The EUROCARE-3 database: methodology of data collection, standardisation, quality control and statistical analysis.

The EUROCARE database contains data on 6.5 million cancer patients diagnosed from 1978 to 1994 in populations covered by 67 cancer registries in 22 European countries. The quality-checked entries specify age, sex, diagnosis date, cancer site, morphology, microscopic confirmation and vital status, as well as containing broad indicators of stage. For EUROCARE-3, which refers to diagnoses from 1990 to 1994, 3389 cases with major data problems and 142,525 second or subsequent cancers were removed, leaving more than 2 million cases for analysis. From these data, observed and relative survival for each cancer site and country were calculated at 1, 3 and 5 years from diagnosis. Overall European survival for each cancer site and for all cancers combined were calculated combining country-specific survival figures. Overall, 1.1% of cases were lost to follow-up, 4.2% were known from death certificates only and 1.2% were known at autopsy only. The percentage of microscopically confirmed cases varied with cancer site and country, and was always higher in northern European countries. Comparison of quality indicators for the EUROCARE-3 database with earlier EUROCARE databases indicates that data quality and standardisation have improved.

EUROCARE-3: survival of cancer patients diagnosed 1990-94--results and commentary.

EUROCARE-3 analysed the survival of 1815584 adult cancer patients diagnosed from 1990 to 1994 in 22 European countries. The results are reported in tables, one per cancer site, coded according to the International Classification of Diseases (ICD)-9 classification. The main findings of the tables are summarised and commented on in this article. For most solid cancers, wide differences in survival between different European populations were found, as also reported by EUROCARE-1 and EUROCARE-2, despite a remarkable (10%) overall increase in cancer survival from 1985 to 1994. Survival was highest in northern Europe (Sweden, Norway, Finland and Iceland), and fairly good in central-southern Europe (France, Switzerland, Austria and Spain). Survival was particularly low in eastern Europe, low in Denmark and the UK, and fairly low in Portugal and Malta. The mix of tumour stage at diagnosis explains much of the survival differences for cancers of the digestive tract, female reproductive system, breast, thyroid, and also skin melanoma. For tumours of the urinary tract and prostate, the differences were explained mainly by differences in diagnostic criteria and procedures. The case mix by anatomic subsite largely explains differences in survival for head and neck cancers. For oesophagus, pancreas, liver and brain cancer, with poor prognoses, survival differences were limited. Tumours, for which highly effective treatments are available, such as testicular cancer, Hodgkin's lymphoma and some haematological malignancies, had fairly uniform survival across Europe. Survival for all tumours combined (an indicator of the overall cancer care performance of a nation's health system) was better in young than old patients, and better in women than men. The affluence of countries influenced overall cancer survival through the availability of adequate diagnostic and treatment procedures, and screening programmes.

Electronic availability of EUROCARE-3 data: a tool for further analysis.

The EUROCARE-3 CD-ROM has been developed to provide more detailed data with respect to those published in the monograph. The CD-ROM provides estimates of age-specific and age-standardised survival figures, cumulative and interval-specific survival, observed and relative survival for 47 cancer sites or combinations of sites, based on >4 million adult cancer patients diagnosed from 1983 to 1994 and reported from 56 European cancer registries. In addition, the CD-ROM provides observed survival proportions for 25 childhood cancer entities based on 23,000 young patients diagnosed from 1990 to 1994. Survival indicators, corresponding standard errors and confidence intervals can be selected according to cancer site, registry or country, sex, age class and disease duration. Basic graphical display and export facilities have also been provided. As an example of how to use this CD-ROM, this paper will report a descriptive analysis of relative survival patterns for all cancers combined, by age, sex and country. The EUROCARE-3 CD-ROM can be ordered free of charge or directly downloaded at http://www.eurocare.it.

Radiation-induced health effects on atmospheric flight crew members: clues for a radiation-related risk analysis.

There are few human data on low-dose-rate-radiation exposure and the consequent acute and late effects. This fact makes it difficult to assess health risks due to radiation in the space environment, especially for long-term missions. Epidemiological data on civilian flight personnel cohorts can provide information on effects due to the low-dose and low-dose rate mixed high- and low-LET radiation environment in the earth's atmosphere. The physical characteristics of the radiation environment of the atmosphere make the results of the studies of commercial flight personnel relevant to the studies of activities in space. The cooperative international effort now in progress to investigate dose reconstructions will contribute to our understanding of radiation risks for space exploration.

Health risks from radiation exposure for civilian aviation flight personnel: a study of Italian airline crew members.

A study of the effects of exposures of civilian aviation flight personnel to atmospheric ionizing radiation (including high-energy neutrons) is being performed. The results of previous studies and of the criteria required for a more satisfactory outcome in future studies are presented, along with a description of the protocol for the Italian national study. A description of the cohort is given in terms of its size, composition and member eligibility. The various ways of determining the exposure and the health status of past and current aircrew members are discussed, and follow-up procedures are described. An overview of the data management and processing philosophy adopted in the Italian study is given with regard to flight routes, radiation dose evaluation along the flight paths, and construction of exposure matrices. Other studies of potential interest are also discussed. The study is still in progress, so the results are preliminary.

Survival of children with Wilms' tumour in Europe.

A total 2535 cases of Wilms' tumours registered in children aged 0--14 years by 34 population-based cancer registries in 16 countries of Europe in 1978--1992 and followed-up until the end of 1994 were included in this EUROCARE study. Overall 5-year observed survival of all children diagnosed in 1985--1989 was 83%, 95% confidence interval (CI) 80--85. Relatively large differences were observed between the European countries, with significantly lower survival of patients registered in the formerly socialist countries, Estonia, Poland and Slovakia. Overall European survival was slightly lower in comparison with results reported from the USA and Australia, which demonstrate a potential for improvement. Over the study period, overall survival adjusted for age, sex and country has increased significantly. This favourable trend is attributed primarily to improvements in treatment, particularly to the introduction of new chemotherapeutic agents.

Radiation-induced biological effects on crew members: a combined analysis on atmospheric flight personnel.

Human data on low dose rate radiation exposure and its effects are not readily available. A huge amount of such data may be obtained through flight personnel cohorts, in the form of epidemiological studies on delayed health effects induced by the cosmic-ray generated atmospheric ionizing radiation, to which flight personnel are exposed all throughout their work activity. All the available results from different studies on flight personnel exposure have been combined in various ways to evaluate the association between atmospheric ionizing radiation environment and health risks and to assess directions for future investigations.

Radiation exposure of civilian airline crew members and associated biological effects due to the atmospheric ionizing radiation environment.

A study, currently in progress, on the radiation exposure and the associated biomedical effects due to the atmospheric ionizing radiation environment for the Italian civilian aviation flight personnel is sketched. After a presentation of the considered data sources, a description of the cohort is given, in terms of criteria for eligibility, and cohort construction, size and composition. Then the protocol for the Italian study is presented: the various ways of investigating the exposure and the health status of past and currently employed aircrew members and follow-up procedures are shown. An overview is given of the data management and processing philosophy with regards to flight routes, radiation dose evaluation along the flight path and exposure matrix building, as adopted in the Italian study. Potential side studies of interest are also shown.