Long-term crude probabilities of death among breast cancer patients by age and stage: a population-based survival study in Northeastern Spain (Girona-Tarragona 1985-2004)

Background: We provide population-based long-term survival indicators of breast cancer patients by quantifying the observed survival, and the probabilities of death due to breast cancer and to other causes by age and tumor stage at diagnosis. Methods; We included a total of 10,195 female patients diagnosed before 85 years with invasive primary breast cancer in Girona and Tarragona during the periods 1985-1994 and 1995-2004 and followed-up until December 31st 2014. The survival indicators were estimated at 5, 10, 15 and 20 years of follow-up comparing diagnostic periods. Results: Comparing diagnostic periods: I) the probability of death due to other causes did not change; II) the 20-year survival for women diagnosed ≤ 49 years increased 13% (1995-2004 = 68%; 1985-1994:55%), whereas their probability of death due to breast cancer decreased at the same pace (1995-2004 = 29%; 1985-1994 = 42%); III) at 10 years of follow-up, decreases in the probabilities of death due to breast cancer across age groups switched from 11 to 17% resulting in a risk of death reduction of 19% after adjusting by stage. During 1995-2004, the stage-specific 10-year probabilities of death due to breast cancer switched from: 3-6% in stage I, 18-20% in stage II, 34-46% in stage III and surpassed 70% in stage IV beyond 5 years after diagnosis. Conclusions: In our study, women diagnosed with breast cancer had higher long-term probability to die from breast cancer than from other causes. The improvements in treatment and the lead-time bias in detecting cancer in an early stage resulted in a reduction of 19% in the risk of death between diagnostic periods

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Predicting the cancer burden in Catalonia between 2015 and 2025: the challenge of cancer management in the elderly

Background. Developing effective cancer control programmes requires information on the future cancer burden in an ageing population. In our study we predicted the burden of cancer in Catalonia from 2015 to 2025. Methods. Bayesian age-period-cohort models were used to predict the burden of cancer from 2015 to 2025 using incidence data from the Girona and Tarragona cancer registries and cancer mortality data from the Catalan mortality registry. Using the Bashir-Estève method, we divided the net change in the number of cases between 2015 and 2025 into changes due to population size (S), cancer risk (R) and age (A) distribution. Results. By 2025, there will be 21,743 new cancer cases in men (40% aged > 74 years) and 17,268 in women (37% aged > 74 years). More than 40% of the new cases will be diagnosed among population aged 74 and older in prostate, colorectal, lung, bladder, pancreatic and stomach cancers in men, and in colorectal, pancreatic and bladder cancers and leukaemia in women. During 2015-2025, the number of new diagnoses will increase by 5.5% in men (A + R + S = 18.1% − 13.3% + 0.7% = 5.5%) and 11.9% in women (A + R + S = 12.4% − 1.1% + 0.6% = 11.9%). Overall cancer mortality rates will continue to decrease during 2015-2025. Lung cancer will be the most lethal cancer among men (N = 2705) and women (N = 1174). Conclusions. The increase in the number of cancer cases in Catalonia from 2015 to 2025 will mostly affect the elderly, prompting the need for increased collaboration between geriatricians and oncologists

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Assessing predicted age-specific breast cancer mortality rates in 27 European countries by 2020

Background. We assessed differences in predicted breast cancer (BC) mortality rates, across Europe, by 2020, taking into account changes in the time trends of BC mortality rates during the period 2000-2010. Methods. BC mortality data, for 27 European Union (EU) countries, were extracted from the World Health Organization mortality database. First, we compared BC mortality data between time periods 2000-2004 and 2006-2010 through standardized mortality ratios (SMRs) and carrying out a graphical assessment of the age-specific rates. Second, making use of the base period 2006-2012, we predicted BC mortality rates by 2020. Finally, making use of the SMRs and the predicted data, we identified a clustering of countries, assessing differences in the time trends between the areas defined in this clustering. Results. The clustering approach identified two clusters of countries: the first cluster were countries where BC predicted mortality rates, in 2020, might slightly increase among women aged 69 and older compared with 2010 [Greece (SMR 1.01), Croatia (SMR 1.02), Latvia (SMR 1.15), Poland (SMR 1.14), Estonia (SMR 1.16), Bulgaria (SMR 1.13), Lithuania (SMR 1.03), Romania (SMR 1.13) and Slovakia (SMR 1.06)]. The second cluster was those countries where BC mortality rates level off or decrease in all age groups (remaining countries). However, BC mortality rates between these clusters might diminish and converge to similar figures by 2020. Conclusions. For the year 2020, our predictions have shown a converging pattern of BC mortality rates between European regions. Reducing disparities, in access to screening and treatment, could have a substantial effect in countries where a non-decreasing trend in age-specific BC mortality rates has been predicted (AU)

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Predicting the cancer burden in Catalonia between 2015 and 2025: the challenge of cancer management in the elderly.

