Showing papers on "Relative survival published in 1999"

Rising incidence of renal cell cancer in the United States

Abstract: ContextClinical surveys have revealed that incidental detection of renal cell carcinoma is rising because of increased use of imaging procedures.ObjectiveTo examine incidence, mortality, and survival trends of renal cell and renal pelvis cancers by age, sex, race, and tumor stage at diagnosis.DesignCalculation of age-adjusted incidence and mortality rates, along with 5-year relative survival rates, using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.Setting and ParticipantsPatients diagnosed as having kidney cancer from 1975 through 1995 in the 9 geographic areas covered by tumor registries in the SEER program, which represent about 10% of the US population.Main Outcome MeasuresIncidence, mortality, and 5-year relative survival rates by time periods.ResultsThe age-adjusted incidence rates for renal cell carcinoma between 1975 and 1995 for white men, white women, black men, and black women were 9.6, 4.4, 11.1, and 4.9 per 100,000 person-years, respectively. The corresponding rates for renal pelvis cancer were 1.5, 0.7, 0.8, and 0.5 per 100,000 person-years. Renal cell cancer incidence rates increased steadily between 1975 and 1995, by 2.3% annually among white men, 3.1% among white women, 3.9% among black men, and 4.3% among black women. Increases were greatest for localized tumors but were also seen for more advanced and unstaged tumors. In contrast, the incidence rates for renal pelvis cancer declined among white men and remained stable among white women and blacks. Although 5-year relative survival rates for patients with renal cell cancer improved among whites but not among blacks, kidney cancer mortality rates increased in all race and sex groups.ConclusionsIncreasing detection of presymptomatic tumors by imaging procedures, such as ultrasonography, computed tomography, and magnetic resonance imaging, does not fully explain the upward incidence trends of renal cell carcinoma. Other factors may be contributing to the rapidly increasing incidence of renal cell cancer in the United States, particularly among blacks.

Cancer surveillance series [corrected]: brain and other central nervous system cancers: recent trends in incidence and mortality.

Abstract: BACKGROUND During the 1980s, the incidence of primary malignant brain and other central nervous system tumors (hereafter called brain cancer) was reported to be increasing among all age groups in the United States, while mortality was declining for persons younger than 65 years. We analyzed these data to provide updates on incidence and mortality trends for brain cancer in the United States and to examine these patterns in search of their causes. METHODS Data on incidence, overall and according to histology and anatomic site, and on relative survival were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute for 1975 through 1995. Mortality data were obtained from the National Center for Health Statistics. Medicare procedure claims from the National Cancer Institute's SEER-Medicare database were used for imaging trends. Statistically significant changes in incidence trends were identified, and annual percent changes were computed for log linear models. RESULTS/CONCLUSIONS Rates stabilized for all age groups during the most recent period for which SEER data were available, except for the group containing individuals 85 years of age or older. Mortality trends continued to decline for the younger age groups, and the steep increases in mortality seen in the past for the elderly slowed substantially. Patterns differed by age group according to the site and grade of tumors between younger and older patients. During the last decade, use of computed tomography scans was relatively stable for those 65-74 years old but increased among those 85 years old or older. IMPLICATIONS Improvements in diagnosis and changes in the diagnosis and treatment of elderly patients provide likely explanations for the observed patterns in brain cancer trends.

Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995 : A National Cancer Data Base Report

Abstract: BACKGROUND In combination with other Commission on Cancer programs, the National Cancer Data Base (NCDB), a national electronic registry system currently capturing > 60% of incident cancers in the U. S., offers a working example of voluntary, accurate, cost-effective “outcomes management” on a both a local and national scale. In addition, it is proving to be of particular value in capturing clinical information concerning rare cancers. METHODS For accession years 1985–1995, the NCDB captured prospectively collected demographic, stage, treatment, and outcome information for a national hospital-based sample of 286 parathyroid carcinoma cases (0.005 % of the total NCDB cancer cases). This report describes clinical and demographic features as well as patterns of care and 5-year and 10-year relative survival rates. RESULTS The NCDB's 10-year accrual of parathyroid carcinoma cases exceeded the cumulative number reported in the English literature though 1991. Gender distribution was equal. The authors were unable to detect any disproportionate clustering by race, income level, or geographic region. Treatment overwhelmingly was surgical. The data from the current study suggest that neither tumor size nor lymph node status are significant prognostic factors. Overall relative survival at 5 years and 10 years was 85.5% and 49.1%, respectively. CONCLUSIONS At 5 years of follow-up, and possibly beyond, neither tumor size nor lymph node status were found to be significant prognostic factors and basing a staging system on them would be useless. Although complete, en bloc resection of all tumor represents the best opportunity for cure, a substantial proportion of patients fail to receive such treatment. The authors speculate that the rarity of this condition and late intraoperative recognition occasionally prevent optimal treatment. [See editorial on pages 378–80, this issue.] Cancer 1999;86:538–44. © 1999 American Cancer Society.

