Showing papers on "Relative survival published in 2004"

Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival

Abstract: BACKGROUND The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the U.S. This year's report features a special section on cancer survival. METHODS Information concerning cancer cases was obtained from the NCI, CDC, and NAACCR and information concerning recorded cancer deaths was obtained from the CDC. The authors evaluated trends in age-adjusted cancer incidence and death rates by regression models and described and compared survival rates over time and across racial/ethnic populations. RESULTS Incidence rates for all cancers combined decreased from 1991 through 2001, but stabilized from 1995 through 2001 when adjusted for delay in reporting. The incidence rates for female lung cancer decreased (although not statistically significant for delay adjusted) and mortality leveled off for the first time after increasing for many decades. Colorectal cancer incidence rates also decreased. Death rates decreased for all cancers combined (1.1% per year since 1993) and for many of the top 15 cancers occurring in men and women. The 5-year relative survival rates improved for all cancers combined and for most, but not all, cancers over 2 diagnostic periods (1975–1979 and 1995–2000). However, cancer-specific survival rates were lower and the risk of dying from cancer, once diagnosed, was higher in most minority populations compared with the white population. The relative risk of death from all cancers combined in each racial and ethnic population compared with non-Hispanic white men and women ranged from 1.16 in Hispanic white men to 1.69 in American Indian/Alaska Native men, with the exception of Asian/Pacific Islander women, whose risk of 1.01 was similar to that of non-Hispanic white women. CONCLUSIONS The continued measurable declines for overall cancer death rates and for many of the top 15 cancers, along with improved survival rates, reflect progress in the prevention, early detection, and treatment of cancer. However, racial and ethnic disparities in survival and the risk of death from cancer, and geographic variation in stage distributions suggest that not all segments of the U.S. population have benefited equally from such advances. Cancer 2004. Published 2004 by the American Cancer Society.

Breast carcinoma in men: a population-based study.

Abstract: BACKGROUND Male breast carcinoma is an uncommon disease, and most previous studies have been single-institution series that were limited by extremely small sample sizes. The goals of the current study were to fill in the major gaps in knowledge regarding the incidence, presenting characteristics, prognostic factors, and survival rates of male breast carcinoma and to determine how breast carcinoma differs between men and women. METHODS Data from the National Cancer Institute Surveillance, Epidemiology, and End Results 1973–1998 database were used. Age-adjusted incidence rates were calculated. Characteristics of the patients and presenting tumors were compared between men and women. Univariate and multivariate analyses were performed to determine the effect of each variable on overall survival. Survival rates by disease stage were compared for men and women. RESULTS Over the years of the study, the incidence of male breast carcinoma increased significantly from 0.86 to 1.08 per 100,000 population (P < 0.001). Men had a higher median age at diagnosis (P < 0.001) and were more likely to have lymph node involvement (P < 0.001), a more advanced stage at diagnosis (P < 0.001), and tumors that were positive for estrogen receptor (ER) (P < 0.001) and progesterone receptor (PR) (P < 0.001). In multivariate analysis, larger tumor size and lymph node involvement were associated with shortened survival. Tumor grade and ER/PR status did not appear to independently influence survival. Relative survival rates by stage of disease for men and women were similar. CONCLUSIONS Although it remains a rare disease, the incidence of male breast carcinoma is increasing. Breast carcinoma in men has some epidemiologic and biologic differences from breast carcinoma in women. Cancer 2004. © 2004 American Cancer Society.

Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973-2000.

