The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

/pdf/global-cancer-statistics-49zjx478re.pdf

Global cancer statistics

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.

/pdf/global-cancer-statistics-2012-18pecqxl5v.pdf

Global cancer statistics, 2012

Estimates of the worldwide incidence and mortality from 27 cancers in 2008 have been prepared for 182 countries as part of the GLOBOCAN series published by the International Agency for Research on Cancer. In this article, we present the results for 20 world regions, summarizing the global patterns for the eight most common cancers. Overall, an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occur in 2008, with 56% of new cancer cases and 63% of the cancer deaths occurring in the less developed regions of the world. The most commonly diagnosed cancers worldwide are lung (1.61 million, 12.7% of the total), breast (1.38 million, 10.9%) and colorectal cancers (1.23 million, 9.7%). The most common causes of cancer death are lung cancer (1.38 million, 18.2% of the total), stomach cancer (738,000 deaths, 9.7%) and liver cancer (696,000 deaths, 9.2%). Cancer is neither rare anywhere in the world, nor mainly confined to high-resource countries. Striking differences in the patterns of cancer from region to region are observed.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.25516

Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.

Estimates of the worldwide incidence and mortality from 36 cancers and for all cancers combined for the year 2018 are now available in the GLOBOCAN 2018 database, compiled and disseminated by the International Agency for Research on Cancer (IARC). This paper reviews the sources and methods used in compiling the cancer statistics in 185 countries. The validity of the national estimates depends upon the representativeness of the source information, and to take into account possible sources of bias, uncertainty intervals are now provided for the estimated sex- and site-specific all-ages number of new cancer cases and cancer deaths. We briefly describe the key results globally and by world region. There were an estimated 18.1 million (95% UI: 17.5-18.7 million) new cases of cancer (17 million excluding non-melanoma skin cancer) and 9.6 million (95% UI: 9.3-9.8 million) deaths from cancer (9.5 million excluding non-melanoma skin cancer) worldwide in 2018.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.31937

Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

There is an entrenched belief among pathologists, biologists and clinicians alike that metastatic tumours are histologically similar to the primary. Although this belief has never been scientifically tested, it forms the conceptual foundation upon which metastasis research has been based for decades. In order to scientifically test this dogma, we conducted a blinded experiment in which three highly experienced professor grade cancer pathologists were asked to predict the site of origin of 298 metastatic tumours arising at nine different sites. The accuracy of prediction of all three examiners was just under 50%. However, there was very little inter-observer agreement, and Kappa statistic generated the value of 0.27 which is much below the figure of 0.4 required to detect even a moderate level of concordance. In only 56 / 298 (18.8%) cases did the examiners agree with each others diagnosis. Thus the possibility cannot be excluded that the correct diagnoses made by the examiners had happened by play of chance. Our finding suggests that histological relationship between primary and metastatic tumours requires further investigation.

/pdf/are-metastatic-tumours-histologically-similar-to-the-primary-209escp1.pdf

Are metastatic tumours histologically similar to the primary? Result of a blinded experiment

