Estimates of the cancer incidence and mortality in Europe in 2006

Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s.

Background A challenge in quantifying the effect of screening mammography on breast-cancer mortality is to provide valid comparison groups. The use of historical control subjects does not take into account chronologic trends associated with advances in breastcancer awareness and treatment. Methods The Norwegian breast-cancer screening program was started in 1996 and expanded geographically during the subsequent 9 years. Women between the ages of 50 and 69 years were offered screening mammography every 2 years. We compared the incidence-based rates of death from breast cancer in four groups: two groups of women who from 1996 through 2005 were living in counties with screening (screening group) or without screening (nonscreening group); and two historical-comparison groups that from 1986 through 1995 mirrored the current groups. Results We analyzed data from 40,075 women with breast cancer. The rate of death was reduced by 7.2 deaths per 100,000 person-years in the screening group as compared with the historical screening group (rate ratio, 0.72; 95% confidence interval [CI], 0.63 to 0.81) and by 4.8 deaths per 100,000 person-years in the nonscreening group as compared with the historical nonscreening group (rate ratio, 0.82; 95% CI, 0.71 to 0.93; P<0.001 for both comparisons), for a relative reduction in mortality of 10% in the screening group (P = 0.13). Thus, the difference in the reduction in mortality between the current and historical groups that could be attributed to screening alone was 2.4 deaths per 100,000 person-years, or a third of the total reduction of 7.2 deaths. Conclusions The availability of screening mammography was associated with a reduction in the rate of death from breast cancer, but the screening itself accounted for only about a third of the total reduction. (Funded by the Cancer Registry of Norway and the Research Council of Norway.)

http://www.comedsoc.org/images/Kalager%20Zelen%20Norway%20NEJM%209-23-2010.pdf

Effect of screening mammography on breast-cancer mortality in Norway.

BACKGROUND
The objective of this study was to provide updated estimates of national trends in cancer incidence and mortality for France for 1980-2005.


METHODS
Twenty-five cancer sites were analysed. Incidence data over the 1975-2003 period were collected from 17 registries working at the department level, covering 16% of the French population. Mortality data for 1975-2004 were provided by the Inserm. National incidence estimates were based on the use of mortality as a correlate of incidence, mortality being available at both department and national levels. Observed incidence and mortality data were modelled using an age-cohort approach, including an interaction term. Short-term predictions from that model gave estimates of new cancer cases and cancer deaths in 2005 for France.


RESULTS
The number of new cancer cases in 2005 was approximately 320,000. This corresponds to an 89% increase since 1980. Demographic changes were responsible for almost half of that increase. The remainder was largely explained by increases in prostate cancer incidence in men and breast cancer incidence in women. The relative increase in the world age-standardised incidence rate was 39%. The number of deaths from cancer increased from 130,000 to 146,000. This 13% increase was much lower than anticipated on the basis of demographic changes (37%). The relative decrease in the age-standardised mortality rate was 22%. This decrease was steeper over the 2000-2005 period in both men and women. Alcohol-related cancer incidence and mortality continued to decrease in men. The increasing trend of lung cancer incidence and mortality among women continued; this cancer was the second cause of cancer death among women. Breast cancer incidence increased regularly, whereas mortality has decreased slowly since the end of the 1990s.


CONCLUSION
This study confirmed the divergence of cancer incidence and mortality trends in France over the 1980-2005 period. This divergence can be explained by the combined effects of a decrease in the incidence of the most aggressive cancers and an increase in the incidence of less aggressive cancers, partly due to changes in medical practices leading to earlier diagnoses.

Iconographies supplémentaires de l'article : Cancer incidence and mortality in France over the period 1980–2005

Purpose The management of locally advanced (LA) pancreatic cancer patients remains controversial. To select patients who could benefit from chemoradiotherapy (CRT), the therapeutic strategy used by the Groupe Cooperateur Multidisciplinaire en Oncologie (GERCOR) consisted of initial chemother- apy (CT) for at least 3 months. The decision to administer CRT or continue CT in nonprogressive patients was the investigator's choice. Patients and Methods Retrospective analysis of outcome in 181 patients with LA pancreatic cancer (76 women and 105 men; mean age, 61 years; range, 37 to 85 years) enrolled onto prospective phase II and III GERCOR studies was performed to compare the survival of patients who received CRT with that of patients who continued CT alone. Results Median progression-free survival (PFS) and overall survival (OS) times for the 181 patients were 6.3 and 11.4 months, respectively. Fifty-three patients (29.3%) had metastatic disease after 3 months of CT and were not eligible for CRT. Among the 128 remaining patients (70.3%) who had no disease progression and who were, therefore, eligible for CRT, 72 (56%) received CRT (group A), whereas 56 (44%) continued with CT (group B). The two groups were balanced for initial characteristics (performance status, sex, age, and type of CT), as well as for induction CT results. In groups A and B, the median PFS times were 10.8 and 7.4 months, respectively (P.005), and the median OS times were 15.0 and 11.7 months, respectively (P.0009). Conclusion These results suggest that, after control of disease by initial CT, CRT could significantly improve survival in patients with LA pancreatic cancer compared with CT alone. A prospective phase III study is ongoing to evaluate this strategy. J Clin Oncol 25:326-331. © 2007 by American Society of Clinical Oncology

