Under-registration of melanoma in Belgium: an analysis.

The overall underestimation of incident cancer cases in the Belgian National Cancer Registry is estimated at about 20-25%, with a probable larger under-registration among males. Melanoma incidence is suspected to be underestimated even further because of the hospital-based reporting system of the National Cancer Registry. To investigate the suspected underestimation of melanoma in Belgium, the official data were compared with international data on melanoma incidence and the results of a melanoma registration programme launched in the province of East Flanders. The Eindhoven Cancer Registry, which covers a registration area near the Belgian border, was used as a reference to calculate the expected number of melanomas in East Flanders for 1995. The results indicate an ongoing under-registration of melanoma cases by the National Cancer Registry. Based on the Eindhoven Cancer Registry data, the under-registration in East Flanders is estimated at 43% for males and 36% for females. The East Flanders registration programme apparently obtains a better registration in females. This is mainly due to a higher registration in the younger age groups. In these groups a higher proportion of in situ melanomas and a thinner median Breslow thickness of the invasive melanomas is observed.

Trends in mortality from cutaneous malignant melanoma in Belgium.

BACKGROUND AND METHODS: Changes over time of mortality rates from cutaneous malignant melanoma (CMM) in Belgium were analysed, based on people (n = 3695) aged 25-84 years, who died of CMM from 1954 to 1992. All data were collected from the Belgian National Institute of Statistics. For the log-linear analysis and calculation of the average annual change, only the data from 1973 to 1992 were considered. RESULTS: The age-adjusted mortality rates (per 10(5)) for the age group 25-84 years old increased from 0.5 in 1954 to 3.0 in 1992 in men, and from 0.8 in 1954 to 2.2 in 1992 in women. The average annual percentage change in men (-0.003%) was stable over the period 1973-1982, and increased to 4.4% over the period 1983-1992. In women, the average annual increase was 4.6% over the period 1973-1982, and continued to increase to 6.8% over the period 1983-1992. Log-linear analysis showed that the change in rates for both men and women was mainly due to an age-'drift' effect, contrary to the results of the average annual percentage change in men. CONCLUSION: The risk of dying from CMM increased in men and women continuously over the whole period, irrespective of birth cohort. In both men and women, there was approximately a 20% increase in CMM mortality per 5-year period.

The melanoma burden in Belgium; premature morbidity and mortality make melanoma a considerable health problem.

The aim of this study was to investigate the impact of melanoma on public health in Belgium. Melanoma incidence and mortality rates were analysed relative to those of other cancers. These cancers were then evaluated for premature morbidity and mortality by studying age-specific incidence rates, years of potential life lost before 65, and years of potential life lost per death. Melanoma accounts for 1.23% of all incident cancer cases and 0.7% of all cancer deaths in Belgium. It is the seventeenth most common cancer in men and the sixteenth most common cancer in women. Compared with other, more frequent cancers, melanoma seems to affect patients at a younger age; in the 20-39 age group melanoma is the third most common cancer in both sexes. It is the second most important cancer in terms of years of potential life lost per death, preceded only by tumours of the central nervous system. These findings show that melanoma incidence and mortality rates are exceeded by many other cancers. Nevertheless, melanoma poses an important health problem because of its predilection for young and middle-aged people. We suspect that these observations are not specific for Belgium and will also apply to other European countries.

Prevalence, awareness, treatment and control of arterial hypertension in an elderly population in Belgium.

OBJECTIVE: To study the prevalence, awareness, treatment and control of arterial hypertension in the elderly population in Belgium. STUDY GROUP: An age- and sex-stratified sample of 2212 Belgian subjects aged 65 years or more, selected from the original cohort of the Belgian Interuniversity Research on Nutrition and Health (BIRNH) study; participation in this follow-up study was 72.6%. METHODS: Blood pressure (BP) was measured at home by trained technicians using a standard protocol. Isolated systolic hypertension (ISH) was defined as a systolic BP > or =160 mm Hg and a diastolic BP <95 mm Hg. Diastolic hypertension was defined as a diastolic BP > or =95 mm Hg. The total hypertensive population was defined as all those with ISH, diastolic hypertension and with BPs <160-95 mm Hg but currently taking antihypertensive drugs. Awareness and treatment status were investigated through a structured interview. RESULTS: The prevalence of arterial hypertension was 43.9%, higher in women than in men and increasing with age in women; elevated BP was found in 22.3 to 28.6% of the participants varying by age and sex. In the >75-year-old subjects this elevation was in two-thirds of the cases due to ISH; 84% of all female hypertensives were aware of the condition compared to 68% in men. Treatment advice had been given in a majority of the aware subjects and two-thirds of all treated persons was under control. Among a variety of independent variables and besides the gender difference, awareness was only related to smoking and to depression while control differed by region of residence. CONCLUSION: Arterial hypertension is highly prevalent in this elderly population; awareness and BP control are within acceptable ranges but there is still room for improvement, particularly in elderly men.

Prognostic value of ischemic electrocardiographic findings for cardiovascular mortality in men and women.

OBJECTIVES: The aim of this study was to investigate the independent prognostic value of ischemic electrocardiographic (ECG) findings for cardiovascular mortality and to evaluate a possible sex-differential in this regard. BACKGROUND: In previous reports, ST segment and T wave changes on the resting ECG were described as independent risk factors for development of coronary heart disease. Although more prevalent in women, they are often given less clinical importance than in men. METHODS: Ten-year follow-up data from the Belgian Interuniversity Research on Nutrition and Health study were used. The results presented here are based on ECGs of the 4,797 men and 4,320 women, aged 25 to 74 years, who were free of angina pectoris at the start of follow-up, had no history of myocardial infarction (MI) and showed no Q wave evidence of an old MI on their ECG. RESULTS: At baseline, the age-standardized prevalence of an "ischemic ECG" (Minnesota codes I3, IV1-3, V1-3 or VII1) was 8.4% in men and 10.6% in women. Cardiovascular mortality rates in men and women with an ischemic ECG were respectively 7.7 and 2.6 per 1,000 person-years, compared with 2.3 and 1.0 in those with no such ECG findings. After correction for the potential confounding effects of established cardiovascular disease (CVD) risk factors, the multivariately adjusted risk ratios were 2.45 (95% confidence interval [CI]: 1.70 to 3.53) for men and 2.16 (95% CI: 1.30 to 3.58) for women. Testing the interaction between an ischemic ECG and sex on CVD mortality revealed that the risk ratios were not significantly changed (p=0.95). The etiologic fraction of CVD deaths attributable to an ischemic ECG was estimated as 19.3% for men and 22.4% for women. Both men and women with major ischemic findings in their baseline electrocardiogram (Minnesota codes IV1,2, V1,2 or VII1) had a fourfold increased risk of CVD death. CONCLUSION: These results support the hypothesis that women with ischemic ECG findings are at the same increased risk for CVD mortality as men.