Ten-year survey of lung cancer treatment and survival in hospitals in the United States: a national cancer data base report.

Abstract: BACKGROUND. Primary lung cancer accounts for approximately 14% of all new cancers and 28% of cancer deaths in the U.S. Previous reviews have shown limited progress in the management or outcome of this devastating disease. METHODS. Reports described in the current study were 713,043 primary lung malignancies diagnosed between 1985 and 1995 and submitted to the National Cancer Data Base. Demographic, tumor, and treatment patterns for 1995 were compared with those for 1985‐1987, 1988 ‐1991, and 1992‐1994. Ten-year relative survival rates were presented for selected demographic and histologic groups and 5-year relative survival rates were presented by stage and dominant treatment modalities for major carcinoma histologies. RESULTS. Previously observed demographic trends were evident, with increasing proportions of patients being older, female, and African American, and more cases reported to be adenocarcinomas. There was a substantial shift toward more complete staging but no change in the distribution of staged cases. Compared with earlier patients, fewer 1995 patients received cancer-directed treatment. More surgical patients underwent lymph node dissection, and radiation treatment was supplemented more often with chemotherapy. The overall 10-year relative survival rate was 7%%. The 5-year survival for American Joint Committee on Cancer Stage I surgical patients was . 50% for all nonsmall cell histologic groups. CONCLUSIONS. Recent shifts in treatment, although minimal, are consistent with current literature concerning the effectiveness of lung carcinoma treatment. The authors believe that the overall poor survival of lung carcinoma patients points to a continuing need for improved prevention and treatment measures. The comparatively superior survival of Stage I nonsmall cell lung carcinoma surgical patients indicates that a substantial number of patients have the potential to be treated successfully. Cancer 1999;86:1867‐76. © 1999 American Cancer Society.

Prognosis in cutaneous T-cell lymphoma by skin stage: long-term survival in 489 patients.

Abstract: Background: Although a number of studies have documented the long-term survival of patients with cutaneous T-cell lymphoma (CTCL), none have provided data as to the relative survival of all 4 skin stages. Objective: We document survival of CTCL patients by T stage relative to that of an age-, sex-, and race-matched population. Methods: The survival of 489 patients with CTCL registered since 1957 was compared with that of a California control population. Results: For stage T1 ( P = .002). At 10 years the relative survivals were: T2 (10% or more skin involved) 67.4%, T3 (tumor stage) 39.2%, T4 (generalized erythroderma) 41.0%. T2 plaque stage patients had an inferior relative survival ( P = .001), whereas T2 patch stage patients did not. Lymphadenopathy had an unfavorable impact on prognosis. There was a strong trend toward diagnosing CTCL at an earlier stage in more recent years. We estimate that from 15% to 20% of our patients died of CTCL or related complications. Conclusion: The relative survival of CTCL patients worsens with increasing skin stage, although stages T3 and T4 had closely similar survivals. The great majority of patients with CTCL do not die of their disease. (J Am Acad Dermatol 1999;40:418-25.)

Response: Re: Brain and Other Central Nervous System Cancers: Recent Trends in Incidence and Mortality

Abstract: Background: During the 1980s, the incidence of primary malignant brain and other central nervous system tumors (hereafter called brain cancer) was reported to be increasing among all age groups in the United States, while mortality was declining for persons younger than 65 years. We analyzed these data to provide updates on incidence and mortality trends for brain cancer in the United States and to examine these patterns in search of their causes. Methods: Data on incidence, overall and according to histology and anatomic site, and on relative survival were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute for 1975 through 1995. Mortality data were obtained from the National Center for Health Statistics. Medicare procedure claims from the National Cancer Institute’s SEER‐Medicare database were used for imaging trends. Statistically significant changes in incidence trends were identified, and annual percent changes were computed for log linear models. Results/ Conclusions: Rates stabilized for all age groups during the most recent period for which SEER data were available, except for the group containing individuals 85 years of age or older. Mortality trends continued to decline for the younger age groups, and the steep increases in mortality seen in the past for the elderly slowed substantially. Patterns differed by age group according to the site and grade of tumors between younger and older patients. During the last decade, use of computed tomography scans was relatively stable for those 65‐74 years old but increased among those 85 years old or older. Implications: Improvements in diagnosis and changes in the diagnosis and treatment of elderly patients provide likely explanations for the observed patterns in brain cancer trends. [J Natl Cancer Inst 1999;91:1382‐90]

Mixture models for cancer survival analysis: application to population-based data with covariates.

