Ethnicity in relation to incidence of oesophageal and gastric cancer in England.

BACKGROUND: This study investigated the variation in incidence of all, and six subgroups of, oesophageal and gastric cancer between ethnic groups. METHODS: Data on all oesophageal and gastric cancer patients diagnosed between 2001 and 2007 in England were analysed. Self-assigned ethnicity from the Hospital Episode Statistics dataset was used. Male and female age-standardised incidence rate ratios (IRRs) were calculated for each ethnic group, using White groups as the references. RESULTS: Ethnicity information was available for 83% of patients (76 130/92 205). White men had a higher incidence of oesophageal cancer, with IRR for the other ethnic groups ranging from 0.17 95% confidence interval (CI) (0.15-0.20) (Pakistani men) to 0.58 95% CI (0.50-0.67) (Black Caribbean men). Compared with White women, Bangladeshi women (IRR 2.02 (1.24-3.29)) had a higher incidence of oesophageal cancer. For gastric cancer, Black Caribbean men (1.39 (1.22-1.60)) and women (1.57 (1.28-1.92)) had a higher incidence compared with their White counterparts. In the subgroup analysis, White men had a higher incidence of lower oesophageal and gastric cardia cancer compared with the other ethnic groups studied. Bangladeshi women (3.10 (1.60-6.00)) had a higher incidence of upper and middle oesophageal cancer compared with White women. CONCLUSION: Substantial ethnic differences in the incidence of oesophageal and gastric cancer were found. Further research into differences in exposures to risk factors between ethnic groups could elucidate why the observed variation in incidence exists.

A comparison of prostate cancer survival in England, Norway and Sweden: a population-based study.

PURPOSE: The objective of the study was to compare patterns of survival 2001-2004 in prostate cancer patients from England, Norway and Sweden in relation to age and period of follow-up. SUBJECTS AND METHODS: Excess mortality in men with prostate cancer was estimated using nation-wide cancer register data using a period approach for relative survival. 179,112 men in England, 23,192 in Norway and 59,697 in Sweden were included. RESULTS: In all age groups, England had the lowest survival, particularly so among men aged 80+. Overall age-standardised five-year survival was 76.4%, 80.3% and 83.0% for England, Norway and Sweden, respectively. The majority of the excess deaths in England were confined to the first year of follow-up. CONCLUSION: The results indicate that a small but important group of older patients present at a late stage and succumb early to their cancers, possibly in combination with severe comorbidity, and this situation is more common in England than in Norway or Sweden.

Investigation of low 5-year relative survival for breast cancer in a London cancer network.

BACKGROUND: Breast cancer 5-year relative survival is low in the North East London Cancer Network (NELCN). METHODS: We compared breast cancer that was diagnosed during 2001-2005 with that in the rest of London. RESULTS: North East London Cancer Network women more often lived in socioeconomic quintile 5 (42 vs 21%) and presented with advanced disease (11 vs 7%). Cox regression analysis showed the survival difference (hazard ratio: 1.27, 95% confidence interval (CI): 1.15-1.41) reduced to 1.00 (95% CI: 0.89-1.11) after adjustment for age, stage, socioeconomic deprivation, ethnicity and treatment. Major drivers were stage and deprivation. Excess mortality was in the first year. CONCLUSION: Late diagnosis occurs in NELCN.

A visual summary of the EUROCARE-4 results: a UK perspective.