Abstract: BACKGROUND. Anal cancer is a rare malignancy of the anogenital tract that historically has affected women at a greater rate than men. METHODS. The authors analyzed changing trends in incidence rates and 5-year relative survival percentages for patients with anal cancer. The publicly available data used in the current study were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program, a system of population-based tumor registries in the United States. RESULTS. The incidence of anal cancer was similar for men and women between 1994 and 2000 (2.04 per 100,000 and 2.06 per 100,000, respectively), the most recent period for which data were available, whereas men had lower rates than did women between 1973 and 1979 (1.06 per 100,000, compared with 1.39 per 100,000), the earliest period for which data were available. In addition, recently, black men had higher incidence rates than did other race-specific and gender-specific groups (2.71 per 100,000). From the earliest period for which data were available to the most recent period, relative 5-year survival improved from 59% to 73% among women, was unchanged among men (60%), and decreased from 45% to 27% among black men. Eighteen percent of patients who had distant disease were alive at 5 years, compared with 78% of patients who had localized disease. CONCLUSIONS. The incidence of anal cancer in the United States increased between 1973 and 2000, particularly among men. There were higher incidence rates and lower survival rates for black men compared with other race-specific and gender-specific groups. Later disease stage was inversely associated with the survival rate, indicating that earlier detection may improve the survival of patients with anal cancer. Cancer 2004;101:281– 8. © 2004 American Cancer Society.

Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001

Abstract: We examined national trends and socioeconomic inequalities in cancer survival in England and Wales during the 1990s, using population-based data on 2.2 million patients who were diagnosed with one of the 20 most common cancers between 1986 and 1999 and followed up to 2001. Patients were assigned to one of five deprivation categories (from ‘affluent’ to ‘deprived’) using characteristics of their electoral ward of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting separately in each deprivation category for background mortality by age, sex and calendar period. We estimated trends in survival and in the difference in survival between deprivation categories (‘deprivation gap’) over the periods 1986–90, 1991–95 and 1996–99. We used period analysis to examine likely survival rates in the near future. Survival improved for most cancers in both sexes during the 1990s, and appears likely to continue improving for most cancers in the near future. The deprivation gap in survival between rich and poor was wider for patients diagnosed in the late 1990s than in the late 1980s. Increases in cancer survival in England and Wales during the 1990s are shown to be significantly associated with a widening deprivation gap in survival.

Survival among women with borderline ovarian tumors and ovarian carcinoma: a population-based analysis.

Abstract: BACKGROUND Serous and mucinous ovarian tumors of low malignant potential (LMP-S and LMP-M, respectively) are noninvasive tumors that portend excellent survival when confined to the ovary. Comparison of the survival for women with LMP tumors staged as distant with women who have carcinoma may have important implications for diagnostic terminology and clinical management. METHODS The authors compared relative survival rates among patients diagnosed with ovarian tumors during the period 1988–1999 (with follow-up through 2000) by histologic type, disease stage, tumor grade (for carcinomas), and patient age, using data from the Surveillance, Epidemiology, and End Results Program. RESULTS The overall relative survival rate at 10 years (± 1.96 standard errors) was 96.9% ± 2.3% for women with LMP-S tumors, 30.4% ± 1.7% for women with serous carcinoma (CA-S); 94.0% ± 3.1% for women with LMP-M tumors, and 64.7% ± 3.4% for women with mucinous carcinoma (CA-M). The survival rate at 10 years for women with distant-stage LMP-S tumors was 89.9% ± 5.3%, compared with 96.1% ± 8.6% for women with well differentiated, localized CA-S. The survival rate for women with distant-stage LMP-M tumors at 5 years was 85.5% ± 9.0%, compared with 95.5% ± 3.4% for women with well differentiated, localized CA-M (data for 10 years were limited). Mucinous ovarian neoplasms were associated with an excess of second malignancies of the digestive tract. CONCLUSIONS Relative survival among women with distant-stage LMP tumors was not 100% and resembled the survival of women who had carcinoma exhibiting favorable prognostic features (localized stage). Future studies of women with high-stage LMP tumors are required to clarify the pathogenesis of extraovarian lesions and their implications for management and prognosis. Cancer 2004;100:1045–52. Published 2004 by the American Cancer Society.

Incidence and management of malignant digestive endocrine tumours in a well defined French population.