BACKGROUND: Developing effective cancer control programmes requires information on the future cancer burden in an ageing population. In our study we predicted the burden of cancer in Catalonia from 2015 to 2025. METHODS: Bayesian age-period-cohort models were used to predict the burden of cancer from 2015 to 2025 using incidence data from the Girona and Tarragona cancer registries and cancer mortality data from the Catalan mortality registry. Using the Bashir-Estève method, we divided the net change in the number of cases between 2015 and 2025 into changes due to population size (S), cancer risk (R) and age (A) distribution. RESULTS: By 2025, there will be 21,743 new cancer cases in men (40% aged > 74 years) and 17,268 in women (37% aged > 74 years). More than 40% of the new cases will be diagnosed among population aged 74 and older in prostate, colorectal, lung, bladder, pancreatic and stomach cancers in men, and in colorectal, pancreatic and bladder cancers and leukaemia in women. During 2015-2025, the number of new diagnoses will increase by 5.5% in men (A + R + S = 18.1% - 13.3% + 0.7% = 5.5%) and 11.9% in women (A + R + S = 12.4% - 1.1% + 0.6% = 11.9%). Overall cancer mortality rates will continue to decrease during 2015-2025. Lung cancer will be the most lethal cancer among men (N = 2705) and women (N = 1174). CONCLUSIONS: The increase in the number of cancer cases in Catalonia from 2015 to 2025 will mostly affect the elderly, prompting the need for increased collaboration between geriatricians and oncologists.

Impacto del cáncer en Cataluña: consecuencias para las prioridades en prevención, diagnóstico y tratamiento / Impact of cancer in Catalonia: consequences for priorities in the prevention, diagnosis and treatment of cancer

FUNDAMENTO: El análisis de la evolución de la incidencia, la supervivencia y la mortalidad debe aplicarse para establecer las prioridades de prevención del cáncer y mejora de la atención oncológica en Cataluña. POBLACIÓN Y MÉTODO: Se revisa el impacto del cáncer en Cataluña y sus tendencias previsibles y las propuestas recientemente elaboradas en Europa sobre prevención del cáncer y mejora de la atención oncológica. RESULTADOS: La reducción del tabaquismo en todas las edades, pero especialmente en jóvenes, mujeres y personas de bajo nivel socioeconómico, continúa siendo el principal objetivo preventivo, junto con la reducción del sobrepeso y la obesidad, la mejora de la dieta y de la exposición solar excesiva. El cribado de cáncer de colon y recto debe cubrir toda la población catalana de 50-69 años. La atención oncológica debe orientarse más a modelos multidisciplinarios, basados en guías de práctica clínica y que tengan en cuenta los aspectos psicosociales y de rehabilitación. La evaluación sistemática de resultados en los centros hospitalarios y la mejora de la coordinación entre centros y profesionales son las asignaturas pendientes de la atención oncológica, que deben ser utilizadas para mejorar el proceso asistencial. CONCLUSIONES: Aplicar el conocimiento actual a la práctica clínica, tanto en el diagnóstico como en el tratamiento, con una orientación multidisciplinaria debe permitir mejorar los resultados clínicos en nuestro país. Reducir el tabaquismo y la obesidad y extender el cribado del cáncer colorrectal son otras prioridades que repercutirán en el impacto del cáncer en Cataluña

BACKGROUND: The results of analysis of incidence, survival and mortality should be applied to set the priorities in cancer prevention and screeningand improvement of cancer care in Catalonia. POPULATION AND METHODS: A review of the impact of cancer in Catalonia and its foreseeable tendencies, as well as the recent proposals made across Europe regarding cancer prevention and care, was carried out. RESULTS: The main priority in prevention continues to be smoking prevention in all age groups but especially among young women and people with a low socioeconomic position, together with overweight and obesity reduction, dietary improvements, and avoidance of excessive sun exposure. Colorectal cancer screening should cover all people aged 50 to 69 years old. Cancer care should be based on a multidisciplinary approach, with clinical practice guidelines, and should take into account the psychosocial and rehabilitation aspects of care. Areas that deserve greater efforts to improve oncology care are outcomes assessment among hospitals and improvements in coordination among centers and health professionals. CONCLUSIONS: The main priority should be to apply current knowledge to clinical practice, both in diagnosis and in treatment, within a multidisciplinary framework to improve outcomes. Other priorities aimed at reducing the impact of cancer in Catalonia are reducing the prevalence of smoking and obesity and extending the coverage of colorectal cancer screening to the target population

Hallazgos colonoscópicos del estudio piloto de cribado de cáncer colorrectal realizado en Cataluña / No disponible