Dear editor, A nationwide multiround National Family Health Survey (NFHS) is conducted by the Government of India (GOI), representing sample of households across India. The fifth round of NFHS results has been released for the years 2019 to 2021. The NFHS-5 comprises data of 636 699 households (Women: 724 115; Men: 101 839). This latest survey of NFHS-5 has also provided the data on cervix, breast and oral cancer screening uptake by adults (age group: 30-49) and results are alarming, showing less than 2% of screening participation. The screening coverage is extremely low compared to European region where screening coverage for cervical cancer (age group: 30-59) and breast cancer (age group: 45-49) is 40.2% and 68.9%, respectively. The GOI has initiated cervix, breast and oral cancer screening, respectively, by visual inspection of cervix with acetic acid, clinical breast examination and thorough examination of oral cavity by oral visual examination using a mouth mirror and a white light for the age group of 30 to 65 once in every 5 years with no cost. These population-based cancer screening programs were started in the year 2016 and are being conducted in nearly 400 districts. The trained health workers are playing an important role in executing these government-run screening programs. The screen positive cases are referred to nearby government health facilities for further evaluation by a health professional. The district hospitals are responsible for the further management of screen positive cases. Several center and state government-funded health schemes are available that assist patients in avoiding financial hardship. The data on screening uptake for cervix, breast and oral cancers are given for the first time in NFHS-5 series. Based on NFHS-5 data, we estimated the number of people who underwent screening using population for the year 2021 provided by the Indian census. The findings are concerning as the number of population covered under screening programs is significantly low. The data suggest that of the total population of 186 015 000 women aged 30 to 49 years, only 3 534 285 (1.9%) women reported to uptake cervix cancer screening test whereas 1 674 135 (0.9%) women reported taking screening test for breast and oral cancers. Similarly, for males, 2 295 540 (1.2%) male population out of the total population of 191 295 000 of the age group 30 to 49 reported to undertake oral cancer screening. Since the screening uptake data in NFHS-5 survey is specific for the age group of 30 to 49 years, the information is not available for the 50 years and above age group. However, compared to the age range of 30 to 49 years, screening uptake is reported to be lower for those aged 50 and above. The state-wise screening uptake for cervix, breast and oral cancers is presented in Table 1. In India, the reported incidence of cervix, breast and oral cancers is high. As per GLOBOCAN 2020, there are 135 929 new lip and oral cavity cancer cases with the age-standardized incidence rate 9.8 per 100 000 population. Moreover, a total of 178 361 and 123 907 breast and cervix cancer cases were reported in India with the agestandardized incidence rate of 25.8 and 18.0, respectively. Furthermore, as per the National Cancer Registry Programme (NCRP) India 2020, data from 28 Population-based Cancer Registries (PBCRs) indicate that oral cancer is the leading cancer among males; whereas breast and cervix cancers are predominant cancers in females. For males, oral cancer is reported the highest among tobacco-related cancers in central (45.0%) and western (34.6%) regions of India; whereas for females, central (44.8%) region is leading, followed by eastern (37.0%), southern (33.9%) and western (29.5%) regions. The oral cancer incidence in Uttar Pradesh state is high and a report published by the Varanasi PBCR reported oral cancer incidence in males for urban area 22.4 per 100 000 and rural 16.2 per 100 000. Even though oral cancer incidence is high in Uttar Pradesh state, the screening uptake for oral cancer is 1%. The current incidence of cervix, breast and oral cancers in India and evidence from NFHS-5 regarding screening uptake point towards the dire need of strengthening the ongoing screening and early detection activities. It is recommended that the policymakers should utilize these data and implement strategic interventions to cover more populations under screening programs and focus on early detection of these preventable cancer cases. The government is taking the necessary steps; however, interventions that improve screening participation are required to reduce the burden of preventable cancers in India. Evidence from the randomized control trials (RCTs) conducted in India show the positive outcome of screening and demonstrates reduced mortality of cervix, breast Received: 11 December 2021 Revised: 18 January 2022 Accepted: 28 January 2022

The fifth round of the National Family Health Survey of India 2019 to 2021 reported low screening uptake alarming to strengthen the implementation of early detection services of the cervix, breast and oral cancer

Worldwide the incidence of esophagus squamous cell carcinoma (ESCC), remains one of the most common causes of cancer death. ESCC is one of the leading types of cancer in the North and Northeast regions of India among both genders. Risk factors of ESCC include tobacco, alcohol, areca nut, hot beverages, low fruit diet, poor oral hygiene, unpiped water, and human papillomavirus infection. This review tries to elaborate on various modifiable risk factors for ESCC, which have been studied worldwide and need to be studied in India. PubMed was used as a search platform using keywords, such as “esophagus cancer,” “esophagus squamous cell carcinoma,” “epidemiology,” “India,” “incidence,” “mortality,” “risk factors,” “treatment,” “survival,” “prevention” and their corresponding Medical Subject Heading terms, were used in combination with Boolean operators “OR” and “AND.” Studies from India are mostly hospital-based case-control studies from the North region. Further research is required in India to understand the etiology, to design large-scale screening and prevention strategies.

