Showing papers by "Freddie Bray published in 2015"

Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.

Abstract: Estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. We review the sources and methods used in compiling the national cancer incidence and mortality estimates, and briefly describe the key results by cancer site and in 20 large “areas” of the world. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung (1.82 million), breast (1.67 million), and colorectal (1.36 million); the most common causes of cancer death were lung cancer (1.6 million deaths), liver cancer (745,000 deaths), and stomach cancer (723,000 deaths).

Global cancer statistics, 2012

Abstract: Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.

Expanding global access to radiotherapy

Abstract: Summary Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015–35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015–35 is US$26·6 billion in low-income countries, $62·6 billion in lower-middle-income countries, and $94·8 billion in upper-middle-income countries, which amounts to $184·0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14·1 billion in low-income, $33·3 billion in lower-middle-income, and $49·4 billion in upper-middle-income countries—a total of $96·8 billion. Scale-up of radiotherapy capacity in 2015–35 from current levels could lead to saving of 26·9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278·1 billion in 2015–35 ($265·2 million in low-income countries, $38·5 billion in lower-middle-income countries, and $239·3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365·4 billion ($12·8 billion in low-income countries, $67·7 billion in lower-middle-income countries, and $284·7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16·9 billion in 2015–35 (–$14·9 billion in low-income countries; –$18·7 billion in lower-middle-income countries, and $50·5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104·2 billion (–$2·4 billion in low-income countries, $10·7 billion in lower-middle-income countries, and $95·9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits.

International Variation in Female Breast Cancer Incidence and Mortality Rates

Abstract: Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer-related death among women worldwide. Herein, we examine global trends in female breast cancer rates using the most up-to-date data available. Methods: Breast cancer incidence and mortality estimates were obtained from GLOBOCAN 2012 (globocan.iarc.fr). We analyzed trends from 1993 onward using incidence data from 39 countries from the International Agency for Research on Cancer and mortality data from 57 countries from the World Health Organization. Results: Of 32 countries with incidence and mortality data, rates in the recent period diverged—with incidence increasing and mortality decreasing—in nine countries mainly in Northern/Western Europe. Both incidence and mortality decreased in France, Israel, Italy, Norway, and Spain. In contrast, incidence and death rates both increased in Colombia, Ecuador, and Japan. Death rates also increased in Brazil, Egypt, Guatemala, Kuwait, Mauritius, Mexico, and Moldova. Conclusions: Breast cancer mortality rates are decreasing in most high-income countries, despite increasing or stable incidence rates. In contrast and of concern are the increasing incidence and mortality rates in a number of countries, particularly those undergoing rapid changes in human development. Wide variations in breast cancer rates and trends reflect differences in patterns of risk factors and access to and availability of early detection and timely treatment. Impact: Increased awareness about breast cancer and the benefits of early detection and improved access to treatment must be prioritized to successfully implement breast cancer control programs, particularly in transitioning countries. Cancer Epidemiol Biomarkers Prev; 24(10); 1495–506. ©2015 AACR .

Cancer Incidence in Five Continents: Inclusion criteria, highlights from Volume X and the global status of cancer registration.

Abstract: Cancer Incidence in Five Continents (CI5), a longstanding collaboration between the International Agency for Research on Cancer and the International Association of Cancer Registries, serves as a unique source of cancer incidence data from high-quality population-based cancer registries around the world. The recent publication of Volume X comprises cancer incidence data from 290 registries covering 424 populations in 68 countries for the registration period 2003-2007. In this article, we assess the status of population-based cancer registries worldwide, describe the techniques used in CI5 to evaluate their quality and highlight the notable variation in the incidence rates of selected cancers contained within Volume X of CI5. We also discuss the Global Initiative for Cancer Registry Development as an international partnership that aims to reduce the disparities in availability of cancer incidence data for cancer control action, particularly in economically transitioning countries, already experiencing a rapid rise in the number of cancer patients annually.

The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Selected High-Resource Countries.

