Descriptive epidemiology of brain and central nervous system cancers in Central and South America.

RATIONALE AND OBJECTIVE: Although malignant tumors of the brain and central nervous system (CNS) represent less than 3% of new cancer cases estimated worldwide, they cause significant morbidity and in the case of gliomas, the most common histological type, have a poor prognosis. We describe patterns and trends in brain and CNS incidence and mortality in Central and South America. METHODS: We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and mortality rates (ASMRs) per 100,000 person-years, and present incidence by histological subtypes. RESULTS: In general, incidence rates were higher in males than in females. The highest incidence ASRs were observed for Cuba (5.1 males, 3.6 females) in Central America, and for Brazil (6.4 males, 4.8 females) and Uruguay (6.2 and 4.0) in South America. Mortality rates closely followed the pattern of incidence rates. Argentina, Brazil and Chile showed increasing mortality trends, although these were not statistically significant. Glioma and unspecified tumors were the most common histological types, accounting for 55.4% and 32.8%, respectively. The proportion of microscopically verified diagnoses was 47-70% in most countries. CONCLUSION: Although incidence and mortality rates in general were low, some countries displayed high- to intermediate-level incidence rates; under-reporting and under-ascertainment of cases could contribute to the geographic variations observed. There is a need to improve both the ascertainment of cases and the accuracy of histological diagnosis. Monitoring of brain and CNS cancers along with etiological research remain priorities.

Burden of gallbladder cancer in Central and South America.

RATIONALE AND OBJECTIVE: Gallbladder carcinoma (GBC) is a rare neoplasm yet it is the most common malignancy of the biliary tract and its prognosis is poor. Incidence of GBC is high in some areas of Central and South America and the Caribbean. We described the current burden of GBC in Central and South America (CSA). METHODS: We obtained GBC incidence data from 48 population-based cancer registries in 13 countries in CSA, and national level cancer death data from the WHO mortality data base for 18 countries. We estimated World population age-standardized incidence and mortality rates per 100,000 persons-years, including distribution and incidence rates by anatomic subsite. RESULTS: GBC rates were the highest in countries located in the Andean region. In 2003-2007, Chile had the highest incidence and mortality rates in CSA (17.1 and 12.9 in females and 7.3 and 6.0 in males, respectively). Females had higher GBC rates than males. The most frequently diagnosed anatomic subsite was gallbladder (60%). Unspecified subsite represented 21% of all cases. Trends in incidence and mortality of GBC remained unchanged in Argentina, Brazil, Chile and Costa Rica in 1998-2008. CONCLUSION: GBC rates varied extensively across the CSA region reflecting, in part, differences in data quality, coverage and healthcare access. Chile had the highest GBC rates in CSA and the world. The large proportion of unspecified cases indicates low precision in diagnosis/registration and highlights the need to promote and improve cancer registration in the region to better understand the burden of GBC in CSA.

Breast cancer survival in the US and Europe: a CONCORD high-resolution study.

Breast cancer survival is reportedly higher in the US than in Europe. The first worldwide study (CONCORD) found wide international differences in age-standardized survival. The aim of this study is to explain these survival differences. Population-based data on stage at diagnosis, diagnostic procedures, treatment and follow-up were collected for about 20,000 women diagnosed with breast cancer aged 15-99 years during 1996-98 in 7 US states and 12 European countries. Age-standardized net survival and the excess hazard of death up to 5 years after diagnosis were estimated by jurisdiction (registry, country, European region), age and stage with flexible parametric models. Breast cancers were generally less advanced in the US than in Europe. Stage also varied less between US states than between European jurisdictions. Early, node-negative tumors were more frequent in the US (39%) than in Europe (32%), while locally advanced tumors were twice as frequent in Europe (8%), and metastatic tumors of similar frequency (5-6%). Net survival in Northern, Western and Southern Europe (81-84%) was similar to that in the US (84%), but lower in Eastern Europe (69%). For the first 3 years after diagnosis the mean excess hazard was higher in Eastern Europe than elsewhere: the difference was most marked for women aged 70-99 years, and mainly confined to women with locally advanced or metastatic tumors. Differences in breast cancer survival between Europe and the US in the late 1990s were mainly explained by lower survival in Eastern Europe, where low healthcare expenditure may have constrained the quality of treatment.

Non-Hodgkin's lymphoma incidence and survival in European children and adolescents (1978-1997): report from the Automated Childhood Cancer Information System project.

Non-Hodgkin's lymphomas (NHLs) constitute a large and heterogeneous group of malignant tumours. This paper describes and interprets geographical patterns (1988-1997) and time trends (1978-1997) of NHL incidence and survival in European children and adolescents. All 7702 lymphomas that were not Hodgkin's, were extracted from the Automated Childhood Cancer Information System (ACCIS) database and included in different analyses. In children under 15 years of age and for the period 1988-1997, the overall NHL age-adjusted incidence rate was 9.4 per million and has been increasing over 20 years by 0.9% per year on average (P=0.002). In adolescents aged 15-19 years, the age-specific incidence rate was 15.9 per million, increasing annually by 1.7% (P=0.007). Five-year survival of children diagnosed in 1988-1997 was 77%, ranging from 58% in the East to 83% in the West. A substantial increase in survival was observed in all European regions. Systematic monitoring and evaluation of childhood and adolescent data on NHL will contribute to further improvement in public health policy for the young population of Europe.