Abstract: Background and aims: Little is known about the epidemiology of malignant digestive endocrine tumours. The aim of this study was to report on their incidence and management in a well defined population. Methods: Data were obtained from the population based Digestive Cancer Registry of Burgundy (France) over a 24 year period. Incidence rates were calculated by sex, age groups, and period of diagnosis. Treatment and stage at diagnosis were also investigated. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed. Results: Between 1976 and 1999, 229 cases were recorded. Age standardised incidence rates were 0.76/100 000 for men and 0.50/100 000 for women. They increased over time in both sexes. The resectability rate was 74.1%. Among recorded cases, 26.6% did not extend beyond the organ, 20% had lymph node metastases, and 53.3% had visceral metastases or were unresectable. There was no improvement in the resection rate or in the stage at diagnosis over the study period. The overall relative survival rate was 66.9% at one year, 50.4% at five years, and 40.6% at 10 years. Stage at diagnosis, age at diagnosis, and subsite were independent significant prognostic factors. Conclusions: Although their incidence is increasing, malignant digestive endocrine tumours remain a rare cancer, representing 1% of digestive cancers. Stage at diagnosis and prognosis at a population level are worse than those reported in hospital series. In the short term, new therapeutic possibilities represent the best way to improve their prognosis.

Incidence and Survival of Mucinous Adenocarcinoma of the Colorectum: A Population-Based Study From an Asian Country

Abstract: PURPOSE:Previous studies have shown conflicting results on the prognosis of mucinous adenocarcinoma of the colorectum. This could be because of heavy bias on patient selection. Furthermore, little data are available from Asian populations. This study was designed to examine incident and prognostic c

Improved survival of follicular lymphoma patients in the surveillance, epidemiology, and end-results (SEER) program

Abstract: 6578 Background: Follicular lymphomas (FL) comprise 17% of non-Hodgkin lymphoma cases in the United States. Several single- and multi-institution groups have published analyses of long-term follow-up of FL patients, yet it remains unclear whether survival patterns in FL have changed over the past twenty years. Methods: Using data provided in the National Cancer Institute's SEER program, 12,088 patients with FL were identified by ICD-O-2 diagnostic codes: grade I (9693–9696), grade II (9691–9692), grade III (9697–9698), grade NOS (9690). Observed median survival curves and proportional death hazard ratios were calculated from Cox regression analysis using SAS version 8.2. SEER*Stat 5.0 was used to calculate relative survival rates where expected survival rates were based on mortality rates for the entire U.S. population. Survival probabilities were calculated accounting for diagnosis era (1983–89, 1990–99), age at diagnosis, gender, race, and tumor grade at diagnosis. Results: Compared with FL patients dia...

Explaining gastric cancer survival differences among European countries.

Abstract: Wide geographic variability in incidence and mortality rates for gastric cancer exists throughout the world despite persistent decreases over several decades. Variability in survival from gastric cancer is also evident and countries with higher incidence rates of gastric cancer show better survival rates than countries with lower incidence. The aim of this study was to identify reasons for the association between incidence and survival and to obtain survival estimates and differences corrected for this variation, thus facilitating further interpretation by clinical factors such as stage and treatment. Relative survival rates for gastric cancer derived from the EUROCARE-2 database for 47 cancer registries in 17 European countries were analyzed with regression methods to adjust differences by age, sex, period of diagnosis, subsite of the stomach, histologic type and stage at diagnosis. Overall, nearly 60% of the variability in gastric cancer relative survival was explained by differences in these variables. Factors are related to treatment and general management of patients is expected to explain the residual variability in gastric cancer survival between European countries. There is a need to improve completeness and standardization of detailed information collected on gastric cancer patients to allow detailed comparative analyses and interpretation.

Are Patients Diagnosed With Breast Cancer Before Age 50 Years Ever Cured

Abstract: Purpose Breast cancer diagnosed before the age of 50 years has become a common disease in many developed countries. Although average remaining life expectancy in the affected age groups is usually several decades, data regarding survival perspectives beyond 10 to 20 years after diagnosis are sparse. The aim of this study was to assess long-term survival in a large population-based sample of patients diagnosed with breast cancer before age 50 years. Patients and Methods Relative survival within up to 40 years after diagnosis was assessed for cohorts of women diagnosed with breast cancer before age 50 years and notified to the nationwide Finnish Cancer Registry within various time intervals since 1953. In addition, up-to-date estimates of 40-year relative survival were obtained by exclusively looking at the survival experience of breast cancer patients in recent years (1993 to 1999) using period analysis, a new method of survival analysis. Results Prognosis of patients diagnosed with breast cancer before ag...