Abstract: Background: Thyroid cancer (TC) incidence is rising in many countries, but the corresponding mortality is constant or declining. Incidence increases appear largely restricted to small papillary TC in young/middle-age individuals. We compared age-specific incidence rates across countries and time periods in order to estimate the fraction of TC possibly attributable to increased surveillance of the thyroid gland (diagnostic changes) following the introduction of neck ultrasonography in the 1980s. Methods: We focused on high-resource countries, including four Nordic countries, England and Scotland, France, Italy, the United States, Australia, Japan, and the Republic of Korea. Before the 1970s, TC incidence in Nordic countries increased proportionally to the second power of age, consistent with the multistage model of carcinogenesis. Using this historical observation for reference, we attributed the progressive departure from linearity of the age curves in each country to an increased detection of asymptomati...

The Changing Global Burden of Cancer: Transitions in Human Development and Implications for Cancer Prevention and Control

Abstract: Changes in fertility and life expectancy are leading to major changes in the structure of the global population and, in turn, in the scale of the cancer problem worldwide and at every resource level (WHO 2011b). In addition to the increasing burden of cancer is a changing spectrum of common cancers that is in different regions correlated with levels of human development (Bray and others 2012). The ongoing cancer transition includes a reduction in infection-related cancers (for example, stomach and cervical cancer) that is offset by increases in cancers linked to a Westernization of lifestyle (for example, breast, prostate, and colorectal cancer). The transition also encompasses changes in risk behavior, including tobacco uptake, with a delayed but large impact on the burden from lung and other tobacco-related cancers (Bray and others 2012). The cancer transition is not uniform, however: in Sub-Saharan Africa, recent increases in cervical cancer are observed in Uganda and Zimbabwe; in many countries, a residual burden of cancers associated with infectious agents accompanies the increasing burden of cancers associated with economic transition (Parkin and others 2014).This chapter presents a global overview of the cancer burden, patterns and profiles, recent trends in common cancers, and the expected future scale of the disease by 2030.We link geographical and temporal patterns of cancer to corresponding levels of economic progress to provide an overview of the key characteristics of the global cancer transition. We use gross national income (GNI) per capita as a national indicator of societal as well as economic development ( http://data.worldbank.org/news/new-country-classifications ), and corresponding rates of cancer incidence and mortality as markers of the extent of the global cancer transition. We draw attention to geographical variations and trends in cancer-specific rates according to differing economic profiles and in each of the world’s regions. In addition, we provide a global, trends-based projection of the likely cancer burden in 2030, based on historical trends refined by incorporating an indicator of level of development.We also examine the number of potentially avoidable new cases and cancer deaths, assuming a reduction in risk factors (Hanley 2001). Even today, tobacco smoking is by far the most important risk factor for cancer (Lim and others 2012). Although the smoking habit is in decline in many high-income countries (HICs), tobacco consumption is still rising in many low- and middle-income countries (LMICs) (Thun and others 2012). As part of the global socioeconomic transition, many countries presently classified as low- or middle-income are increasingly adopting Westernized diets and more sedentary and less physically active lifestyles, leading to a rapid shift in the profile of common cancers in these populations (Bray and others 2012). In view of these developments, this chapter also reviews the main causes of cancer, with an emphasis on the sources of disparities that contribute to an increasingly greater proportional burden from cancer in LMICs, and the prospects for cancer control in different settings.We conclude by pointing to how the high-level political commitment to reduce the rising burden of cancer and other noncommunicable diseases (NCDs) can advance the measurement of cancer to inform cancer control action. There remains an overwhelming need to improve the quality and coverage of population-based cancer registration in most LMICs, as an essential component in planning and evaluating national cancer control activities.This chapter uses the World Health Organization’s (WHO) geographical regions: Africa, the Americas, South-East Asia, Europe, Eastern Mediterranean, and Western Pacific.

