden of cancer death at five major primary sites accounted for 60.8% of all cancer mortalities in the USA and for nearly half in other countries. Lung, breast and colon cancer were the common forms of cancer in all the countries. In most of the countries, lung cancer was placed first, except for the Philippines and Brazil where it was second. Breast cancer was also common in most countries; the most frequent in the Philippines (24.1%) and Brazil (15.5%), and the second most frequent in the USA (15.0%), the UK (16.1%), Poland (13.1%) and Australia (15.5%). In contrast, it was the fifth most frequent in Japan (8.6%). In Japan, stomach cancer was the second most frequent in females (the same as for males), and it accounted for 5.9% in Brazil. Liver cancer was reported as the third most common for the Philippines, and cancer of the cervix uteri was reported as the third most common in Brazil. Pancreas cancer was placed fourth or fifth, except for the Philippines and Brazil. The distribution of burden of cancer death showed great variety; however, in ranking of the burden of cancer mortality, the USA was similar to Australia, and the UK was similar to Poland.

Evaluation of Feedback Interventions for Improving the Quality Assurance of Cancer Screening in Japan: Study Design and Report of the Baseline Survey

OBJECTIVE The importance of quality assurance in cancer screening has recently gained increasing attention in Japan. To evaluate and improve quality, checklists and process indicators have been developed. To explore effective methods of enhancing quality in cancer screening, we started a randomized control study of the methods of evaluation and feedback for cancer control from 2009 to 2014. METHODS We randomly assigned 1270 municipal governments, equivalent to 71% of all Japanese municipal governments that performed screening programs, into three groups. The high-intensity intervention groups (n = 425) were individually evaluated using both checklist performance and process indicator values, while the low-intensity intervention groups (n= 421) were individually evaluated on the basis of only checklist performance. The control group (n = 424) received only a basic report that included the national average of checklist performance scores. We repeated the survey for each municipalitys quality assurance activity performance using checklists and process indicators. RESULTS In this paper, we report our study design and the result of the baseline survey. The checklist adherence rates were especially low in the checklist elements related to invitation of individuals, detailed monitoring of process indicators such as cancer detection rates according to screening histories and appropriate selection of screening facilities. Screening rate and percentage of examinees who underwent detailed examination tended to be lower for large cities when compared with smaller cities for all cancer sites. CONCLUSIONS The performance of the Japanese cancer screening program in 2009 was identified for the first time.

Five-year Relative Survival Rate of Gallbladder Cancer in the USA, Europe and Japan

In order to compare survival rates in Japan with those in the USA and European countries, we abstracted the 5-year relative survival rate from several data sources. Survival rates of cancer diagnosed in 1995 – 99 in the USA were abstracted from 18 cancer registries in the Surveillance Epidemiology and End Results (SEER) data (1). Survival rates of cancer diagnosed in 1995 – 99 in the UK and Norway were from four cancer registries (Norway, the UK: Northern Ireland, the UK: Scotland and the UK: Wales) in the European Network of Cancer Registries (ENCR) data (2), and the rate of cancer diagnosed in 2000 – 2002 in Japan was reported from six cancer registries (Miyagi, Yamagata, Niigata, Fukui, Osaka, and Nagasaki) in the Monitoring of Cancer Incidence in Japan (MCIJ) project (3). Here, we compared the survival rate of gallbladder and other biliary cancer coded as C23 – C24 (ICD10). Figure 1 shows the 5-year relative survival rate of gallbladder and other biliary cancer by age category for males; Fig. 2 shows these data for females. The 5-year relative survival rate of gallbladder cancer was decreasing with age; however, the age differences were not so large compared with other cancer sites. This is because the rates in those below 55 years old were relatively lower than those of other cancer sites. The rates were between 10 and 30% for males, and between 10 and 20% for females. In Japan, the rates tend to be high in all age categories, and in the USA and European areas, the rates were similar.

Five-year Relative Survival Rate of Cancer in the USA, Europe and Japan

In order to compare survival rates in Japan with those in the USA and European countries, we abstracted the 5-year relative survival rate from several data sources. Survival rates of cancer diagnosed in 1995 – 99 in the USA were abstracted from 18 cancer registries in the Surveillance Epidemiology and End Results (SEER) data (1). Survival rates of cancer diagnosed in 1995 – 99 in the UK and Norway were obtained from three cancer registries (Norway, the UK: Northern Ireland, the UK: Scotland and the UK: Wales) in the European Network of Cancer Registries (ENCR) data (2), and the rate of cancer diagnosed in 2000 –0 2 in Japan was reported from six cancer registries (Miyagi, Yamagata, Niigata, Fukui, Osaka and Nagasaki) in the monitoring of cancer incidence in Japan (MCIJ) project (3). Here, we compared the survival rate of all cancer sites coded as C00 – 97 (ICD10) in the SEER and ENCR data and as C00 – 96 (ICD10) in the MCIJ data. Figure 1 shows the 5-year relative survival rate of all cancer sites by age category for males; Fig. 2 shows these data for females. The 5-year relative survival rates for females ,65 years old were higher than those for males and the rates for males and females aged � 65 years were in the same range. The reason why survival rates for young females are higher could be that breast and uterus cancers, which have high survival rates, are the main cancer for young females. The survival rates in the USA were the highest in all age – sex categories, except in 15 – 44 years for males. Otherwise, the rates in the UK were relatively lower than those in other countries. Norway and Japan showed similar survival rates in both sexes and all age categories. Basically, the older the age at diagnosis of cancer, the lower the 5-year survival rate; however, only in the USA for males, the rates in those ,75 years old were not changed. The reason why the survival rates for patients � 45 years of age in the USA were at the same level is that patients diagnosed with prostate cancer from PSA screening test had very high survival rates.