Cancer survival in a southern African urban population.

Abstract: This paper provides the first comprehensive population based cancer survival estimates from the African continent. Five-year absolute and relative survival estimates are presented for black and white Zimbabwean patients diagnosed with cancer in Harare, Zimbabwe between the years 1993 and 1997. The survival of black Zimbabwean cancer patients are among the lowest ever reported from population based cancer registries. For most cancer sites, white Zimbabwean patients have much higher survival than black Zimbabweans, except for lung and colorectal cancer, for which the estimates are similarly poor. Race specific comparisons to cancer patients in the United States show that Zimbabwean patients have much lower survival than American cancer patients and that the gap between black Zimbabwean patients and black American patients is broader than between white Zimbabwean and white American patients. Access to and the ability to pay for medical care may be a very important barrier to better survival for the majority of black Zimbabwean patients and the most important cause for the very low cancer survival in this population.

Population-based survival from cancers of breast, cervix and ovary in women in Mumbai, India.

Abstract: Background: Breast, cervix and ovarian cancers contribute more than 45% of the total in women in Mumbai and survival proportions for these neoplasms are very high in most developed populations in the World. The authors here report and discuss the population-based survival for these cancers in Mumbai, India. Methods: Follow-up information on 4865 cancers of breast, cervix and ovary, registered in the Mumbai Population Based Cancer Registry for the period 1992-1994 was obtained by a variety of methods, including matching with death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits and scrutiny of medical records. The survival for each case was determined as the duration between the date of diagnosis and date of death, date of loss to follow-up or the closing date of the study (December 31 st , 1999). Cumulative observed and relative survival was calculated by the Hakulinen Method. For comparison of results with other populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used in univariate analysis to identify the potentially important prognostic variables. The variables showing statistical significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the independent predictors of survival. Results: The 5-year relative survival rates were 46.2% for breast, 47.7% for the cervix and 25.4% for the ovary. Higher survival was observed for those younger than 35 years for all these three sites. For each, survival declined with advancing age. Single patients who remained unmarried had better survival. For all sites Muslims had a better and Christians a lower survival as compared to Hindus. Education did not appear to be of significance. Survival decreased rapidly with advancing clinical extent of disease for all sites. With localized cancer, 5-year rates ranged from 54.7% to 69.3%, for regional spread 20.4% to 41.6% and distant metastasis not a single site recorded more than 5%. On multivariate analysis, age and extent of disease emerged as independent predictors of survival for all the sites. Conclusion: All the sites included in the study demonstrated moderate survival rates with significant variation. Comparison with other populations revealed lower survival rates as compared to developed countries, particularly for breast and ovary. In Indian populations survival proportions did not show much variation for these cancers. Early detection and treatment are clearly important factors to reduce the mortality from these cancers.

Small cell lung cancer in Norway. Should more patients have been offered surgical therapy

Abstract: Objective: The final outcome of patients with small cell lung cancer (SCLC) is poor with an overall 5-year survival rate of less than 10%. Therefore, the question of surgery in patients with a technically-operable solitary tumor has been raised. The purpose of this study was to identify the proportion of patients with operable SCLC and to assess the prognosis of different treatment strategies. For patients who were operated, we compared the resection specimens from patients with more than 5-year survival with those with shorter survival to see whether the specimens belonged to different subclasses of SCLC. Methods: In Norway all clinical and pathologic departments submit reports on cancer patients to the Cancer Registry. The Registry also has a law-regulated authority to collect supplemental information regarding diagnosis, treatment and outcome for all cancer patients from the hospitals in charge. All reports on patients diagnosed as having SCLC in limited disease or unknown stage during the time interval 1993 –1999 were reviewed. Patients with a T2-tumor, in whom a pneumonectomy would have to be performed, were classified as potentially operable. Five-year relative survival was calculated for patients diagnosed in 1993– 1997. Results: During the actual period 2442 individuals with SCLC were identified. The majority was treated with conventional chemotherapy or concurrent chemoradiotherapy while 38 underwent surgical therapy. Following reclassification of 697 patients reported to have limited disease or unknown stage 180 were judged to be in stage I. In addition to the 38 resected patients 14 were considered fit for surgery technically and medically while 97 were found to be potentially operable treatment modalities apart from surgery yielded a 5-year survival rate , 7%. For stage I ðN ¼ 96Þ the rate was 11.3% in conventionally treated patients compared to 44.9% for those who underwent surgical resection. By pathological review of surgical specimens a diagnosis of SCLC was confirmed in all patients treated by surgery in the groups with long and short survival. Conclusion: This investigation demonstrates that patients with SCLC having a peripherally located tumor should be referred to surgery, as long time survival is far better than for conventionally treated patients. q 2004 Elsevier B.V. All rights reserved.