Abstract: The interest in estimating the probability of cure has been increasing in cancer survival analysis as the curability of many cancer diseases is becoming a reality. Mixture survival models provide a way of modelling time to death when cure is possible, simultaneously estimating death hazard of fatal cases and the proportion of cured case. In this paper we propose an application of a parametric mixture model to relative survival rates of colon cancer patients from the Finnish population-based cancer registry, and including major survival determinants as explicative covariates. Disentangling survival into two different components greatly facilitates the analysis and the interpretation of the role of prognostic factors on survival patterns. For example, age plays a different role in determining, from one side, the probability of cure, and, from the other side, the life expectancy of fatal cases. The results support the hypothesis that observed survival trends are really due to a real prognostic gain for more recently diagnosed patients.

The conditional probability of survival of patients with primary malignant brain tumors: surveillance, epidemiology, and end results (SEER) data.

Abstract: BACKGROUND Five-year survival estimates in standard cancer reports provide a general description of disease outcome that is useful for surveillance and comparison purposes. However, for cancer survivors these overall survival rates may be discouraging, and the relevant question regarding an individual is this: Once he or she has survived for a specified period of time, what is the probability of survival over the next period of time? METHODS To address this, conditional survival rates by histology for malignant brain tumor survivors were estimated using the SEER public use data and the Portable Survival System, with 19,105 brain and other nervous system patients diagnosed between 1979 and 1993. Given that the survival curve declines more rapidly in the first 2 years than in subsequent years, conditional probabilities of surviving 5 years given survival to 2 years and 95% confidence intervals (CIs)were calculated. As age is a strong prognostic factor for these tumors, conditional probabilities were also estimated by categories of age. RESULTS Estimated 2- and 5-year relative survival rates for patients with malignant brain and other CNS tumors were 36.2% and 27.6%; however, the conditional probability of surviving to 5 years, given survival to 2 years, reaches 76.2% (95% CI: 74.8–77.6). Conditional probabilities varied by histology and age at diagnosis. The conditional probability of surviving 5 years after surviving 2 years was 67.8% (95% CI: 62.6–73.1) for patients with anaplastic astrocytomas, 36.4% (95% CI: 31.9–41.6) for patients with glioblastomas, and 79.8% (95% CI:75.3–84.1) for patients with medulloblastomas. CONCLUSIONS Conditional probabilities provide important and encouraging information for those who are brain tumor survivors. The utility of these estimates for other time intervals and other cancers or diseases should be considered. Cancer 1999;85:485–91. © 1999 American Cancer Society.

Cancer in old age—is it inadequately investigated and treated?

Abstract: The proportion of the United Kingdom population over 75 years of age will increase from around 7% to nearly 11% in the next 50 years, with a disproportionate rise in those over 85 years. There will be a large increase in the number of elderly patients with cancer Already over one third of cancers are diagnosed in people over 75, yet we do not know how best to investigate and treat cancers in these patients. Many clinical trials have used arbitrary upper age limits. Even trials in allegedly elderly subjects start at age 65. Very few studies include large numbers of old (over 75) or very old (over 85) people.1 The role and effectiveness of many cancer treatments is therefore not evidence based in those most affected. Studies of cancer care in elderly patients show fewer diagnostic and staging procedures and less treatment with advancing age. Disease specific survival rates decline with age.2–6 This is illustrated by data from the Yorkshire Cancer Registry on histological confirmation (a useful marker for the adequacy of investigation), receipt of definitive treatment, and relative survival in relation to age group (table).7 The Yorkshire Cancer Registry is one of the registries used in the Eurocare study. It covers a population of 3.7 million, constituting 7.2% of the total population of England and Wales. View this table: Proportion (%) of cancers confirmed by histology, cancer patients with no definitive treatment, and cancer patients surviving five years, by age group, Yorkshire 1989-93 #### Summary points Although more than a third of cancers are diagnosed in people over 75, this group is less extensively investigated and receives less treatment than younger patients 75 year old women and 75 year old men have life expectancies of 11.1 years and 8.5 years respectively Reduced levels of intervention are not wholly explained …