International patterns and trends in testicular cancer incidence, overall and by histologic subtype, 1973-2007

Abstract: Background Incidence rates of testicular cancer in Northern European and North American countries have been widely reported, whereas rates in other populations, such as Eastern Europe, Central/South America, Asia, and Africa, have been less frequently evaluated. We examined testicular cancer incidence rates overall and by histologic type by calendar time and birth cohort for selected global populations 1973-2007.

Bone cancer incidence by morphological subtype: a global assessment.

Abstract: To better understand the relevance of environmental factors to the changing patterns of bone cancer subtypes, we examine the incidence of osteosarcoma (OS), Ewing sarcoma (ES), and chondrosarcoma (CS) using data from cancer incidence in five continents. Age-specific and age-standardized incidence rates (ASRs) per 100,000 person-years were computed and stratified by country (n = 43), subtype, and sex during 2003–2007. Temporal patterns of ASRs were examined during 1988–2007 (12 countries). Age–period–cohort models were fitted for the USA and UK by subtype. For most countries, OS represented 20–40 % of all bone cancers, ES < 20 %, while CS proportions varied more considerably. Overall ASRs of bone cancers were 0.8–1.2/100,000 in men and 0.5–1.0 in women (0.20–0.35/100,000 for OS and 0.10–0.30/100,000 for CS in both men and women, and <0.10–0.25/100,000 in men and 0.05–0.25/100,000 in women for ES). The age-specific incidence rates revealed a bimodal peak of OS, one peak of ES in childhood, and a more heterogeneous pattern for CS. The overall bone cancer incidence trends are generally flat, but more heterogeneous for ES and CS. A declining OS incidence was observed in the UK and USA (men), an increase in CS in the UK and USA (female), and an apparent increase in ES, followed by a leveling off in successive US and UK cohorts. Monitoring bone cancer incidence trends with data assembled from a geographically broader range of registries may generate hypotheses about additional risk factors and ensure that high-risk populations are not overlooked in cancer control efforts.

Cancer incidence in indigenous people in Australia, New Zealand, Canada, and the USA: a comparative population-based study

Abstract: Summary Introduction Indigenous people have disproportionally worse health and lower life expectancy than their non-indigenous counterparts in high-income countries. Cancer data for indigenous people are scarce and incidence has not previously been collectively reported in Australia, New Zealand, Canada, and the USA. We aimed to investigate and compare, for the first time, the cancer burden in indigenous populations in these countries. Methods We derived incidence data from population-based cancer registries in three states of Australia (Queensland, Western Australia, and the Northern Territory), New Zealand, the province of Alberta in Canada, and the Contract Health Service Delivery Areas of the USA. Summary rates for First Nations and Inuit in Alberta, Canada, were provided directly by Alberta Health Services. We compared age-standardised rates by registry, sex, cancer site, and ethnicity for all incident cancer cases, excluding non-melanoma skin cancers, diagnosed between 2002 and 2006. Standardised rate ratios (SRRs) and 95% CIs were computed to compare the indigenous and non-indigenous populations of each jurisdiction, except for the Alaska Native population, which was compared with the white population from the USA. Findings We included 24 815 cases of cancer in indigenous people and 5 685 264 in non-indigenous people from all jurisdictions, not including Alberta, Canada. The overall cancer burden in indigenous populations was substantially lower in the USA except in Alaska, similar or slightly lower in Australia and Canada, and higher in New Zealand compared with their non-indigenous counterparts. Among the most commonly occurring cancers in indigenous men were lung, prostate, and colorectal cancer. In most jurisdictions, breast cancer was the most common cancer in women followed by lung and colorectal cancer. The incidence of lung cancer was higher in indigenous men in all Australian regions, in Alberta, and in US Alaska Natives than in their non-indigenous counterparts. For breast cancer, rates in women were lower in all indigenous populations except in New Zealand (SRR 1·23, CI 95% 1·16–1·32) and Alaska (1·14, 1·01–1·30). Incidence of cervical cancer was higher in indigenous women than in non-indigenous women in most jurisdictions, although the difference was not always statistically significant. Interpretation There are clear differences in the scale and profile of cancer in indigenous and non-indigenous populations in Australia, New Zealand, Canada, and the USA. Our findings highlight the need for much-improved, targeted programmes of screening, vaccination, and smoking cessation, among other prevention strategies. Governments and researchers need to work in partnership with indigenous communities to improve cancer surveillance in all jurisdictions and facilitate access to cancer data. Funding International Agency for Research on Cancer–Australia Fellowship.