Do younger female breast cancer patients have a poorer prognosis? Results from a population-based survival analysis.

Abstract: Younger women who develop breast cancer are hypothesized to have poorer survival rates than women who develop it at a later stage in life. Several studies have suggested that differences in biologic characteristics of breast cancer in younger (premenopausal) and older (postmenopausal) women may account for the prognostic variation. This population-based cohort study reports on survival rates of breast cancer in Singapore and examines the hypothesis that younger breast cancer patients have a poorer prognosis. A total of 6,397 breast cancer patients diagnosed from 1968 to 1992 were identified from the population-based cancer registry and followed up through 1997. Outcome measures were relative survival rates (RSRs) calculated using Hakulinen's method and excess hazards ratios (HRs) derived from a regression model based on relative survival. The 2-, 5- and 10-year RSRs were worse among those aged > 75 (65%, 48% and 39%, respectively). The best survival rates were seen among those aged 40–44 (84%, 67% and 56%). Patients younger than 35 years faired reasonably well (79%, 60% and 50%). When the data were stratified according to clinical stage and calendar year, the highest risk of excess deaths was found in women ≥ 75 years old. In patients with localized cancer and/or regional metastases, those in the 35–39 age group had the lowest excess risk. In patients with distant metastases, those younger than 35 years of age had the lowest excess risk of death. At the population level, younger women (< 45 years) with breast cancer in Singapore have higher relative survival rates. © 2003 Wiley-Liss, Inc.

Survival rates of childhood cancer patients in Osaka, Japan.

Abstract: Background Survival of childhood cancer patients is often described in specialized hospitals and/or institutions, but not in the general population. Methods The trends and patterns of childhood cancer survival during 20 years were investigated using the Osaka Cancer Registry's data. The study subjects were 3443 reported cases diagnosed as having the first primary cancer between 1975 and 1994 at the ages of 0-14 years and who lived in Osaka Prefecture, excluding Osaka City. All childhood cancers were classified into 12 diagnostic groups according to the International Classification of Childhood Cancer based on the histology of the cancer. The 5 year relative survival was calculated by the Ederer II method. Results The 5-year relative survival was 58% for all cancers. The survivals of retinoblastoma and kidney tumor patients were as high as 89 and 72%, respectively, whereas those of leukemia and liver tumor patients were as low as 45 and 47%, respectively. When divided into the first and second half-periods, the survival for all cancers was markedly improved from 48 to 68%. The survivals, especially for patients with leukemia, lymphoma, neuroblastoma, hepatoma and gonadal or embryonal tumors, were enhanced by >20% between the first and second half-periods. When these results were compared with those reported in England and Wales and the USA, however, the survivals for many diagnostic groups in Osaka were lower, except that for neuroblastoma. Conclusions The survivals of childhood cancer patients have been markedly improved in Japan, but this finding suggested that the introduction and practice of chemotherapy was insufficient.

Postsurgical disparity in survival between African Americans and Caucasians with colonic adenocarcinoma.