The National Cancer Data Base Report on age, gender, treatment, and outcomes of patients with chronic lymphocytic leukemia

Abstract: BACKGROUND The natural history of chronic lymphocytic leukemia (CLL) is changing, although the reasons (potential changes in the disease's biology or in patterns in patient characteristics, treatment, or referral) are unclear. METHODS This report uses National Cancer Data Base (NCDB) data, which reflect a hospital-based patient population from a broad spectrum of hospitals in the United States. Age, gender, race/ethnicity, income, treatment, overall survival, and relative survival were evaluated according to time period (1985–1990 and 1991–1995). Comparisons were made with U.S. population figures for 1990 and with series published over the last 70 years. RESULTS CLL comprised 22.6% of the 108,396 cases of leukemia in the data base. The risk of developing CLL increased progressively with age and did not plateau; the average age was 69.6 years. At the time of initial diagnosis, 60.5% of patients received no treatment (this proportion increased from 58.1% to 62.7% between the 2 time periods). Overall survival was 48.2% at 5 years and 22.5% at 10 years. The 5-year relative survival was 69.5%, 72.2%, 63.1%, and 41.7% for age groups <40, 40–59, 60–79, and 80+ years, respectively; these rates indicated that CLL, and not comorbid disease, caused the greatest percentage of deaths. CONCLUSIONS The risk of developing CLL increases progressively with age without plateauing and is 2.8 times higher for older men than for older women. There is an increasing trend toward no treatment at the time of initial diagnosis. Long term overall survival of CLL patients is poor. CLL is a more fatal disease among older individuals because of the disease itself, not because of comorbid conditions. Cancer 1999;86:2684–92. © 1999 American Cancer Society.

Axillary dissection in breast-conserving surgery for stage I and II breast cancer: a National Cancer Data Base study of patterns of omission and implications for survival.

Abstract: Background: Breast conservation (partial mastectomy, axillary node dissection or sampling, and radiotherapy) is the current standard of care for eligible patients with Stages I and II breast cancer. Because axillary node dissection (AND) has a low yield, some have argued for its omission. The present study was undertaken to determine factors that correlated with omission of AND, and the impact of the decision to omit AND on 10-year relative survival. Study Design: A retrospective review of National Cancer Data Base (NCDB) data for 547,847 women with Stage I and Stage II breast cancer treated in US hospitals from 1985 to 1995 was undertaken. A subset of 47,944 Stage I and 23,283 Stage II women treated with breast-conserving surgery (BCS) was identified. Cross-tab analysis was used to compare patterns of surgical care within this subset. Relative survival was calculated as the ratio of observed survival to the expected survival for women of the same age and racial/ethnic background. Results: The rate of BCS with and without AND increased steadily from 17.6% and 6.4% of patients from 1985–1989, to 36.6% and 10.6% of patients from 1993–1995 respectively. AND was more likely to be omitted in women with Stage I than women with Stage II disease (14.5% versus 5.5%). Similarly, AND was omitted more frequently in women with Grade 1 than women with higher grades (Grade 1, 14.9%; Grade 2, 10.1%; Grade 3, 7.1%; Grade 4, 7%). Although the rate of BCS with AND varied considerably according to location in the breast, the overall rate of BCS without AND appeared independent of site of lesion. Women over the age of 70 years were more than twice as likely to have AND omitted from BCS than their younger counterparts. Women with lower incomes, women treated in the Northeast, or at hospitals with annual caseloads Conclusions: A significant number of women with Stage I breast cancer do not undergo AND as part of BCS. The trend is most pronounced for the elderly, but significant fractions of women of all ages are also being undertreated by current standards. Ten-year survival is significantly worse when AND is omitted. This adverse survival effect is not solely from understaging.

The changing survival of patients with mycosis fungoides: a population-based assessment of trends in the United States.