BACKGROUND: This paper provides a one-page visual summary of the previously published relative survival estimates for 42 types of cancers in 23 countries in Europe. METHODS: The cancer patients in these analyses were 15 years or older at the time of their diagnosis in the period 1995-1999. Follow-up was to the end of 2003 and relative survival estimates were computed by the cohort method. RESULTS: The analysis of 1-year survival had good discriminatory power and visibly separated a group of countries with consistently high survival estimates (Switzerland, France, Sweden, Belgium and Italy) and another group of countries with lower estimates (Poland, Czech Republic, Ireland, Denmark and United Kingdom-Northern Ireland). After the first year, there was less variation between the countries. CONCLUSION: To more fully understand the UK situation, a rational comparison would select countries with data-quality, prosperity and healthcare systems that are similar to the United Kingdom. In otherwise comparable populations, a pronounced difference in 1-year survival is most likely to be due to variation in a strong prognostic factor, which exerts its effect in the short term. A likely explanation for the short-term survival deficit in the United Kingdom compared with the Nordic countries is a less favourable stage distribution in the United Kingdom. However, the present superficial analysis does not exclude possible functions for other factors relating to the organisation and quality of cancer care services.

Trends in the epidemiology of larynx and lung cancer in south-east England, 1985-2004.

We analysed data on 8987 larynx and 174060 lung cancer patients diagnosed between 1985 and 2004, of which 17.3% of larynx and 35.5% of lung cancers were in females. The age-standardised rates for each cancer declined in both sexes, but since the 1990s, the rates in females over 70 years of age have been diverging.

How is place of death from cancer changing and what affects it? Analysis of cancer registration and service data.

We aimed to compare trends in place of cancer death with the growth of palliative care and nursing home services, and investigate demographic, disease-related and area influences on individual place of death, using registration data for 216404 patients with breast, lung, colorectal and prostate cancer and aggregate data on services in South East England. Between 1985 and 1994 there was a trend away from hospital death (67-44%), to home (17-30%) and hospice death (8-20%). After 1995, this partly reversed. By 2002, hospital death rose to 47%, home death dropped to 23%, hospice death remained stable and nursing home death rose from 3 to 8%. Numbers of palliative care services increased, but trends for hospice and nursing home deaths most clearly followed the beds available. Cancer diagnosis and treatment influenced individual place of death, but between 1998 and 2002, age and area of residence were associated with most variation. Older patients and those living in more deprived areas died more often in hospitals and less often at home. Despite more palliative care services the proportion of people dying at home has not increased. Variation by age, deprivation and area of residence is unlikely to reflect patient preference. More active surveillance and planning must support policies for choice in end of life care.

A retrospective observational study of the effect of surface treatments and cementing media on the durability of gold palatal veneers.

This paper reports on the results of a retrospective observational study that sought to determine both the longevity and effects of surface treatments of gold palatal veneers used to restore tooth surface loss. Details of all gold palatal veneers fabricated from Mattident 60 were sourced from hospital records spanning 11 years and 9 months. The case notes of each individual were accessed and, for each restoration, a note was made of the date and method of cementation, together with the period of patient follow-up. When patients continued their routine checkups, the records were scrutinized closely for evidence of restoration failure. This yielded a data set of 151 palatal gold veneer cementations for which the surface treatments and/or cementing media were known. Survival analysis by the Kaplan-Meier method of alumina blasted veneers revealed median survival times of 4,663 days when cemented with Panavia 21 and 687 days if cemented with Aquacem. Veneers that were alumina blasted, oxidized and cemented with Panavia 21 had a survival probability of 1.0. A Logrank test revealed highly statistically significant differences between the survival curves (p<0.0001). It was concluded that: (1) Alumina blasting the fit surface of a gold veneer prior to cementation with Panavia 21 resulted in a significantly more durable restoration compared to alumina blasting and cementation with Aquacem and no etching of tooth substance. (2) Due to low MST cementing, gold palatal veneers with a conventional glass polyalkenoate cement are not recommended. (3) Pre-treatment of gold palatal veneers by alumina blasting and oxidation prior to cementing with Panavia 21 appears to improve the chances of obtaining a dependable restoration. A greater number of restorations would be required to statistically test this trend.

Squamous cell carcinoma of the oral cavity in patients aged 45 years and under: a descriptive analysis of 116 cases diagnosed in the South East of England from 1990 to 1997.