Objetivo: evaluar las lesiones detectadas en las dos rondas yafinalizadas del Programa Piloto de Cribado en Cáncer Colorrectal(CCR) llevado a cabo en L’Hospitalet de Llobregat (Barcelona).Material y métodos: el programa de cribado de CCR se inicióen el año 2000. La población, comprendida entre 50 y 69años residentes en el área, fue invitada a participar a través de ladeterminación bienal de sangre oculta en heces mediante el testguaiaco y colonoscopia en los participantes con test positivo. Serealizó polipectomía de las lesiones detectadas o biopsias cuandono era posible la extirpación. Los pólipos se clasificaron según criteriosde la Organización Mundial de la Salud.Resultados: se realizaron 442 colonoscopias de los 495 testpositivos. En 213 individuos, se detectaron: 36 cánceres invasivos,121 adenomas de alto riesgo, 29 adenomas de bajo riesgo y27 pólipos hiperplásicos. En el 25,8% de los casos, el tamaño delos adenomas fue < 10 mm. La mayoría de las lesiones diagnosticadas(37,2%) estaban localizadas en el colon distal, el 5,7% a nivelproximal y ambas localizaciones en el 5,2%. Las neoplasiasavanzadas se asociaron significativamente al sexo masculino y lalocalización distal. La prevalencia de neoplasias avanzadas a nivelproximal entre los pacientes sin pólipos distales fue del 5,1%.Conclusiones: los adenomas de alto riesgo de localizacióndistal han sido las lesiones detectadas con mayor frecuencia. Elcribado poblacional mediante la determinación de sangre ocultaen heces es un método factible para detectar pequeñas lesionesprecancerosas, factor clave para disminuir la incidencia de CCR

Objective: to evaluate lesions detected in two screeningrounds performed in a pilot screening program for colorectal cancerin Catalonia, Spain.Material and methods: a colorectal cancer screening programwas initiated in 2000. The target population included menand women aged 50-69 years. Screening consisted of biennialguaiac-based fecal occult blood testing (FOBT), and colonoscopyfor participants with a positive FOBT. Any polyps found were removed,and biopsies were performed for any masses.Results: Colonoscopies were performed in 442 of 495 peoplewith positive FOBT. In 213 (48.2%), 36 invasive cancers, 121high-risk adenomas, 29 low-risk adenomas, and 27 hyperplasticpolyps were diagnosed. Lesion size was smaller than 10 mm in25.8% of cases. Most detected lesions (37.2%) were located in thedistal colon, followed by the proximal colon (5.7%) and both locations(5.2%). Advanced neoplasm was significantly associated withmale gender and distal location. The prevalence of advancedproximal neoplasms among patients with no distal polyps was5.1%.Conclusions: the most common lesions detected bycolonoscopy were high-risk adenomas located in the distal colon.FOBT is a suitable method for detecting small precancer lesionsduring population screening, and is thus a key factor in reducingthe incidence of colorectal cancer

La evidencia del cribado del cáncer de mama: la historia continúa / The evidence on breast cancer screening: the story continues

La publicación de la nueva revisión Cochrane sobre el cribado de cáncer de mama mediante mamografía ha iniciado un nuevo período de discusión y reflexión sobre este cribado. Los autores de dicha revisión se han reafirmado en la falta de eficacia del cribado mamográfico, mientras que la actualización de la revisión de los estudios suecos y dos nuevas revisiones sistemáticas realizadas por la Agency for Healthcare Research and Quality para la US Preventive Services Task Force y por un grupo de trabajo bajo los auspicios de la IARC, que han tenido muy en cuenta las discusiones sobre los aspectos metodológicos de los ensayos discutidos en los últimos años, se han reafirmado en la eficacia del cribado mamográfico. No obstante, sigue abierto el debate sobre la efectividad y las recomendaciones en mujeres menores de 50 años. El debate actual ha puesto sobre la mesa aspectos como la mejor medida de los beneficios de un ensayo sobre cribado o los potenciales efectos adversos del cribado en forma de sobrediagnóstico o sus repercusiones sobre el tratamiento, que se discuten en este artículo. Asimismo, nos reafirma en la necesidad de introducir cribados de beneficio demostrado y discutir e informar a la población sobre estos beneficios, pero también sobre los riesgos y las incertidumbres del cribado del cáncer (AU)

The publication of the new Cochrane review on screening for breast cancer with mamography has revived the debate on breats screening and raised some new topics. Whereas the Cochrane reviewers reasserted on their previous conclusion of the lack of efficacy of breast screening, the new review of the Swedish studies, the new systematic review of the Agency for Healthcare Research and Quality commissioned by the US Preventive Services Task Force, and the recent review of an IARC working group supported the efficacy of breast screening after carefully considering the methodological quality of trials. Nevertheless, the efficacy of breast screening for younger women remains controversial. The present controversy has raised other issues like the measure of the benefit in screening trials or the potential adverse effects of screening, particularly, overdiagnosis and its impact on therapy that are discussed in this papers. It also stresses of evaluating screening before introducing it and the need to inform the population about the benefits and the potential harms and about uncertainties about cancer screening (AU)