Abstract: BACKGROUND The authors sought to evaluate trends in survival among a population-based group of patients with mycosis fungoides, in response to informal evidence of improved prognosis and concerns about the influence of detection bias on incidence data. METHODS Data used in this study were drawn from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, which includes 9 population-based cancer registries. Together, these registries cover approximately 10% of the U.S. population and have tracked the survival of all mycosis fungoides patients who were registered during the years 1973–1992. Data included follow-up through 1994. RESULTS There was a total of over 10,000 person-years of follow-up for the 1633 patients studied. Relative survival changed little after 11 years, at which point it was 66%. Advanced age and black race were associated with poorer survival. The prognoses of Asian and Hispanic patients were slightly but not significantly worse than those of whites, and there were no significant geographic differences related to prognosis. The survival of married women was superior to that of other gender and marital-status groups. Prognosis did improve substantially over the 20-year period of study. CONCLUSIONS Mycosis fungoides is usually not a fatal disease, although the mortality risk is substantial. The authors quantified various prognostic factors and documented an improved prognosis over the 20-year period of study. The data from this study raise concern about possible detection bias in incidence data. These data are also consistent with the concept that beyond 11 years after diagnosis, this disorder has relatively little impact on the risk of death. Cancer 1999;85:208–12. © 1999 American Cancer Society.

Mortality and prostate cancer risk in 19,598 men after surgery for benign prostatic hyperplasia.

Abstract: Objectives To examine postoperative mortality and prostate cancer risk after the first prostatectomy for benign prostatic hypertrophy over a 17-year period in a population-based cohort of men in Western Australia, using improved methods to adjust for comorbidity. Patients and methods The relative survival from death and prostate cancer incidence was calculated against the background population rates. The outcomes of transurethral resection of the prostate (TURP) and open prostatectomy (OP) were compared adjusting for calendar year, age, admission type and comorbidity using Cox regression. Fractional polynomials were used to take account of nonlinearity in confounder effects. Results At 10 years, the relative survival was 116.5% in TURP patients and 123.5% after OP. Adjusting only for confounding by age, calendar year and admission type, TURP had a higher mortality rate than OP (rate ratio, RR, 1.20; 95% confidence interval 1.08-1.34). The RR fell to 1.10 (0.99-1.23) after adjustment for comorbidity and to 1.07 (0.95-1.19) when accounting for nonlinearity. The relative survival from the incidence of prostate cancer at 10 years was 103.7% after TURP and 104.5% after OP. The RR adjusted for age and calendar year was 1.44 (0.94-2.21) for incidence and 1.37 (0.81-2.29) for prostate cancer mortality. Conclusion There is at most a small and clinically unimportant excess mortality risk from TURP; any difference could be due to a protective effect of OP on the long-term risk of prostate cancer and a lower rate of repeat prostatectomy.

Evidence of improving survival of patients with rectal cancer in France: a population based study

Abstract: Background—Over the past 20 years there have been many changes in the management of rectal cancer. Their impact on the overall population is not well known. Aims—To determine trends in management and prognosis of rectal cancer in two French regions. Subjects—1978 patients with a rectal carcinoma diagnosed between 1978 and 1993. Methods—Time trends in treatment, stage at diagnosis, operative mortality, and survival were studied on a four year basis. A non-conditional logistic regression was performed to obtain an odds ratio for each period adjusted for the other variables. To estimate the independent eVect of the period a multivariate relative survival analysis was performed. Results—Over the 16 year period resection rates increased from 66.0% to 80.1%; the increase was particularly noticeable for sphincter saving procedures (+30.6% per four years, p=0.03). The percentage of patients receiving adjuvant radiotherapy increased from 24.0% to 40.0% (p=0.02). The proportion of patients with Dukes’ type A cancer increased from 17.7% to 30.6% with a corresponding decrease in those with more advanced disease. Operative mortality decreased by 31.1% per four years (p=0.03). All these improvements have resulted in a dramatic increase in relative survival (from 35.4% for the 1978‐ 1981 period to 57.0% for the 1985‐1989 period). Conclusions—Substantial advances in the management of rectal cancer have been achieved, but there is evidence that further improvements can be made in order to increase survival. (Gut 1999;44:377‐381)

Unchanged survival of gastric cancer in the southeastern Netherlands since 1982: result of differential trends in incidence according to Laurén type and subsite.

Abstract: Despite widespread use of endoscopy and improved surgical treatment, the prognosis for gastric cancer remains poor. Although the incidence has been declining for more than 2 decades, unfavourable changes in relative frequency of histological subtypes and subsites may have occurred. We therefore assessed the nature and impact of these changes in association with socio-economic status in a population-based study during the period 1983–1995. Furthermore, tumour characteristics were analysed as predictors of survival for 1,543 cases recorded in the Eindhoven Cancer Registry during the period 1983–1992. Overall 5-year relative survival remained at 22%, being 70%, 37% and 11% for stage I, II and III, respectively. The Lauren histological type and location were also found to have prognostic value. Tumours with the worst prognosis (diffuse type and located at the cardia) developed predominantly in younger patients and were increasing. Moreover, unlike for other tumours, high educational status was associated with unfavourable prognosis. Stage at diagnosis and survival have remained unchanged, despite likely improvements in early detection through better access to endoscopy and better supportive care after surgical treatment. The unfavourable, in part relative, changes in incidence are likely to be responsible for the lack of improvement of survival rates. Int. J. Cancer (Pred. Oncol.) 84:28–32, 1999. © 1999 Wiley-Liss, Inc.