BACKGROUND: there is, currently, much anecdotal and some epidemiological evidence for a rise in oral cancer rates amongst younger individuals, many of whom have had no exposure to traditional risk factors such as tobacco and heavy alcohol use, or at least not the exposure over decades usually associated with this disease. The probity of this assertion and the presence or absence of traditional risk factors needs further evidence. OBJECTIVES: this paper describes the demography and the exposure to potential risk factors amongst a cohort aged 45 years and younger, diagnosed with squamous cell carcinoma of the oral cavity between 1990 and 1997 from the South East of England. MATERIALS AND METHODS: eligible patients registered with a cancer registry were included in this retrospective study. Information was accessed from the database and by a postal questionnaire survey. The self-completed questionnaire contained items about exposure to the following risk factors: tobacco; alcohol; diet; frequency of dental visits and familial cancer. RESULTS AND CONCLUSIONS: this is the largest UK epidemiological study so far to be undertaken on young subjects diagnosed with oral cancer. One-hundred and sixteen cases were recruited representing a response rate of 59%. Slightly over 90% of this cohort were classified as white European. A large proportion of cases (40%) were from social classes I & II suggesting either a true social class difference in young cases versus older oral cancer cases or a possible bias in responders or survivors. Risk factors of tobacco use and excessive alcohol consumption were present in the majority (75%) of patients. Significant differences in the pattern of alcohol consumption were found in female subjects, who were less likely to consume over the recommended amounts of alcohol compared with male subjects. Daily regular fresh fruit and vegetable consumption during the ten year period before cancer diagnosis was recorded to be low. There was a distinct subgroup of cases, 26% of the group, that showed little, if any, exposure to any major risk factors.

Epidemiological study of oesophageal and gastric cancer in south-east England.

BACKGROUND: This epidemiological study was carried out to establish the magnitude of the changing incidence of gastric and oesophageal cancer. METHODS: Time-trend analyses of subsite-specific cancers of the oesophagus and stomach were performed using data from the Thames Cancer Registry database (1960-1996) for the South Thames Region. The changes in sex ratio and peak age of incidence are reported. RESULTS: In the upper two-thirds of the oesophagus there was no significant change in the incidence rate, but the lower third of the oesophagus showed a marked rise for both sexes (average annual change + 0.05 for men, + 0.009 for women). For the gastric cardia, the incidence in males increased (average annual change + 0.025), while in females it remained unchanged. Cancers of the oesophagogastric junction showed a clear increase for both sexes (average annual change + 0.07 for men, + 0.009 for women). There were changes in the sex ratio and peak age of incidence for all subsite cancers for both sexes. CONCLUSION: Over a 37-year period the incidence of cancer of the oesophagogastric junction increased threefold, while the incidence of cancers of the other subsites of the stomach decreased. Further studies are needed to investigate the aetiology of these changes.

Increase in the incidence of oesophagogastric carcinoma in the south thames region: an epidemiological study

Aims: There is some evidence to indicate that the incidence of gastric and oesophageal carcinoma is changing rapidly in the West. However, to study the true magnitude of the problem (to help in planning health and cancer strategies over the next decades), this epidemiological study was performed. METHODS: The Thames Cancer Registry database for the years 1960-1995 was searched for all oesophageal and gastric cancers in the South Thames region, and was analysed for all subsites for both sexes separately. Statistical analysis using the age-standardized ratio (ASR) (world) and chi2 test for trend for each subgroup was performed. RESULTS: The overall incidence of carcinoma of the oesophagus for both sexes saw a marked rise in the period studied, while the overall incidence of gastric cancer fell. In the upper two-thirds of the oesophagus, the increase in incidence was more dramatic for women (from 0.30 in 1960 to 0.70 in 1996; chitrend2 = 18.7, P = 0.00015) than men (from 0.59 in 1960 to 1.09 in 1996; chitrend2 = 4.4, P = 0.0354). In the lower third of the oesophagus, there was a rise in men (ASR from 0.93 in 1960 to 3. 43 in 1996; chitrend2 = 466.3, P < 0.0001) as well as in women (ASR from 0.42 in 1960 to 0.91 in 1996; chitrend2 = 51.4, P < 0.0001). For the gastric cardia, the incidence in men increased (ASR from 1. 24 in 1960 to 2.41 in 1996; chitrend2 = 109.8, P < 0.0001), while in women it remained unchanged (ASR from 0.33 in 1960 to 0.55 in 1996; chitrend2 = 0.0, P = 0.8281). The incidence of distal gastric carcinoma has decreased in men (ASR from 2.47 in 1980 to 0.63 in 1996; chitrend2 = 264.7, P < 0.0001) and women (from 1.14 in 1980 to 0.43 in 1996, chitrend2 = 131.8, P < 0.0001). For cancers of other subsites of the stomach (fundus, lesser and greater curvature, and body), there was a fall in incidence in both sexes. CONCLUSION: There has been a twofold to threefold increase over 36 years in the incidence of cancer of the oesophagogastric junction with a decreasing incidence in the distal stomach. There was also an increase in the incidence of upper oesophageal cancers, and a decrease in the incidence of cancers of other subsites of the stomach. Studies to cope with this increase and resources to cope with the treatment of these patients are required.