https://ascopubs.org/doi/pdf/10.1200/jco.2006.07.5663

Impact of Chemoradiotherapy After Disease Control With Chemotherapy in Locally Advanced Pancreatic Adenocarcinoma in GERCOR Phase II and III Studies

Position du probleme : La surveillance de la tendance de l'incidence et de la mortalite par cancers est essentielle a la recherche en cancerologie et a la planification en sante publique. Les registres de cancer francais ne couvrent pas l'ensemble du territoire et ne procurent pas un echantillon representatif de l'ensemble de la population. Notre etude a pour objectif d'estimer la tendance de l'incidence et de la mortalite, au niveau national et sur la plus longue periode possible. Materiel et methode : Les donnees d'incidence et de mortalite ont ete collectees sur la periode 1978-1997. Vingt-sept sites de cancer ont ete retenus ; pour chaque site, les taux d'incidence et de mortalite par sexe et par âge ont ete estimes pour chaque annee de 1978 a 2000. Les donnees d'incidence et de mortalite observees dans les populations couvertes par un registre ont ete modelisees par un modele âge-cohorte. Une estimation du rapport incidence/mortalite a ete obtenue a partir de cette modelisation et appliquee a des taux de mortalite predits par un modele âge-cohorte issu des donnees de mortalite de l'ensemble de la France. Les personnes-annees d'observation ont ete calculees par cohorte de naissance a partir des donnees du recensement de la population. Resultats : L'incidence du cancer a augmente de 63 % au cours de la periode d'etude, passant de 170 000 nouveaux cas en 1980 a 278 000 nouveaux cas en 2000. Cette croissance est due au changement demographique mais aussi a l'augmentation du risque de cancer qui est estimee a 35 % durant la meme periode. Pour les hommes, ce changement est largement explique par l'augmentation de l'incidence du cancer de la prostate. Pour les femmes, cette evolution est dominee par l'accroissement continu de l'incidence du cancer du sein. Des augmentations importantes ont aussi ete observees pour le lymphome malin non hodgkinien, le melanome de la peau et le cancer de la thyroide pour les deux sexes, pour le cancer du poumon dans la population feminine. La mortalite par cancer a augmente de 20 %, passant de 125 000 deces en 1980 a 150 000 deces en 2000. Cette augmentation est moindre que celle predite par les changements demographiques et correspond en fait a une diminution du risque de deces estimee a environ 8 %, diminution legerement plus importante chez les femmes que chez les hommes. La baisse de la mortalite est associee a une baisse de l'incidence pour les cancers de l'estomac pour les deux sexes, pour les cancers lies a l'alcool chez l'homme et pour les cancers du col de l'uterus chez la femme. Conclusion : Entre 1980 et 2000, cette etude montre un large changement, a la fois qualitatif et quantitatif du poids que represente le cancer en France. La diminution des expositions, un diagnostic plus precoce et les progres therapeutiques expliquent en partie cette situation, mais d'une facon generale la distribution des cancers tend vers une distribution avec moins de cancers agressifs. Une divergence frappante est observee entre les tendances de l'incidence et les tendances de la mortalite pour un grand nombre de cancers. Le cancer de la prostate partage avec le cancer du sein le meme type d'evolution, avec un accroissement severe de son incidence et une stabilite de sa mortalite. Ceci indique d'importants changements dans les pratiques medicales qui necessitent des analyses supplementaires.

Cancer incidence and mortality in France over the period 1978-2000

Estimations nationales : tendances de l`incidence et de la mortalité par cancer en France entre 1978 et 2000

Les cancers de la vulve et du vagin sont essentiellement des carcinomes epidermoides develop- pes aux depens des muqueuses.On rencontre aussi des melanomes malins,des sarcomes et quelques adenocarcinomes,notamment des adenocarcinomes a cellules claires du vagin chez des jeunes filles dont la mere a pris du diethylstilbestrol durant les premiers mois de la grossesse.

M. Sauvage

Papers

Cancer incidence and mortality in France over the period 1978-2000

Estimations nationales : tendances de l`incidence et de la mortalité par cancer en France entre 1978 et 2000

Vulve et vagin