Subsite distribution of stomach cancer from Cancer Incidence in Five Continents Vol. X

In order to compare the subsite distribution of cancers occurring worldwide, we abstracted the incidence in 2003–2007 from Cancer Incidence in Five Continents Vol. X (CI5-X). The International Agency for Research on Cancer (IARC) provides the CI5 detailed databases on the incidence of cancer recorded by cancer registries (regional and national) worldwide. We used the number of incidences in Japan, the Republic of Korea, the USA, Brazil, the UK, Italy andAustralia from the CI5 databasewhich contains the incidence for selected cancer registries published inCI5-X for 2003–2007. TheRepublic of Korea and the USA (NPCR: National Program of Cancer Registries) reported the cancer incidence covered by all the country; however, the remaining countries reported the cancer incidence by registry.We aggregated eight registries in Japan, two registries in Brazil, four registries in the UK, 21 registries in Italy, and five registries in Australia. We compared the subsite distribution between countries for stomach cancer coded as C16 (ICD10). Figure 1 shows the subsite distribution for stomach cancer for males; Fig. 2 shows these data for females. These data were calculated excluding the cases classified as ‘other and unspecified carcinoma’. Briefly, the proportion of ‘other and unspecified carcinoma’ was 40–50% in Japan, the Republic of Korea and the USA, and 50–60% in the UK, Italy and Australia; however, it was extremely high in Brazil (approximately 90%). In Japan and the Republic of Korea, the subsite distributions were similar for both sexes; body and pylorus and antrummade up about 90% of all stomach cancer in these countries. However, the proportion of each subsite was different between these countries; pylorus and antrum was the most predominant subsite in the Republic of Korea (54–56%), whereas body was the most predominant in Japan (47–49%). The proportions of cardia and fundus in Japan were higher than those in the Republic of Korea. In Brazil and Italy, for both sexes, the proportion of body was relatively high (approximately 25%), following Japan and the Republic of Korea (40–50%). However, as described above, the proportion of ‘other and unspecified carcinoma’was extremely high in Brazil (approximately 90%), and the data should be interpreted carefully. In Italy, fundus was comparatively high, and pylorus and antrum was the leading subsite. In the USA and Australia, the differences in the distribution pattern between males and females were similar. Thus, in both countries for males, the leading subsite was cardia (58–60%), followed by pylorus and antrum (25%). For females, the proportion of pylorus and antrum (40%) was slightly higher than that of cardia (31–40%). In the UK, the proportion of cardia was very much higher than that of other countries for both sexes. Overall, the proportion of cardiawas relatively high for males; the proportions of cardia and pylorus and antrumwere relatively high for females.

Five-year Relative Survival Rate of Larynx Cancer in the USA, Europe and Japan

In order to compare survival rates in Japan with those in the USA and European countries, we abstracted the 5-year relative survival rate from several data sources. Survival rates of cancer diagnosed in 1995 – 99 in the USA were abstracted from 18 cancer registries in the Surveillance Epidemiology and End Results (SEER) data (1). Survival rates of cancer diagnosed in 1995 – 99 in the UK and Norway were from four cancer registries (Norway, the UK: Northern Ireland, the UK: Scotland and the UK: Wales) in the European Network of Cancer Registries (ENCR) data (2), and the rate of cancer diagnosed in 2000 – 2002 in Japan was reported from six cancer registries (Miyagi, Yamagata, Niigata, Fukui, Osaka, and Nagasaki) in the Monitoring of Cancer Incidence in Japan (MCIJ) project (3). Here, we compared the cancer survival rate for larynx coded as C32 (ICD10). Figure 1 shows the 5-year relative survival rate of larynx cancer by age category for males; Fig. 2 shows these data for females. In these figures, even if the 5-year relative survival rate was over 100%, the rate was shown as it was. The survival rates for males are in the range from 60 to 80% for all age categories. In Japan, the rates are the highest in almost all age groups. In the USA and the UK (Scotland and Wales), survival rates are the highest in the youngest age category and they decrease with age afterwards. The degree of the decrease in survival rate with age in the USA is a little smaller than those in the UK, and is almost constant especially after 55 – 64 years old. The rates in Japan, Norway, and Northern Ireland show a similar trend. Those in the former two countries are the highest in those aged 45 – 54 years, and that in Northern Ireland is the highest in those aged 55– 64 years. Survival rates in these three countries decrease gently after these peaks. The survival rates for females are in the range from 40 to 100%. Since the incident rates of larynx cancer among females are considerably low (4), the relative survival rates in Japan and UK exceed 100% and the age trends are not smooth. However, it seems to be clear that the survival rate in Japan is higher than those in other countries, and that the survival rate in the advanced age group tends to be lower.

Trends in the quality assurance process indicators for Japanese colorectal cancer screening during 2003–13

Background Recently, the importance of quality assurance (QA) for cancer screening has gained increasing attention in Japan. This study aimed to evaluate QA process indicators for population-based colorectal cancer screening during 2003-13. Methods A national cancer screening database was used to evaluate the following process indicators: the positivity rate, diagnostic follow-up rate, unidentified results rate, non-compliance with diagnostic follow-up rate, cancer detection rate and positive predictive value (PPV). Results The positivity rate remained constant at 6.5% until 2011, and then increased slightly thereafter. During 2003-13, the cancer detection rate increased from 0.15% to 0.21%, and the PPV increased from 2.2% to 3.1%. Although the diagnostic follow-up rate increased from 58% to 67%, the non-compliance with diagnostic follow-up rate decreased from 24% to 16% and the unidentified results rate decreased from 18% to 17%. Conclusions During the study period, the QA process indicators for colorectal cancer screening in Japan generally improved. However, the recent increase in the positivity rate requires careful observation. Innovative solutions are needed to increase the diagnostic follow-up rate.