Abstract: Colorectal carcinoma (CRC) is the third most common malignancy and the second most common cause of cancer mortality among men and women in the United States In 2003, there were an estimated 147,500 new cases of CRC and 57,100 deaths due to this malignancy1 In the United States, there are racial differences in CRC incidence, mortality, and survival Compared with Caucasians, African Americans have higher incidence and mortality rates and lower survival rates2 Recent trends indicate that the incidence of CRC among Caucasians has declined slightly and recently stabilized, whereas CRC incidence among African Americans has increased The racial discrepancy is even more prominent with respect to mortality: Mortality rates have declined steadily for Caucasians, whereas they have increased for African Americans, and particularly African-American men For each disease stage at diagnosis, 5-year relative survival rates are lower for African Americans with CRC than for Caucasians2 Several studies of survival differences between African-American and Caucasian patients with CRC have reported poorer prognosis and shorter survival among the former group3–15 (Table 1) These studies analyzed survival and/or mortality among patients with colonic, rectal, or colorectal carcinoma (patients with colonic and rectal tumors were analyzed as a single group) A variety of explanations for the racial disparity in survival have been proposed, including differences in age, advanced disease stage at the time of diagnosis, treatment options, socioeconomic factors, and biologic characteristics (Table 1) TABLE 1 Review of Studies Evaluating Differences in Survival between African Americans and Caucasians with Colorectal Adenocarcinoma We conducted survival analyses to elucidate the differences in survival between African-American patients and Caucasian patients with CRC based on tumor site and tumor stage, because neoplasia of the colon and the rectum should be viewed as distinct disease entities, each with their own prognostic factors All patients underwent surgery (alone) with curative or palliative intent at the University of Alabama–Birmingham (UAB; Birmingham, AL) or at an affiliated Birmingham Veterans Affairs (VA) hospital The current clinical cohort of patients may represent the population dynamics of the southeastern United States

Long-term Survival of Patients with Small Intestinal Carcinoid Tumors

Abstract: Midgut carcinoid tumors are rare and have a markedly better prognosis than adenocarcinoma in the small intestine. New diagnostic methods and medical as well as surgical therapies have evolved during the last decades, leading to more active care of these patients. Patients with small intestinal carcinoids diagnosed from 1960 to 2000 in the duodenum (n = 89) and jejunum/ileum (n = 2437) were identified in the Swedish Cancer Registry. Cases without histologic verification and autopsy cases were excluded. Overall, cause-specific and relative survival were calculated. The overall 5-, 10-, and 15 year survivals were, respectively, 60%, 46%, and 28% for duodenal tumors and 56%, 36%, and 23% for jejunal/ileal tumors. Cause-specific 5-, 10-, and 15-year survival was 94% for all three follow-up periods for duodenal tumors and 87%, 80%, and 77% for those in the jejunum/ileum. The corresponding relative survivals were, respectively, 72%, 67%, and 51% for duodenal tumors and 67%, 54%, and 44% for those in the jejunum/ileum. Sex did not influence overall or cause-specific survival. The age at diagnosis correlated inversely with overall and cause-specific survival for tumors in the jejunum/ileum. For tumors in the jejunum/ileum, the overall and cause-specific survival correlated with the time period of diagnosis, with a more favorable prognosis for those diagnosed in recent years. A multivariate Cox proportional hazards model showed similar results. We concluded that young age and diagnosis in recent years are positive predictors of survival for patients with midgut carcinoids. The divergence between cause-specific and relative survival implies the need for a more detailed analysis of the causes of death of these patients.

Assessment of outcomes after colorectal cancer resection in the elderly as a rationale for screening and early detection.

Abstract: Background: Clinical, social and survival outcomes in elderly patients undergoing bowel cancer surgery were studied to explore the justification for the current upper age limit in colorectal cancer screening programmes. Methods: Scottish national data were analysed to determine age-specific population survival following a diagnosis of colorectal cancer. Detailed analysis of outcome variables was undertaken in a cohort of 180 patients aged over 80 years who underwent resection of colorectal cancer. Results: Population analysis revealed that the absolute risk of developing colorectal cancer was highest in those aged over 80 years, but relative survival was disproportionately poor. Of 180 patients in this age group, 30·0 per cent required an emergency procedure and only 4·6 per cent had Dukes' stage A tumours. Determinants of all-cause mortality were tumour stage (P < 0·001) and degree of co-morbidity (P = 0·004). Some 88·0 per cent of elderly patients returned to the same category of accommodation as that before admission. Conclusion: Colorectal cancer is increasingly common in people aged over 80 years and survival is disproportionately poor compared with that in other age groups. Elective management of early-stage cancer has a better outcome than emergency surgery. The majority of patients maintain social independence. These population and hospital data provide a rationale for early, and even presymptomatic, detection of colorectal cancer in the elderly. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Cancer patient survival in Sweden at the beginning of the third millennium: predictions using period analysis