Cancer of mouth, pharynx and nasopharynx in Asian and Chinese immigrants resident in Thames regions.

Studies on migrants can generate important clues on the etiology of cancer. The purpose of the present study was to determine the relationship between ethnic origin and the incidence of oral and pharyngeal cancers among residents of the Thames regions in southern England. Records from the Thames Cancer Registry during the period 1986-91 were examined and south Asians and Chinese ethnic immigrants flagged using their place of birth and names. Computation of relative incidence among head and neck cancers (n = 7222) showed that oral cancer was significantly higher among Asians (95/232 = 40.9%) and nasopharyngeal cancer among Chinese (45/67 = 67.2%). Some differences in the intra-oral site of cancer and ethnic origin were noted. The ethnic migrants were significantly younger (Asians 51.6 +/- 34.8 years, Chinese 47.6 +/- 14.8 years) compared to the rest of the population (64.8 +/- 15.6 years) at the time of cancer diagnosis (p = 0.0) but no significant differences were found for the stage of presentation. The mean survival period for a cancer of the head and neck was 2.2 years and significant differences in cumulative rates of survival were noted among the three groups studied (p = 0.003). A strong correlation was noted between the incidence of oral cancer and local authorities with a high percentage of Asian residents. The south Asian and Chinese ethnic minorities constitute important high risk groups for oral and nasopharyngeal cancer, for whom targeted prevention is indicated.

Field studies on the efficacy of a long acting preparation of oxytetracycline in controlling outbreaks of enzootic abortion of sheep.

The effects of long acting oxytetracycline in controlling outbreaks of enzootic abortion of ewes were studied over three consecutive years in 13 different commercial flocks. When used in the face of an outbreak the compound produced a statistically significant reduction in abortion in treated ewes when compared to untreated controls. There was, however, only a marginal difference in the overall abortion rate between treated and untreated groups of ewes in known infected flocks, where the drug was used in anticipation of an abortion storm, mainly because the abortion rate was too low in the control group. It is suggested that oxytetracycline therapy should only be used in an effort to control an actual abortion outbreak on the understanding that the treatment will not eradicate infection from the flock.

Salmonellae in sewage sludge and abattoir effluent in south-east Scotland.

A survey into the prevalence of salmonella organisms in sewage in the Borders Region of South-east Scotland is described. A total of 317 isolates representing 34 different serotypes were made, of which only 5 serotypes appeared in animals, supporting the view that the spreading of sewage sludge on to pastureland presents little risk to livestock provided the recommended guidelines are followed. Nevertheless, Salmonella typhimurium phage type 12, identified in sewage, was also recovered from animals in incidents on 11 farms, including 4 which had received sludge from this source. A further 48 isolates (13 serotypes) were obtained from the parallel monitoring of abattoir effluents, indicating that the background level of salmonella infection in the animal population appears to be low in comparison to that in humans.