Long-Term Realism and Cost-Effectiveness: Primary Prevention in Combatting Cancer and Associated Inequalities Worldwide

Abstract: The global figure of 14 million new cancer cases in 2012 is projected to rise to almost 22 million by 2030, with the burden in low- and middle-income countries (LMICs) shifting from 59% to 65% of all cancer cases worldwide over this time. While the overheads of cancer care are set to rapidly increase in all countries worldwide irrespective of income, the limited resources to treat and manage the growing number of cancer patients in LMICs threaten national economic development. Current data collated in the recent second edition of The Cancer Atlas by the American Cancer Society and International Agency for Research on Cancer show that a substantial proportion of cancers are preventable and that prevention is cost-effective. Therefore, cancer control strategies within countries must prioritize primary and secondary prevention, alongside cancer management and palliative care and integrate these measures into existing health care plans. There are many examples of the effectiveness of prevention in terms of declining cancer rates and major risk factors, including an 80% decrease in liver cancer incidence rates among children and young adults following universal infant hepatitis B vaccination in Taiwan and a 46% reduction in smoking prevalence in Brazil after the implementation of a more aggressive tobacco control program beginning in 1989. Prevention can bring rich dividends in net savings but actions must be promoted and implemented. The successful approaches to combatting certain infectious diseases provide a model for implementing cancer prevention, particularly in LMICs, via the utilization of existing infrastructures for multiple purposes.

Africa’s Oesophageal Cancer Corridor: Geographic Variations in Incidence Correlate with Certain Micronutrient Deficiencies

Abstract: Background The aetiology of Africa’s easterly-lying corridor of squamous cell oesophageal cancer is poorly understood. Micronutrient deficiencies have been implicated in this cancer in other areas of the world, but their role in Africa is unclear. Without prospective cohorts, timely insights can instead be gained through ecological studies. Methods Across Africa we assessed associations between a country’s oesophageal cancer incidence rate and food balance sheet-derived estimates of mean national dietary supplies of 7 nutrients: calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn). We included 32 countries which had estimates of dietary nutrient supplies and of better-quality GLOBCAN 2012 cancer incidence rates. Bayesian hierarchical Poisson lognormal models were used to estimate incidence rate ratios for oesophageal cancer associated with each nutrient, adjusted for age, gender, energy intake, phytate, smoking and alcohol consumption, as well as their 95% posterior credible intervals (CI). Adult dietary deficiencies were quantified using an estimated average requirements (EAR) cut-point approach. Results Adjusted incidence rate ratios for oesophageal cancer associated with a doubling of mean nutrient supply were: for Fe 0.49 (95% CI: 0.29–0.82); Mg 0.58 (0.31–1.08); Se 0.40 (0.18–0.90); and Zn 0.29 (0.11–0.74). There were no associations with Ca, Cu and I. Mean national nutrient supplies exceeded adult EARs for Mg and Fe in most countries. For Se, mean supplies were less than EARs (both sexes) in 7 of the 10 highest oesophageal cancer ranking countries, compared to 23% of remaining countries. For Zn, mean supplies were less than the male EARs in 8 of these 10 highest ranking countries compared to in 36% of other countries. Conclusions Ecological associations are consistent with the potential role of Se and/or Zn deficiencies in squamous cell oesophageal cancer in Africa. Individual-level analytical studies are needed to elucidate their causal role in this setting.

