Response to Crocetti et al.

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Does the ‘Scottish effect’ apply to all ethnic groups? All-cancer, lung, colorectal, breast and prostate cancer in the Scottish Health and Ethnicity Linkage Cohort Study

Copyright 2012 Elsevier B.V., All rights reserved.Peer reviewedPublisher PD

Occult blood in faeces is associated with all-cause and non-colorectal cancer mortality

Objective: An association between detectable faecal haemoglobin (f-Hb) and both the risk of death from colorectal cancer (CRC) and all-cause mortality has been reported. We set out to confirm or refute this observation in a UK population and to explore the association between f-Hb, as indicated by a positive guaiac faecal occult blood test (gFOBT) result, and different causes of death. Design: All individuals (134 192) who participated in gFOBT screening in Tayside, Scotland between 29/03/2000 and 29/03/2016 were studied by linking their test result (positive or negative) with mortality data from the National Records of Scotland database and following to 30/03/2016. Results: Those with a positive test result (n=2714) had a higher risk of dying than those with a negative result, from CRC: HR 7.79 (95% CI 6.13 to 9.89), p<0.0001, (adjusted for, gender, age, deprivation quintile and medication that can cause bleeding) and all non-CRC causes: HR 1.58 (95% CI 1.45 to 1.73), p<0·0001.· In addition, f-Hb detectable by gFOBT was significantly associated with increased risk of dying from circulatory disease, respiratory disease, digestive diseases (excluding CRC), neuropsychological disease, blood and endocrine disease and non-CRC. Conclusion: The presence of detectable f-Hb is associated with increased risk of death from a wide range of causes

Completeness of primary intracranial tumour recording in the Scottish Cancer Registry 2011-12

IntroductionA high level of case ascertainment by cancer registries is essential to allow estimation of accurate incidence rates and survival. Nearly 20 years ago, researchers assessed the completeness and accuracy of registration of primary intracranial tumours (Scottish Cancer Registry [SCR]) compared to a database assembled in the context of a detailed incidence study carried out in the Lothian region of Scotland covering the period of diagnosis, 1989–1990.1 and 2 Disappointingly, SCR identified only 54% of cases, although the registry at that time did not attempt to collect information on ‘benign’ intracranial neoplasms which were included in the detailed incidence study. Even so, only 84% of neuro-epithelial tumours were identified by SCR, probably related in part to the fact that the cancer registry was not receiving neuropathology data from the regional neuro-oncology centre. An English study reported similar findings with only 52% of cases appearing in the regional cancer registry.3Over time, access to diagnostic techniques has improved alongside improvements and changes in classification and clinical coding. Furthermore, SCR now receives neuropathology data from all neuro-oncology centres in Scotland, and has sought to collect information on benign tumours of the brain and spinal cord since the year of diagnosis, 2000. In light of these developments, we aimed to determine the completeness of ascertainment of primary intracranial tumours by SCR through independent/clinical case ascertainment in NHS Lothian for the period of diagnosis, 2011–2012.MethodsScottish Cancer RegistrySCR operates by bringing together predominantly electronic information from hospital patient administration systems including patient discharges from hospital (Scottish Morbidity Record 01), radiotherapy, oncology, and pathology records; death records from National Records Scotland; and private hospital records.4 All primary malignant and benign brain tumours are recorded on the SCR.Inclusion and exclusion criteriaThis retrospective cohort study was restricted to the period of diagnosis between 1 January 2011 and 31 December 2012 and limited to adults (age ≥18 years on the date of diagnosis) with a postcode within the NHS Lothian health board region (mid-year population ∼650,000). The date of diagnosis was taken as i) the date of the first abnormal imaging, or ii) the date of biopsy/resection. Patients in whom there was no neuro-radiology or histology were excluded, i.e. diagnosis of prolactinoma had to be supported by blood tests and imaging.All suspected and histologically proven primary intracranial tumours (benign and malignant) of the brain and cranial nerves were counted, including primary central nervous system lymphoma. Meningeal, pituitary region and pituitary gland tumours were also included. Cerebral metastases, tumours of the spinal cord and spinal nerves, and recurrent intracranial tumours of any type were excluded.Extraction from the SCRData were extracted for the study period for all records including the following anatomical site codes selected from the third edition of the International Classification of Diseases for Oncology (ICD-O-3): C70.0; C70.9; C71; C72.2; C72.3; C72.4; C72.5; C72.8; C72.9; C75.1; C75.2; and C75.3 (all behaviour codes).Clinical case ascertainmentThree clinical sources were trawled as follows: i) neuro-oncology multidisciplinary team meeting (MDTM) minutes; ii) an endocrinology database; and iii) neuropathology records (sources i and ii are independent of the SCR data collection system). The neuro-oncology MDTM aims to discuss all intracranial tumours identified via any means including both benign and malignant tumours. The endocrinology database records all patients attending the endocrine outpatient clinics in the NHS Lothian region and each is assigned a diagnosis by a Consultant Endocrinologist. Both sources i and ii for the period 1 January 2011 – 31 March 2013 were reviewed manually by JRM. The neuropathology records hold information on all tissue samples analysed in the pathology system for NHS Lothian hospitals and an electronic extract was obtained using Systematized Nomenclature of Medicine codes matching those above. To ensure cases were true incident cases meeting the full inclusion criteria, each was cross-referenced with the patient's electronic secondary care medical record.AnalysisClinically ascertained cases were reconciled against the SCR extract. We have previously quantified the extent of misclassification of incidence year in the Scottish Cancer Registration database.5 We did not regard misclassifications of incidence year as missed or ‘over-diagnosed’ cases as there is no reason to believe that such misclassification is other than random.Completeness was defined as the proportion of intracranial tumours included in the SCR out of all those identified as diagnosed in residents of NHS Lothian area during the study period. Confidence intervals (95%) for completeness were calculated using the exact method.Completeness was calculated for all intracranial tumours with secondary analysis of completeness by tumour morphology and tumour grade (see Supplementary File for coding definitions).ResultsThere were 320 records of primary intracranial tumours registered on the SCR for the period of interest and 264 clinical cases were ascertained. Fig. 1 shows the final ascertainment of clinical cases missing from the SCR

