Changes in the site distribution of common melanoma subtypes in Queensland, Australia over time: implications for public health campaigns

Abstract\ud BACKGROUND:\ud \ud An examination of melanoma incidence according to anatomical region may be one method of monitoring the impact of public health initiatives.\ud OBJECTIVES:\ud \ud   To examine melanoma incidence trends by body site, sex and age at diagnosis or body site and morphology in a population at high risk.\ud MATERIALS AND METHODS:\ud \ud   Population-based data on invasive melanoma cases (n = 51473) diagnosed between 1982 and 2008 were extracted from the Queensland Cancer Registry. Age-standardized incidence rates were calculated using the direct method (2000 world standard population) and joinpoint regression models were used to fit trend lines.\ud RESULTS:\ud \ud   Significantly decreasing trends for melanomas on the trunk and upper limbs/shoulders were observed during recent years for both sexes under the age of 40 years and among males aged 40-59years. However, in the 60 and over age group, the incidence of melanoma is continuing to increase at all sites (apart from the trunk) for males and on the scalp/neck and upper limbs/shoulders for females. Rates of nodular melanoma are currently decreasing on the trunk and lower limbs. In contrast, superficial spreading melanoma is significantly increasing on the scalp/neck and lower limbs, along with substantial increases in lentigo maligna melanoma since the late 1990s at all sites apart from the lower limbs.\ud CONCLUSIONS:\ud \ud   In this large study we have observed significant decreases in rates of invasive melanoma in the younger age groups on less frequently exposed body sites. These results may provide some indirect evidence of the impact of long-running primary prevention campaigns

Elderly patients with stage III or IV ovarian cancer: should they receive standard care?

Due to the higher risk of morbidity and perioperative mortality compared to younger patients, elderly patients with advanced ovarian cancer are challenging to treat. A population-based analysis was performed to predict treatment outcomes and establish risk factors for early death of elderly patients with advanced ovarian cancer using a cohort of 3994 women diagnosed with stage III or IV ovarian cancer between 1992 and 1999, registered with the Surveillance, Epidemiology and End Results Cancer Registries. A multivariate accelerated failure time model allowed estimation of a risk factor model for overall survival. Patient's age, stage at presentation, presence of comorbidities, and oncology treatment facility were independently associated with overall survival at 12 months from diagnosis. Patients were assigned to low (0-7 points), moderate (8-14 points) or high (≥15 points) risk groups according to accumulation of risk factors, which showed good ability to predict 12-month mortality (receiver-operator characteristics curve [ROC] derivation cohort = 0.763; ROC validation cohort = 0.756). Across all three risk groups, patients who received both surgery and chemotherapy showed significantly improved survival as compared to patients who received only surgery or chemotherapy. For patients 80 years and over who had upfront surgery, perioperative mortality was significantly greater in the high-risk group (21%; 95% CI = 16-26%) compared to patients within the moderate (8%; 95% CI = 5-12%) and low-risk groups (0%; 95% CI = 0-11%). The risk factor profile established could be helpful to plan future clinical trials to establish optimal treatment for elderly patients with advanced stage ovarian cancer

International comparisons of the incidence and mortality of sinonasal cancer

Background: This paper reviews international patterns in sinonasal cancer incidence and mortality in light of changes in exposure to known risk factors. Sinonasal tumours are relatively rare, but they have the second highest occupational attributable fraction of all types of cancer, with a well-established link for workers exposed to wood dust. Methods: Data for a variety of countries, mainly in Europe, North America and the Asia-Pacific region, were obtained from publicly accessible sources and supplemented with information requested from selected cancer registries. Rates were directly age-standardised to the World Health Organization Standard Population. Results: The average annual incidence of sinonasal cancer was typically between 5 and 10 per million in males and between 2 and 5 per million in females between 2004 and 2008. Denmark reported the highest rates, with incidence continuing to increase, in contrast to trends in other countries which either remained relatively stable, or were decreasing slightly. There were significant recent decreases in sinonasal cancer mortality rates within two-thirds of the included countries. Conclusions: Our observations are generally consistent with efforts to limit exposure to wood dust and other potentially causal substances in the workplace, as well as a reduction in the prevalence of smoking in many developed countries. Of concern is that occupational and behavioural risks related to sinonasal cancer are likely to increase among people in less developed countries into the future. However the incentive to intervene in these countries is limited by the lack of accurate and reliable cancer data