Do morphology and stage explain the inferior lung cancer survival in Denmark

Abstract: Danish lung cancer patients diagnosed during 1983-1987 experienced 5-yr relative survival rates 2-7% inferior to patients in the other Nordic countries, despite the similarity of cancer registration and healthcare systems in the Nordic countries. Is the inferior relative survival in Denmark due to differences in morphology or stage of lung cancers? The present study compared in detail the survival of 92,719 patients diagnosed with lung cancer during 1978-1992 in Denmark, Finland, and Norway. In particular, differences in morphology and extent of disease were studied. A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed. However, this could not explain the relative survival differences observed between countries. Extent of disease was the most important predictor of survival. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Differences in treatment are unlikely to explain the findings, although delays in diagnosing and treating patients in Denmark compared with neighbouring countries could partially explain the lower patient survival in Denmark. In conclusion, the main factor in the lower survival rate in Denmark is unfavourable stage distribution.

Cancer patient survival--patterns, comparisons, trends--a population-based Cancer Registry study in Finland.

Abstract: The effects of primary site, sex, age, stage and histological type on cancer patient survival were analysed on the basis of the population-based material of the Finnish Cancer Registry from 1985 to 1994. In addition, trends in survival were constructed for the period 1955-1994. Detailed site-specific data are published as Supplement 12 to Vol. 38 of Acta Oncologica. Within a given site, the survival differences by gender were not large. However, because of different site distributions, the average prognosis for female patients, all sites taken together, was superior to that of males: the 5-year relative survival rates (RSR) were 58% and 43%, respectively. In general, older patients had a poorer outcome compared with younger patients (partly because of different stage and histology distributions). Stage was a strong determinant of patient survival. In some cancers with a poor average prognosis the 5-year RSR for localized tumours was reasonable, e.g. 61% for stomach cancer, males, 34% for gallbladder cance...

Influence of stage at diagnosis on survival differences for rectal cancer in three European populations.

Abstract: Important differences have recently been highlighted between European countries in the survival of colorectal cancer patients. As data on stage at diagnosis were available for rectal cancers in three European population-based registries (Geneva Switzerland; Cote d'Or, France; Mallorca, Spain), we compared relative survival while assessing the effect of stage in a multiple regression model. We analysed 1005 rectal cancer cases diagnosed between 1982 and 1987 and followed up for at least 5 years. In the Mallorca registry, 16% of the patients were diagnosed in the TNM stage I (versus 21% in the Cote d'Or registry and 29% in the Geneva registry, P < 10−4) and the 5-year relative survival rate was lower (35%) than in the other two registries (Cote d’Or 47%, Geneva 48%, P = 0.01). In the multivariate analysis, stage was the only independent prognostic factor, whereas the excess death risk did not vary significantly among registries (compared to Geneva, Cote d'Or relative risk was 1.0, Mallorca relative risk 1.11, 95% confidence interval 0.76–1.32 and 0.85–1.44 respectively). Survival differences between the registries were mainly due to stage at diagnosis. Thus, diagnostic conditions appear to be the main determinant of the survival inequalities found in those three European populations. © 1999 Cancer Research Campaign

Survival from contralateral breast cancer.

Abstract: First primary, or unilateral, breast cancer (UBC) cases diagnosed in 1960-89 at the Cancer Institute (WIA), Chennai, India were followed-up until December 31, 1994. Patients with UBC (n = 3163) and those who developed second cancer in the contralateral breast (CBC) after the initial breast cancer (n = 67 or 2.1% of UBC) were analysed. Compared to UBC patients, those who developed CBC were younger at the time of diagnosis of initial breast cancer and had higher frequency of breast cancer among the family members. The relative survival rate takes into account competing causes of death and was estimated as the ratio of observed survival rate to the expected survival rate. The cumulative relative survival from UBC at 5 and 10 years were 51% and 41%, respectively, and the corresponding rates for CBC were 47% and 30%; the survival difference seen between UBC and CBC patients was not statistically significant. The survival rates among younger, middle-aged and older women were significantly different from each other in UBC but not in CBC patients. Both UBC and CBC with early stage disease had a better survival compared to late stage disease. Survival advantage was also seen among both UBC and CBC patients with family history of breast cancer compared to those without. The multivariate analysis by the life table proportional hazards model showed that the age at diagnosis is an independent prognostic factor for breast cancer. The study results should be interpreted in the light of small sample size of second cancers.