Cancer risk: Role of chance overstated

Abstract: The recent assertion from C. Tomasetti and B. Vogelstein that most variation in cancer risk among tissues is due to “bad luck” demands close consideration, especially as they go on to argue for increased focus on early detection (“Variation in cancer risk among tissues can be explained by the number of stem cell divisions,” Reports, 2 January, p. [78][1]). Observations from cancer epidemiology and limitations in their analysis argue strongly against this conclusion. Most cancers show considerable differences in incidence rates between distinct populations. Rates change over time, and migrants soon exhibit incidence rates similar to their host country. Each of these is consistent with a major etiologic role for environment and lifestyle. Consequently, a majority of cancers are preventable, with primary prevention achieving notable successes and promising more ([ 1 ][2]). In their analysis, the authors correlate total stem cell divisions in selected organs or sites, and lifetime risk of a particular cancer at those sites. There is much uncertainty in the estimates of total stem cell divisions for each cancer site, and the vast age-related fluctuations in cell division for some tissues are overlooked. Of greater concern is the lifetime risk of cancers. Their analysis excludes frequent cancers with major environmental causes (such as stomach, breast, and cervix) and oversamples cancers rare in all populations (such as osteosarcomas, small intestine, and medulloblastoma). Overall, the cancer sites included account for only 34% of the cancer cases in the United States ([ 2 ][3]). The choice of the U.S. population is also arbitrary. A different population with different cancer patterns would have provided different results. We also take issue with the statistical analysis. Despite the reported correlation of 0.81, stem cell replication is a poor predictor of incidence rates at any given cancer site. The residual standard deviation of the log rates is 0.75, so the 95% confidence limits for the log rate of any cancer site are given by the linear predictor ±1.47 (i.e., 1.96 × 0.75). Converting from a log10 scale to an absolute scale gives an error factor of 101.47=29.4; i.e., the incidence rate may be 30 times higher or 30 times lower than the value predicted by stem cell division rates alone. This residual variation is consistent with large effects of environmental and lifestyle factors. The role of chance underlying the onset of any individual cancer has long been recognized ([ 3 ][4]). However, although important for the individual, chance has little to say about the incidence rate in a population, or differences between populations. These are far better explained by exposure to environmental and lifestyle factors, allowing important opportunities for, and supporting implementation of, primary prevention. 1. [↵][5] 1. B. W. Stewart, 2. C. P. Wild World Cancer Report 2014, B. W. Stewart, C. P. Wild, Eds. (IARC, Lyon, France, 2014). 2. [↵][6] National Cancer Institute, Surveillance Epidemiology and End Results Program ([www.seer.cancer.gov][7]). 3. [↵][8] 1. P. Armitage, 2. R. Doll , Br. J. Cancer 8, 1 (1954). [OpenUrl][9][CrossRef][10][PubMed][11][Web of Science][12] [1]: /lookup/doi/10.1126/science.1260825 [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #xref-ref-1-1 "View reference 1 in text" [6]: #xref-ref-2-1 "View reference 2 in text" [7]: http://www.seer.cancer.gov [8]: #xref-ref-3-1 "View reference 3 in text" [9]: {openurl}?query=rft.jtitle%253DBritish%2BJournal%2Bof%2BCancer%26rft.stitle%253DBritish%2BJournal%2Bof%2BCancer%26rft.aulast%253DArmitage%26rft.auinit1%253DP.%26rft.volume%253D8%26rft.issue%253D1%26rft.spage%253D1%26rft.epage%253D12%26rft.atitle%253DThe%2Bage%2Bdistribution%2Bof%2Bcancer%2Band%2Ba%2Bmulti-stage%2Btheory%2Bof%2Bcarcinogenesis.%26rft_id%253Dinfo%253Adoi%252F10.1038%252Fbjc.1954.1%26rft_id%253Dinfo%253Apmid%252F13172380%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [10]: /lookup/external-ref?access_num=10.1038/bjc.1954.1&link_type=DOI [11]: /lookup/external-ref?access_num=13172380&link_type=MED&atom=%2Fsci%2F347%2F6223%2F728.1.atom [12]: /lookup/external-ref?access_num=A1954YC50900001&link_type=ISI

International testicular cancer incidence trends: generational transitions in 38 countries 1900–1990

Abstract: Purpose Rapid increases in testicular cancer incidence have marked the second half of the last century. While these secular rises, observed mainly in countries attaining the highest levels of human development, appear to have attenuated in the last decade, rates continue to increase in countries transiting toward high developmental levels. The purpose of our study was to provide a comprehensive analysis and presentation of the cohort-specific trends in testicular cancer incidence rates in 38 countries worldwide.