Epidemiological Review: Esophagus Squamous Cell Carcinoma in India

Background: The hazard function is defined as time-dependent. However, it is an overlooked area of research about the estimation of hazard function within the frame of time. The possible explanation could be carried by estimating function through the changes of time points. It is expected that it will provide us the overall idea of survival trend. This work is dedicated to propose a method to work with piecewise hazard rate. It is a data-driven method and provides us the estimates of hazard function with different time points. Methods: The proposed method is explored with prostate cancer patients, registered in the Surveillance, Epidemiology, and End Results Program and having aged at diagnosis with range 40–80 years and above. A total of 610,814 patients are included in this study. The piecewise hazard rate is formulated to serve the objective. The measurement of piecewise hazard rate is compared with Wald-type test statistics, and corresponding R function is provided. The duration of follow-ups is split into different intervals to obtain the piecewise hazard rate estimates. Results: The maximum duration of follow-up observed in this study is 40 years. The piecewise hazard rate changes at different intervals of follow-ups are observed almost same except few later intervals in the follow-up. The likelihood of hazard in earlier aged patients observed lower in comparison to older patients. The hazard rates in different grades of prostate cancer also observed separately. Conclusion: The application of piecewise hazard helps to generate statistical inference in a deeper manner. This analysis will provide us the better understanding of a requirement of effective treatment toward prolonged survival benefit for different aged patients.

/pdf/prostate-cancer-survival-estimates-an-application-with-52ee4yjiwu.pdf

Prostate cancer survival estimates: An application with piecewise hazard function derivation.

Background Early thyroid cancers have excellent long-term outcomes, yet the word “cancer” draws unnecessary apprehension. This study aimed to define when the recommendations for observation and surveillance may be extended to early thyroid cancers at the population level. Methods Non-metastasized thyroid cancers ≤40 mm diameter were identified from the 1975–2016 Surveillance, Epidemiology and End Results (SEER) database. Causes of death were compared across demographic data. Disease-specific outcomes were compared to the age-adjusted healthy United States (US) population. Survival estimates were computed using Kaplan–Meier and compared using the Cox proportional hazard model. Dynamic benchmarks impacting disease-specific overall survival were determined by decision tree modeling and tested by the Cox model. Results Of the 28,728 thyroid cancers included in this study, 98.4% underwent some form of thyroid-specific treatment and were followed for a maximum of 10.9 years. This group had a 4.3% mortality rate at the end of follow-up (10.9 years maximum), with 13 times more deaths attributed to competing risks rather than thyroid cancer (stage T1a versus stage T1b, P=1.000; T1 versus T2, P<0.001). Among the untreated T1a or T1b tumors, the risk of disease-specific death was 21 times lower than death due to other causes. There was no significant difference between T1a and T1b tumors nor across sex. The age-adjusted risk of death for the healthy US population was higher than for the population with thyroid cancer. Dynamic categorization demonstrated worsening outcomes up to 73 years, uninfluenced by sex or tumor size. For patients over 73 years of age, only tumors >26 mm impacted outcomes. Conclusion Based on the current data, T1a and T1b nodules have similar survival outcomes and are not significantly impacted even when left untreated. Multi-institutional prospective studies are needed to confirm these findings so that current observation and surveillance recommendations can be extended to certain T1 thyroid nodules.

https://www.rmmj.org.il/userimages/1305/2/PublishFiles/1384Article.pdf

Rajesh Dikshit

Papers

Are metastatic tumours histologically similar to the primary? Result of a blinded experiment

The fifth round of the National Family Health Survey of India 2019 to 2021 reported low screening uptake alarming to strengthen the implementation of early detection services of the cervix, breast and oral cancer

Epidemiological Review: Esophagus Squamous Cell Carcinoma in India

Prostate cancer survival estimates: An application with piecewise hazard function derivation.

Population-level Outcomes of Early Thyroid Cancers: A Need to Revisit Current Practice