Survival after rectal cancer: differences between hospital catchment areas. A nationwide study in Sweden

Abstract: BACKGROUND—The quality of rectal cancer surgery at small units has been debated. No national studies of this issue have been undertaken and most studies have been based on insufficient data to clarify the controversy. It has been claimed that observed differences in outcomes between specialised centres and smaller hospitals are confounded by differences in stage/severity. AIM—To compare survival after rectal cancer between hospital catchment areas. PATIENTS—All patients with rectal cancer notified to the Swedish Cancer Register in 1973-1992 (n = 30 811) were followed up by record linkage to the nationwide Death Register. METHODS—Relative survival—that is, ratio of observed to expected survival—was computed as a measure of excess mortality attributable to rectal cancer. Multivariate analysis was then performed to estimate the independent effects of hospital catchment area categories and age, year of diagnosis, and duration of follow up. RESULTS—One year relative survival among rectal cancer patients residing in catchment areas of large regional hospitals was 76%, compared with 72% for small local hospitals (p<0.001). A difference was already noted after 30 days and remained five years after diagnosis. Relative survival improved considerably overall, but the differences between catchment area categories persisted. These were not reduced by adjustment for age, time after diagnosis, or time period in multivariate models. CONCLUSION—The differences in outcome between catchment area categories could not be explained by differences in age, time period, or duration of follow up after diagnosis. They are unlikely to be explained by differences between catchment area populations with regard to the average stage of the disease at which symptoms lead to diagnosis. The differences may therefore be attributable to different strategies for diagnosing and managing patients with rectal cancer. Keywords: rectal neoplasms; cancer; survival; Sweden

Striking increase in incidence of prostate cancer in men aged < 60 years without improvement in prognosis.

Abstract: Increased awareness and improved diagnostic techniques have led to earlier diagnosis of prostate cancer and increased detection of subclinical cases, resulting in improved prognosis. We postulated that the considerable increase in incidence under age 60 is not attributable only to increased detection. To test this hypothesis, we studied incidence, mortality and relative survival among middle-aged patients diagnosed in south-east Netherlands and East Anglia (UK) between 1971 and 1994. Prostate-specific antigen (PSA) testing did not occur before 1990. Between 1971 and 1989, the age-standardized incidence at ages 40-59 increased from 8.8 to 12.5 per 10(5) in The Netherlands and from 7.0 to 11.6 per 10(5) in East Anglia. Five-year relative survival did not improve in East Anglia and even declined in southeast Netherlands from 65% [95% confidence interval (CI) 47-83) in 1975-79 to 48% (CI 34-62) in 1985-89. Mortality due to prostate cancer among men aged 45-64 years increased by 50% in south-east Netherlands and by 61% in East Anglia between 1971 and 1989, but decreased slightly in the 1990s. Because other factors adversely influencing the prognosis are unlikely, our results indicate an increase in the incidence of fatal prostate cancer among younger men in the era preceding PSA testing.

Variations in survival for invasive cervical cancer among European women, 1978-89

Abstract: Objectives: To analyze cervical cancer survival trends in 10 European countries using models that estimate the proportion of cured patients (having the same life expectancy as the general population) and the survival of fatal cases (who die from cervical cancer) Methods: We considered 40,906 cases diagnosed over 12 years (1978–89) collected from cancer registries participating in EUROCARE Results: From 1978 to 1989, 5-year relative survival in Europe improved (60%→63%) The proportion of cured patients increased slightly but significantly (53%→55%, p = 005) For countries with poorer survival at the end of the 1970s the proportion of cured patients increased faster than average, particularly evident in England (49%→56%) and Scotland (44%→53%) By contrast, in Finland, Sweden and Germany with organized screening, 5-year survival and cure rate did not improve, but incidence declined to very low levels Conclusions: Cervical screening can explain the trends in cervical cancer survival: this identifies premalignant lesions, reduces incidence and selectively prevents less aggressive cancers The decreased proportion of the latter means that survival does not improve in countries with low incidence of cervical cancer The increased proportion of cured patients with time shows that survival improvement was not due simply to earlier diagnosis with no patient advantage

Trends in survival of patients with ovarian cancer in Saarland, Germany, 1976-1995.

