Liver cancer epidemic in China: past, present and future.

Prostate specific antigen (PSA) screening was introduced to detect prostate cancer at an early stage and to reduce prostate cancer-specific mortality. Until results from clinical trials are available, the efficacy of PSA screening in reducing prostate cancer mortality can be estimated by surveillance of prostate cancer mortality trends. Our study analyzes recent trends in prostate cancer mortality in 38 countries. We used the IARC-WHO cancer mortality database and performed joinpoint analysis to examine prostate cancer mortality trends and identified 3 patterns. In USA, and to a lesser extent in Germany, Switzerland, Canada, France, Italy and Spain, prostate cancer-specific mortality decreased to a level lower than before the introduction of PSA screening. In Australia, New Zealand, Austria, Finland, The Netherlands, Norway, United Kingdom, Hungary, Slovakia, Israel, Singapore, Sweden and Portugal, mortality from prostate cancer decreased but rates remain higher than before the introduction of PSA screening. Prostate cancer mortality continued to increase in Belgium, Denmark, Greece, Ireland, Bulgaria, Czech Republic, Belarus, Ukraine, Russian Federation, Romania, Poland, Argentina, Chile, Cuba, Mexico, Japan, China Hong Kong and the Republic of Korea. The trends in prostate cancer mortality rates in examined countries suggest that PSA screening may be effective in reducing mortality from prostate cancer.

Recent trends in prostate cancer mortality show a continuous decrease in several countries

Recent progress in malaria control has caused renewed interest in mass drug administration (MDA) as a potential elimination strategy but the evidence base is limited. China has extensive experience with MDA, but it is not well documented. An ecological study was conducted to describe the use of MDA for the control and elimination of Plasmodium vivax in Jiangsu Province and explore the association between MDA and malaria incidence. Two periods were focused on: 1973 to 1983 when malaria burden was high and MDA administered to highly endemic counties province-wide, and 2000 to 2009, when malaria burden was low and a focal approach was used in two counties. All available data about the strategies implemented, MDA coverage, co-interventions, incidence, and adverse events were collected and described. Joinpoint analysis was used to describe trends in incidence and the relationship between MDA coverage and incidence was explored in negative binomial regression models. From 1973 to 1983, MDA with pyrimethamine and primaquine was used on a large scale, with up to 30 million people in target counties covered in a peak year (50% of the total population). Joinpoint analyses identified declines in annual incidence, -56.7% (95% CI -75.5 to -23.7%) from 1973–1976 and -12.4% (95% CI -24.7 to 2.0%) from 1976–1983. Population average negative binomial models identified a relationship between higher total population MDA coverage and lower monthly incidence from 1973–1976, IRR 0.98 (95% CI 0.97 to 1.00), while co-interventions, rainfall and GDP were not associated. From 2000–2009, incidence in two counties declined (annual change -43.7 to -14.0%) during a time when focal MDA using chloroquine and primaquine was targeted to villages and/or individuals residing near passively detected index cases (median 0.04% of total population). Although safety data were not collected systematically, there were rare reports of serious but non-fatal events. In Jiangsu Province, China, large-scale MDA was implemented and associated with declines in high P. vivax malaria transmission; a more recent focal approach may have contributed to interruption of transmission. MDA should be considered a potential key strategy for malaria control and elimination.

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Mass drug administration for the control and elimination of Plasmodium vivax malaria: an ecological study from Jiangsu province, China

Relationships between arsenic concentrations in drinking water and lung and bladder cancer incidence in U.S. counties

Relationships between arsenic concentrations in drinking water and lung and bladder cancer incidence in U.S. counties.

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

The aim of the present paper was to analyse cancer mortality in the Umbria region, from 1978 to 2004. Mortality trends depend on a number of factors including exposures, health system interventions, and possibly artefact (e.g. classification change, variations of data completeness). Descriptive data on mortality only allow for generation of hypotheses to explain observed trends. Some clues on the respective role of possible mortality determinants may be found comparing mortality with incidence and survival data. Mortality data for the periods 1978–1993 and 1994–2004 were supplied by the National Institute of Statistics (ISTAT) and the Regional Causes of Death Registry (ReNCaM) respectively. Sex and site-specific mortality time trends were analysed by the "joinpoint regression" method. For all sites combined, in both sexes, the standardised rate was first increasing before the end of the eighties and decreasing thereafter. Gastric cancer mortality showed a different trend by gender; that is the rate constantly decreased over the period among females while, for males, it was first increasing up to 1985 and decreasing thereafter. Liver cancer trend showed a pattern similar to gastric cancer. Large bowel cancer showed a gender specific trend, that is it was increasing among males and stable among females. Also lung cancer mortality varied by gender: it started to decline after 1989 among males but was steadily increasing over the study period among women. A decreasing trend for female breast cancer mortality began in 1994. Prostate cancer mortality trend is the only one showing two significant joinpoints: mortality decreased up to 1990, then it increased up to 1998 and, finally, was decreasing. Overall cancer mortality was decreasing in both sexes in Umbria and this favourable trend will probably continue and further improve since population screening against breast, cervix, and large bowel cancers were recently introduced. Besides gastric cancer, tobacco-related cancers and prostate cancer mainly contributed to mortality reduction in males, whereas breast cancer mainly contributed to declining mortality in females.