Abstract: Estimates of cancer patient survival made using traditional, cohort-based, methods can be heavily influenced by the survival experience of patients diagnosed many years in the past and may not be particularly relevant to recently diagnosed patients. Period-based survival analysis has been shown to provide better predictions of survival for recently diagnosed patients and earlier detection of temporal trends in patient survival than cohort analysis. We aim to provide predictions of the long-term survival of recently diagnosed cancer patients using period analysis. The period estimates are compared with the latest available cohort-based estimates. Our results, based on period analysis for the years 2000-2002, suggest an improvement in survival for many forms of cancer during recent years. For all sites combined the 5-, 10-, 15-, and 20-year relative survival ratios were 62%, 53%, 48%, and 47% for males and 67%, 62%, 60%, and 59%, for females. These estimates were 3-14% units higher than those obtained using the latest available cohorts with the respective lengths of follow-up. The interval-specific relative survival stabilised for males at 97% after 8 years of follow-up and for females at 98% after 7 years for both period and cohort analyses.

Prognostic value of morphology and hormone receptor status in breast cancer – a population-based study

Abstract: We analysed the 5-year relative survival among 4473 breast cancer cases diagnosed in 1990-1992 from cancer registries in Estonia, France, Italy, Spain, the Netherlands and the UK. Among eight categories based on ICD-O codes (infiltrating ductal carcinoma, lobular plus mixed carcinoma, comedocarcinoma, 'special types', medullary carcinoma, not otherwise specified (NOS) carcinoma, other carcinoma and cancer without microscopic confirmation), the 5-year relative survival ranged from 66% (95% CI 61-71) for NOS carcinoma to 95% (95% CI 90-100) for special types (tubular, apocrine, cribriform, papillary, mucinous and signet ring cell); 27% (95% CI 18-36) for cases without microscopic confirmation. Differences in 5-year relative survival by tumor morphology and hormone receptor status were modelled using a multiple regression approach based on generalised linear models. Morphology and hormone receptor status were confirmed as significant survival predictors in this population-based study, even after adjusting for age and stage at diagnosis.

Recent increase in cancer survival according to age: higher survival in all age groups, but widening age gradient

Abstract: A major increase in long-term survival of cancer patients in the 1990s has recently been demonstrated. It is unclear, however, to what extent this increase has been shared by cancer patients at various ages. Using the 1973–2000 data base of the Surveillance, Epidemiology, and End Results programme, recent increase in10-year relative survival of cancer patients in the U S was assessed for 4 major age groups and 15 major cancer sites by comparing results of a period analysis for the 1996–2000 period with results of a cohort analysis for patients diagnosed in 1986–1990. Period estimates of 10-year relative survival for all forms of cancer combined in 1996–2000 were 66.1, 58.8, 56.3 and 47.1 for age groups 15–54, 55–64, 65–74 and ≥75years, respectively. They were 7.4, 10.4, 7.8 and 3.0 units higher than the respective 1986–1990 cohort estimates for these age groups. The increase in 10-year relative survival strongly varied by cancer site, but it was generally less pronounced in older than in younger patients. We conclude that long-term survival expectations of cancer patients have increased in all age groups in the 1990s. However, for most common forms of cancer, the age gradient in survival has either persisted or widened.

Estimating regional variation in cancer survival: a tool for improving cancer care.

