This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21660

Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

Viral hepatitis in all its forms is a major public health problem throughout the world, affecting several hundreds of millions of people. Viral hepatitis is a cause of considerable morbidity and mortality both from acute infection and chronic sequelae which include, in the case of hepatitis B, C and D, chronic active hepatitis and cirrhosis. Hepatocellular carcinoma, which is one of the 10 commonest cancers worldwide, is closely associated with hepatitis B and, at least in some regions of the world, with hepatitis C virus. This timely monograph is a distillation of knowledge of hepatitis B, C and D, based on a review of 1000 studies by a small group of scientists. (It is interesting to note in passing that some 5000 papers on viral hepatitis are published annually in the world literature.) The epidemiological, clinical and experimental data on the association between infection with hepatitis B virus and primary liver cancer in humans are reviewed in a readable and succinct format. The available information on hepatitis C and progression to chronic infection is also evaluated and it is concluded (perhaps a little prematurely) that hepatitis C virus is carcinogenic. However, it is concluded that hepatitis D virus, an unusual virus with a number of similarities to certain plant viral satellites and viroids, cannot be classified as a human carcinogen. There are some minor criticisms: there are few illustrations and some complex tabulations (for example, Table 6) and no subject index. A cumulative cross index to IARC Monographs is of little value and occupies nearly 30 pages. This small volume is a useful addition to the overwhelming literature on viral hepatitis, and the presentation is similar to the excellent World Health Organisation Technical Reports series on the subject published in the past. It is strongly recommended as a readable up-to-date summary of a complex subject; and at a cost of 65 Sw.fr (approximately £34) is excellent value. A J ZUCKERMAN

https://jcp.bmj.com/content/jclinpath/48/7/691.1.full.pdf

IARC Monographs on the Evaluation of Carcinogenic Risks to Humans

Prospective Cohort Study

2 1 The innovative transport systems and the CityMobil project 10 1.1 The research questions 10 2 The state of art in the field of automatic transport systems 12 2.1 Case studies and demand studies for innovative transport systems 12 3 The design and implementation of surveys 14 3.1 Definition of experimental design 14 3.2 Questionnaire design and delivery 16 3.3 First analyses on the collected sample 18 4 Calibration of Logit Multionomial demand models 21 4.1 Methodology 21 4.2 Calibration of the “full” model. 22 4.3 Calibration of the “final” model 24 4.4 The demand analysis through the final Multinomial Logit model 25 5 The analysis of interaction between the demand and socioeconomic attributes 31 5.1 Methodology 31 5.2 Application of Mixed Logit models to the demand 31 5.3 Analysis of the interactions between demand and socioeconomic attributes through Mixed Logit models 32 5.4 Mixed Logit model and interaction between age and the demand for the CTS 38 5.5 Demand analysis with Mixed Logit model 39 6 Final analyses and conclusions 45 6.1 Comparison between the results of the analyses 45 6.2 Conclusions 48 6.3 Answers to the research questions and future developments 52

The European commission

Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012

In this study the regional trends in the incidence of cervical cancer in Denmark from 1943 to 1977 are related to available data on the total smear-taking activity in the regions. In 1980 some 40% of women in Denmark were covered by organized screening programmes, but the total number of smears taken in the country was sufficient to cover the whole female population by an organized programme. Therefore, in order to evaluate the impact of the screening activity in Denmark account must be taken of trends in cervical cancer from areas both with and without organized programmes and of data for smears taken both in and outside the programmes. The study shows a considerable decline in the cumulative incidence of cervical cancer for women aged 30-59 in areas with organized screening programmes commenced before 1969. The decline in areas without organized programmes but with a higher or equivalent screening activity in 1974/75 is in general smaller or occurring later. In half of the areas with a lower level of smear-taking activity in 1974/75 only minor reductions in the incidence of cervical cancer are observed. Hysterectomies cannot explain the decline in the incidence for women below the age of 60. The observed pattern gives further evidence of a decline in the incidence of cervical cancer following the introduction of pap smears, but future trends should be kept under close surveillance.

