Cancer survival among adolescents in France.

Cancer is the third most significant cause of mortality in French adolescents. The aim of this study was to investigate survival of adolescents with cancer. Overall (OS), disease-specific (DSS) and event-free survival (EFS) were used for the outcome analysis of adolescents (15-19 years) with cancer, recorded by nine French population-based registries during the 1988-1997 period. Five-year OS, DSS and EFS were, respectively, 74.0% (70.7-77.4), 74.5% (71.2-77.9), and 69.0% (65.4-72.5). Five-year DSS was 94% for carcinomas, 89% for germ-cell tumours, 85% for lymphomas, 67% for soft-tissue sarcomas, 64% for CNS tumours, 55% for malignant bone tumours, and 41% for leukaemia. Compared with paediatric series, poor results in acute lymphoblastic leukaemia, malignant bone tumours, and soft-tissue sarcomas have to be highlighted, and deserve further studies concerning the type of regimens used for these patients. Multidisciplinary management of adolescent cancer in paediatric, adult, or specialized units will improve cure rates and treatment outcomes for these patients.

Cancer incidence among adolescents in France.

BACKGROUND: In France, cancer ranks third as the most significant cause of mortality in young people. However, the incidence, the survival, and the management of adolescent cancers have never been studied. The aim of this study is to investigate incidence rate (IR) of adolescents with cancer from data recorded in French Cancer Registries covering eight administrative areas, representing 10% of the French population, over a 10-year period (from 1988 to 1997). PROCEDURE: Data from the FRANCIM network of French population-based Cancer Registries were used to analyze cancer incidence among adolescents aged from 15 to 19 years, excluding basal cell carcinomas of skin. RESULTS: In total, 699 cases were recorded. Of these, 22.9% were lymphomas, 12.7% germ-cell tumors, 11.9% leukemias, 10.6% central-nervous-system tumors, 10.0% bone neoplasms, 7.6% soft-tissue sarcomas, and 19.5% tumors of adulthood (thyroid carcinomas 4.9%, melanomas 9.0%, and other carcinomas 5.6%). The overall IR was 172.9 per million adolescents (M/F: 1.2) with an annual increase of 3% (P = 0.58). Over the two 5-year periods (1988-1992 and 1993-1997) the IR increases significantly for malignant melanomas (respectively 10.4 and 21.2; P = 0.04). CONCLUSIONS: Our findings are similar to that reported by previous studies performed in European and North-American countries. Future studies need to focus on the etiology explaining the increase in incidence, the management and the impact of the type of care on outcomes.

Breast carcinoma survival in Europe and the United States.

BACKGROUND: Breast carcinoma survival rates were found to be higher in the U.S. than in Europe. METHODS: Multiple regression analysis of breast carcinoma survival rates among women diagnosed between 1990 and 1992 was performed using clinical data from population-based case series from the Surveillance, Epidemiogy, and End Results (SEER) program (13,172 women) and the European Concerted Action on survival and Care of Cancer Patients (EUROCARE) project (4478 women). RESULTS: Early-stage tumors (T1N0M0) were more frequent in the SEER data (41% of cases) than in the EUROCARE data (29%). In the SEER data, early tumors were more frequent in women age > or = 65 years (43%) than in younger women (38%), whereas the reverse was true in the European data (25% vs. 31%). In both case series, > 90% of women underwent surgery and 81-82% underwent lymphadenectomy, but the number of axillary lymph nodes evaluated was higher in the SEER data than in the EUROCARE data. The 5-year survival rate was higher in the U.S. case series (89%) than in the European series (79%). This differential was observed for each stage category evaluated: early (T1N0M0), large lymph node-negative (T2-3N0M0), lymph node-positive (T1-3N+M0), locally advanced (T4M0), and metastatic (M1) tumors. The overall relative excess risk (RER) of death was significantly higher (RER, 1.37; 95% confidence interval [95% CI], 1.25-1.50) among European women compared with U.S. women (referent group). Adjustment for stage, age, surgery, and the number of lymph nodes evaluated explained most of the excess risk (RER, 1.07; 95% CI, 0.98-1.17). CONCLUSIONS: Transatlantic differences in the 5-year survival rates for women diagnosed with breast carcinoma between 1990 and 1992 were attributable mainly to differences in stage of disease. Resources should be invested to achieve earlier diagnosis of breast carcinoma in Europe, especially for elderly women.