Abstract: Objective: To improve estimation of regional variation in cancer survival and identify cancers to which priority might be given to increase survival. Methods: Survival measures were calculated for 25 major cancer types diagnosed in each of 17 health service regions in New South Wales, Australia, from 1991 to 1998. Region-specific risks of excess death due to cancer were estimated adjusting for age, sex, and extent of disease at, and years since, diagnosis. Empirical Bayes (EB) methods were used to shrink the estimates. The additional numbers of patients who would survive beyond five years were estimated by shifting the State average risk to the 20th centile. Results: Statistically significant regional variation in the shrunken estimates of risk of excess death was found for nine of the 25 cancer types. The lives of 2903 people (6.4%) out of the 45,047 whose deaths within 5 years were attributable to cancer could be extended with the highest number being for lung cancer (791). Conclusions: The EB approach gives more precise estimates of region-specific risk of excess death and is preferable to standard methods for identifying cancer sites where gains in survival might be made. The estimated number of lives that could be extended can assist health authorities in prioritising investigation of and attention to causes of regional variation in survival.

Population-based survival from cancers having a poor prognosis in Mumbai (Bombay), India.

Abstract: Background: Oesophagus, stomach, pancreas and lung cancers contribute more than 35% of the total cancer incidence in Mumbai and survival rates for these cancers are very poor in most populations in the world. The authors here report and discuss the population-based survival from these cancers in Mumbai, India. Methods: Follow-up information on 5717 cancers patients having a low prognosis, registered in the Mumbai Population-Based Cancer Registry for the period 1987-1991, was obtained by a variety of methods, including matching with death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits and scrutiny of medical records. The survival for each case was determined as the duration between the date of diagnosis and date of death, loss to follow-up or the closing date of the study at the end of 1996. Cumulative observed and relative survival rates were calculated by the Hakulinen Method. For comparison of results with other populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used with univariate analysis to identify the potentially important prognostic variables. The variables showing statistical significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the independent predictors of survival. Results: The 5-year relative survival rates were 11.8% for oesophagus, 10.1% for the stomach, 4.1% for the pancreas, and 7.0% for lung. Females had higher survival rates than males, except with lung cancer. Lower survival was observed for those younger than 35 years for all 4 sites. For each site, survival declined with advancing age. Single patients who remained unmarried had better survival, except with pancreatic cancer. For all sites Muslims had a better survival and Christians had a lower survival as compared to Hindus. Education did not show any pattern for any site. Survival decreased rapidly with advancing clinical extent of disease for all sites. Survival for localized cancer ranged from12.5% to 31.3%, for regional spread 1.3% to 3.4% and with distant metastasis not a single site recorded more than 1%. On multivariate analysis, extent of disease emerged as an independent predictor of survival with all the sites. Also, age for oesophagus, stomach and lung, religion for oesophagus and stomach, and education for stomach and lung, emerged as independent predictors of survival. Conclusion: All the sites included in the study demonstrated very low survival rates with significant variation. Comparison with other populations revealed lower survival rates than for Shanghai-China. In remaining populations, survival proportions did not show much variation for pancreas and lung cancers. For stomach cancer, European countries showed better survival rates. Early detection with treatment is clearly important to reduce the mortality from these cancers.

The relative survival of COPD patients on long-term oxygen therapy in Australia: A comparative study.

Abstract: Objective: The survival of patients with COPD on long-term oxygen therapy (LTOT) has been studied using both univariate and multivariate procedures. There has been only one previous report of relative survival. Relative survival takes into account the risk of death due to increasing age. The objective of this study was to determine the relative survival of a group of South Australian patients prescribed home oxygen therapy for COPD. Methodology: A method proposed by Hakulinen was used to determine relative survival. The results were compared with the relative survival of a similar group of French COPD patients. Results: A total of 505 COPD patients (249 males, 256 females) were included in the survival analysis. Relative survival corrected for life expectancy was 78.1%, 56.7%, 23.1% and 1.1% at 1, 2, 5 and 10 years, respectively, which was less than that reported in a recent French study of comparable patients. Our patients were similar with respect to age, severity of hypoxaemia and oxygen usage to those in the French study. Conclusions: Using relative survival analysis, Australian LTOT patients with COPD have worse outcomes than some European patients. Factors contributing to the excess mortality in South Australian COPD patients need to be investigated.