Abstract: Purpose: We aimed to monitor recent progress in survival of patients with ovarian cancer. Methods: We assessed trends in survival in 1976–1995 among patients notified to the population-based cancer registry of Saarland, Germany, with a first diagnosis of ovarian cancer below the age of 80 years. A new statistical methodology was applied that allows the most timely detection of changes in survival rates. Results: There was a dramatic, ongoing increase in 5-year relative survival rates from 36.6% in 1976–1980 to 60.1% in 1991–1995 among patients whose cancer was detected below the age of 55 years, and from 23.7% to 42.9% in patients aged 55–64 years at the time of diagnosis. No such improvement was seen among older patients, who continued to have a very poor prognosis. Therefore, the variation of prognosis with age was strongly increasing over time. Conclusions: Improvement of prognosis in younger patients most likely reflects the benefits of more aggressive surgery and chemotherapy in these age groups. Efforts should be made to overcome obstacles to more successful therapy for older patients.

Borderline ovarian tumours in Vaud, Switzerland: incidence, survival and second neoplasms

Abstract: Between 1976 and 1996, 176 borderline ovarian tumours were registered in the Cancer Registry of the Swiss canton of Vaud, corresponding to an age-adjusted incidence (world standard) of 2.7 in 100 000. Incidence rose from 1.7 per 100 000 during 1976–81 to 2.7 per 100 000 during 1987–91, and then levelled off; 58% of cases were serous and 41% mucinous. Relative survival was 94% at 10 years; 18 second neoplasms were observed, compared with 10.3 expected, and there was a significant excess of invasive ovarian cancers (four observed, including three synchronous, compared with 0.4 expected). © 1999 Cancer Research Campaign

Cancer of the Mobile Tongue in Finland: Increasing Incidence, but Improved Survival

Abstract: A population-based descriptive study was conducted to describe incidence and survival of cancer of the mobile tongue in Finland between 1953 and 1994. The study included 1504 patients, drawn from the Finnish Cancer Registry, with first primary mobile tongue cancer diagnosed between 1953 and 1994. Incidence and relative survival were determined. The age-standardized overall incidence rate was 0.6 per 100000 years in 1953-1994. At the time of diagnosis 78% of the patients had either localized or regional disease. The age-standardized incidence rate decreased after the mid-1960s, but increased in the 1990s. The 5-year relative survival rate increased gradually from 40% in 1953 1959 to 58% in 1988-1994. Disease stage at the time of the diagnosis strongly affected the survival rate. Survival increased especially in regional disease. Cancer of the mobile tongue is increasing in Finland, but survival has increased particularly in regional disease, probably because of improved treatment. Early diagnosis is emphasized for a good prognosis.

Trends in survival rates of cancer in Cuba.

Abstract: Reports of population-based survival rates of cancer from developing countries are infrequent. In Latin America, only the Cancer Registry of Puerto Rico has published population-based survival data. The National Cancer Registry of Cuba has achieved three survival studies with cases incident in 1976, 1982 and 1988-1989. This article deals with the global observed and relative survival rates estimated in the latter study. Survival time trends are analysed. In the period 1988-1989, 12,985 primary cancer cases were included from the most common cancer sites, with the exclusion of cancer in situ cases and 8900 cases reported by 'death certificate only' (DCO) (35.8%). The vital status of cases was checked up to 31 December 1994 using a mixed follow-up system with the exclusion of 2900 cases lost to follow-up (11.2%). DCO proportions are shown for the major sites and compared to those of 1982. Observed survival rates were estimated by Kaplan-Meier method using the SPSS Statistical Software. The relative rates were estimated by the Hakulinen's Computer Program Package for Cancer Survival Studies (1988) using life tables from Cuban population. Statistical comparisons of survival curves by year of diagnosis were achieved by using the Log-Rank and Pearson statistic tests. Global results are shown by year of follow-up and a comparative analysis is done in time and with internationals values. Survival rates decreased in the period 1982/1988-1989 for colon, prostate and lung cancer. Prostate cancer shows a low five years relative survival rate when compared with the USA, but its observed rate is comparable with Puerto Rico's. Figures for mouth and lung cancer were comparable with the corresponding figures of the USA and Europe. Breast and cervix cancers rates are comparable with the European mean and the blacks in USA.