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Cancer mortality trends in the Umbria region of Italy 1978–2004: a joinpoint regression analysis

Differences in gynaecological cancer incidence and mortality in the urban and rural areas of the Umbria region (central Italy) were investigated. All women with primary invasive breast cancers, uterine cervix and uterine corpus, and ovarian cancers diagnosed during the periods 1978-1982 and 1998-2002 were identified and analysed according to place of residence (either urban or rural). Mortality data were supplied by the National Institute of Statistics (ISTAT) for the period 1978 to 1982, whereas for the 1994-2002 period they were supplied by the Regional Nominative Causes of Death Registry (ReNCaM). Incident cases considered were taken from an ad hoc survey for the first period and from the Umbrian Population Cancer Registry database for the second one. For each site the age-adjusted incidence (AAIR) and mortality (AADR) rates were calculated. The expected number of rural cases was obtained from indirect standardisation with urban incidence and mortality rates of several sites. The significance of the observed expected ratios (SIRs for incidence and SMRs for mortality) and the corresponding 95% confidence intervals were based on the Poisson distribution. Urbanisation levels were established following the classification of the Italian Institute of Statistics. For all sites, excluding the ovary during the most recent period, the SIR relative to rural areas was below 1, but the rates were statistically significant only for breast cancer in both periods (SIR 0.81, 95% CI 0.74-0.88 and SIR 0.82, 95% CI 0.77-0.88, respectively) and for cervix uteri in the first period (SIR 0.77, 95% CI 0.59-0.94). The lower breast cancer incidence in the rural area could also be due to lesser compliance with screening procedures which, up until 2002, were not provided in the form of mass-screenings throughout the region by the Regional Health Department. These results underscore the need for continued efforts to provide preventive health services to medically underserved women throughout Umbria, including rural communities. Underutilisation of preventive healthcare services may result in failure to identify healthcare problems that might be successfully managed with medication or lifestyle changes, as well as missed opportunities to prevent potentially life-threatening diseases.

Urban-rural differences in gynaecological cancer occurrence in a central region of Italy: 1978-1982 and 1998-2002.

The aim of the present paper is to analyse the mortality from external causes in the Umbria region, from 1994 to 2004, in order to have an indication of the effectiveness of primary prevention interventions. Sex and cause-specific AADR (the age-adjusted death rates) and YPLL rates (the age-adjusted rates of years of potential life lost up to 74 yrs) time trends were analysed by means of joinpoint regression utilising SEER software. The expected annual percent change and its significance were also calculated. The cause groups examined were: all external causes, transport accidents, falls, accidental poisoning and exposure to noxious substances, intentional self-harm and assault. The age-adjusted death rates from the selected external causes showed, in both sexes, a decreasing trend. The joinpoint regression of AADR indicated that all statistically significant variations are declining. For the AADR cause group significant decreases were found in all external combined and poisoning causes for both sexes, transport accidents and falls for females. Among males the age-adjusted YPLL rates showed significant decreases for all external causes combined (EACP = -2.8%). This analysis provides a useful tool to evaluate the effectiveness of interventions performed in the last decade and indicates that further assessment and monitoring are needed.

Trends of mortality from external causes in the Umbria region of Italy: 1994-2004

Background: The aim of this study is to verify the existence of different rates of cancer incidence and mortality in males in the urban and rural populations of Umbria and to formulate hypotheses as to why this occurs. Methods: Directly age-adjusted incidence rates (AAIR) and age-adjusted death rates (AADR) were calculated for 1998-2002 and the expected number of rural cases (standardized incidence ratios-SIRs and standardized mortality ratios-SMRs) was determined by indirect standardization using urban incidence and mortality. Results: Urban zones have higher AAIR’s for the most common cancer sites. Significantly lower SIRs, in rural areas, were shown for skin melanoma, prostate and bladder cancers and a significantly lower SIR was also determined for the combination of all cancer sites. Lower AADRs in rural areas were demonstrated for the most common cancer sites and significant low SMRs were shown for lung cancer and skin melanoma. Prostate cancer incidence is significantly higher in urban areas whereas the mortality rate is slightly higher in rural municipalities probably due to the effects of the opportunistic screening widely available in Umbria, particularly in zones near diagnostic services. A very similar pattern was found for urinary bladder cancer; this could be related to the association between prostate and bladder cancer sites. Both incidence and mortality from melanoma are significantly lower in rural areas, this may be due to the difficulty in accessing diagnostic services or/and to different occupational exposure patterns. Conclusion: It would appear in Umbria that differences in health services utilization continue to exist. In particular, our results are compatible with a lower diffusion of preventive activities for prostate cancer and skin melanoma in rural areas.

Urban-rural differences in male cancer incidence and mortality in the Umbria region of Italy

In order to obtain information regarding the efficacy of healthcare services in the region of Umbria (Italy), trends in mortality due to the main causes of death in this region, between 1994-2004, were analysed. Mortality data was collected from the Nominal Registry of Causes of Death. Standardized mortality and years of potential life lost (YPLL) rates, and cumulative death risk were used as indicators. Joinpoint regression was used to determine whether temporal changes in indicator trends were statistically significant. The joinpoint analysis of mortality trends has shown that general mortality, as well as specific mortality due to malignant tumors, cardiovascular disease, gastrointestinal disease and accidental causes declined over the examined time period. Statistically significant decreases in the indicators used were constant over time: in fact, joinpoints were found only for YPLL and cumulative risk trends for cardiovascular disease-related mortality. These results have provided important information regarding healthcare in the Umbria region.

Antonio Canosa

Papers

Cancer mortality trends in the Umbria region of Italy 1978–2004: a joinpoint regression analysis

Urban-rural differences in gynaecological cancer occurrence in a central region of Italy: 1978-1982 and 1998-2002.

Trends of mortality from external causes in the Umbria region of Italy: 1994-2004

Urban-rural differences in male cancer incidence and mortality in the Umbria region of Italy

[Trends in mortality due to the main causes of death in Umbria (Italy), 1994-2004].