Regional Trends in Incidence of Cervical Cancer in Denmark in Relation to Local Smear-Taking Activity

The incidence of ovarian cancer and non-Hodgkin's lymphomas (NHL) between 1971 and 1985 or 1987 has been studied on the basis of cancer registry data among women employed in hairdressing or related occupations at 1970 census in Denmark, Sweden, Norway, and Finland. Overall, the standardized incidence ratio (SIR) for ovarian cancer was 1.18 (95% confidence interval, 0.98 to 1.40). The increase was present among hairdressers from Denmark (SIR, 1.23) and Finland (SIR, 1.88); whereas hairdressers from Sweden and Norway had an incidence close to expectation (SIR 0.95 and 0.96, respectively). In three of the four countries, the SIR was higher in 1971 to 1975 than in later years. The SIR for NHL was 1.20 (0.84 to 1.66); an excess was seen in Denmark (SIR, 1.92) and a decrease was found in Sweden (SIR, 0.63). In previous studies, hairdressers have been reported to be at increased risk of ovarian cancer: this study adds some evidence in favor of the presence of an association. This study also offers some support to the hypothesis of an association between exposure to hair dyes and risk of NHL, that was reported among personal users from the United States. This study, however, strongly suggests that occupational cancer risk among female hairdressers depends on temporal and geographical factors.

Employment as hairdresser and risk of ovarian cancer and non-Hodgkin's lymphomas among women

Patterns of cervical coinfection with multiple human papilloma virus types in a screening population in Denmark.

At the end of last year the BMJ published two studies by Barker and colleagues, on the relation between growth in utero and serum cholesterol concentration in adult life1 and mortality from cardiovascular disease.2 The first study used records from a hospital in Sheffield from 1939-40 on weight, length, and the circumference of the head, chest, and abdomen at birth. The second used midwives' and health visitors' records from Hertfordshire from 1911 onwards on birth weight, infant feeding, and weight at 1 year. Both sets of records included enough personal identification to enable the researchers to trace the subjects' deaths or addresses four to eight decades later. Most people would agree that these studies are valuable and have major public health implications. Nevertheless, record linkage studies like these are potentially under threat from a proposed European Union directive on confidential data.

The draft directive was first proposed in 1990 and is now in its second version,3 with amendments being negotiated …

European directive on confidential data: a threat to epidemiology.

The selective uptake of screening by healthy participants and its impact on the evaluation of screening effectiveness in non-randomized studies have been discussed, but hardly studied. We quantified excess mortality among cervical screening non-participants compared to participants. Based on Danish healthcare registers, we determined women's participation in cervical screening in 1990-1993 (one screening round) and 1990-1997 (two screening rounds). Women were followed until end of 2010. We computed hazard ratios (HR) comparing non-participants' and participants' risk of death, and analyzed the impact of age, calendar period of screening evaluation, screening intensity, length of follow-up and cause of death. After one screening round, the 17-year HR of death in non-participants was 1.61 (95% CI: 1.59-1.63), with an increasing trend over calendar time. After two rounds, regular non-participants had a HR of 2.09 (95% CI: 2.05-2.14) compared to regular participants. The HR for human papillomavirus (HPV)-related cancers other than cervical cancer was 3.80 (95% CI: 2.67-5.41). Younger women, whose coverage rates were higher, had higher all-cause mortality HRs. Women screened more frequently than recommended had the same mortality as those screened as recommended. Acute illness did not seem to be a major reason for non-participation, as the excess risk of death was not higher in the first years following screening evaluation. Non-participants in cervical screening had substantially higher all-cause mortality than participants, and a particularly increased risk of HPV-related causes of death. These results indicate that improper control for the selective uptake of cervical screening may result in overestimating its effectiveness.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.28586

Elsebeth Lynge

Papers

Regional Trends in Incidence of Cervical Cancer in Denmark in Relation to Local Smear-Taking Activity

Employment as hairdresser and risk of ovarian cancer and non-Hodgkin's lymphomas among women

Patterns of cervical coinfection with multiple human papilloma virus types in a screening population in Denmark.

European directive on confidential data: a threat to epidemiology.

Mortality of non-participants in cervical screening: Register-based cohort study.