Quantitative evaluation of hepatitis B virus mutations and hepatocellular carcinoma risk: a meta-analysis of prospective studies.

Abstract: Background: The temporal relationship between hepatitis B virus (HBV) mutations and hepatocellular carcinoma (HCC) remains unclear. Methods: We conducted a meta-analysis including cohort and nested case-control studies to prospectively examine the HCC risk associated with common variants of HBV in the PreS, Enhancer II, basal core promoter (BCP) and precore regions. Pertinent studies were identified by searching PubMed, Web of Science and the Chinese Biological Medicine databases through to November 2014. Study-specific risk estimates were combined using fixed or random effects models depending on whether significant heterogeneity was detected. Results: Twenty prospective studies were identified, which included 8 cohort and 12 nested case-control studies. There was an increased risk of HCC associated with any PreS mutations with a pooled relative risk (RR) of 3.82 [95% confidence interval (CI): 2.59-5.61]. The pooled-RR for PreS deletion was 3.98 (95% CI: 2.28-6.95), which was higher than that of PreS2 start codon mutation (pooled-RR=2.63, 95% CI: 1.30-5.34). C1653T in Enhancer II was significantly associated with HCC risk (pooled-RR=1.83; 95% CI: 1.21-2.76). For mutations in BCP, statistically significant pooled-RRs of HCC were obtained for T1753V (pooled-RR=2.09; 95% CI: 1.49-2.94) and A1762T/G1764A double mutations (pooled-RR=3.11; 95% CI: 2.08-4.64). No statistically significant association with HCC risk was observed for G1896A in the precore region (pooled-RR=0.77; 95% CI: 0.47-1.26). Conclusions: This study demonstrated that PreS mutations, C1653T, T1753V, and A1762T/G1764A, were associated with an increased risk of HCC. Clinical practices concerning the HCC risk prediction and diagnosis may wish to focus on patients with these mutations.

Trends in Corpus Uteri Cancer Mortality in Member States of the European Union.

Abstract: Objectives The burden of corpus uteri cancer varies in the European Union (EU). We analysed trends in corpus uteri cancer mortality in 26 EU member states from 1970 onward. Methods Population numbers and number of uterine cancer deaths were extracted from the World Health Organisation mortality database. Corpus uteri cancer mortality rates were corrected for certification problems using different reallocation rules for deaths registered as uterine cancer not otherwise specified, or using mixed disease codes. Join point regression was used to study the annual percentage change of age-standardised corpus uteri cancer mortality rates. Changes in corpus uteri cancer mortality rates by calendar period and standardised cohort mortality ratios were also estimated. Results In 2008, 12,903 women died from corpus uteri cancer in the EU. Corrected age-standardised corpus uteri cancer mortality rates have decreased significantly over the past decades in most member states, with exception of Malta and Bulgaria, where rates increased; Greece, where rates remained low but stable; and Sweden, where rates have been stable since 1970. Original member states showed a steeper decrease than newer member states. The standardised cohort mortality ratios indicated that corpus uteri cancer mortality does not decrease further, nor does it increase, among women born after 1940, although these birth cohorts may still be too young for corpus uteri cancer incidence to be fully evaluated. Conclusion Our corrected corpus uteri cancer mortality rates showed a decrease in most EU member states among women born before 1940.

Mortality of Testicular Cancer in East and West Germany 20 Years after Reunification: A Gap Not Closed Yet

Abstract: Background: The decline of testicular cancer mortality in East Germany began in the 1980s, about 10 years later than that recorded in West Germany. We aimed at pr