Interval cancers in a national colorectal cancer screening programme

BACKGROUND: Little is known about interval cancers (ICs) in colorectal cancer (CRC) screening. OBJECTIVE: The purpose of this study was to identify IC characteristics and compare these with screen-detected cancers (SCs) and cancers in non-participants (NPCs) over the same time period. DESIGN: This was an observational study done in the first round of the Scottish Bowel Screening Programme. All individuals (772,790), aged 50–74 years, invited to participate between 1 January 2007 and 31 May 2009 were studied by linking their screening records with confirmed CRC records in the Scottish Cancer Registry (SCR). Characteristics of SC, IC and NPC were determined. RESULTS: There were 555 SCs, 502 ICs and 922 NPCs. SCs were at an earlier stage than ICs and NPCs (33.9% Dukes’ A as against 18.7% in IC and 11.3% in NPC), screening preferentially detected cancers in males (64.7% as against 52.8% in IC and 59.7% in NPC): this was independent of a different cancer site distribution in males and females. SC in the colon were less advanced than IC, but not in the rectum. CONCLUSION: ICs account for 47.5% of the CRCs in the screened population, indicating approximately 50% screening test sensitivity: guaiac faecal occult blood testing (gFOBT) sensitivity is less for women than for men and gFOBT screening may not be effective for rectal cancer

Real-world evidence was feasible for estimating effectiveness of chemotherapy in breast cancer; a cohort study

Objective: Evidence-based guidelines recommend adjuvant chemotherapy in early stage breast cancer whenever treatment benefit is considered sufficient to outweigh the associated risks. However, many groups of patients were either excluded from or underrepresented in the clinical trials that form the evidence base for this recommendation. This study aims to determine whether using administrative healthcare data – Real World Data (RWD) - and econometric methods for causal analysis to provide ‘Real World Evidence’ (RWE) are feasible methods for addressing this gap.Methods: Cases of primary breast cancer in women from 2001 to 2015 were extracted from the Scottish cancer registry (SMR06) and linked to other routine health records (inpatient and outpatient visits). Four methods were used to estimate the effect of adjuvant chemotherapy on disease-specific and overall mortality: (1) regression with adjustment for covariates (2) propensity score matching (3) instrumental variables analysis and (4) regression discontinuity design. Hazard ratios for breast cancer mortality and all-cause mortality were compared to those from a meta-analysis of randomised trials.Results: 39,805 cases included in the analyses. Regression adjustment, propensity score matching and instrumental variables were feasible while regression discontinuity was not. Effectiveness estimates were similar between RWE and randomised trials for breast cancer mortality but not for all-cause mortality.Conclusions: RWE methods are a feasible means to generate estimates of effectiveness of adjuvant chemotherapy in early stage breast cancer. However, such estimates must be interpreted in the context of the available randomised evidence and the potential biases of the observational methods.<br/

Seasonal variation in diagnosis of invasive cutaneous melanoma in Eastern England and Scotland.

BACKGROUND: Worldwide, the incidence of cutaneous melanoma has been reported to be highest in the summer and lowest in the winter. Northern Irish data suggested seasonal variation for women only, especially those with thinner melanomas, sited on limbs. We interrogated two larger UK cancer registries for temporal differences in melanoma diagnosis and associated patient characteristics. METHODS: Melanomas diagnosed from 2006 to 2010 in the Eastern England and Scottish cancer registries (n=11,611) were analysed by month of diagnosis, patient demographics and melanoma characteristics, using descriptive and multivariate modelling methods. RESULTS: More patients with melanoma were diagnosed in the summer months (June 9.9%, July 9.7%, August 9.8%) than the winter months (December 7.2%, January 7.2%, February 7.1%) and this pattern was consistent in both regions. There was evidence that the seasonal patterns varied by sex (p=0.015), melanoma thickness (p=0.002), body site (p=0.006), and type (superficial spreading melanomas p=0.005). The seasonal variation was greatest for diagnosis of melanomas occurring on the limbs. CONCLUSION: This study has confirmed seasonal variation in melanoma diagnosis in Eastern England and Scotland across almost all population demographics and melanoma characteristics studied, with higher numbers diagnosed in the summer months, particularly on the limbs. Seasonal patterns in skin awareness and related help-seeking are likely to be implicated. Targeted patient interventions to increase sun awareness and encourage year-long skin inspection are warranted.The paper was materially supported by the National Institute for Health Research (NIHR-CS-012-030), supporting FMW through a Clinician Scientist award. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. During this project, GL was supported by a post-doctoral fellowship by the National Institute for Health Research (PDF-2011-04-047) to the end of 2014; and by a Cancer Research UK Clinician Scientist Fellowship award (A18180) from March 2015.This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.canep.2015.06.00

Risk of skin cancer after neonatal phototherapy : retrospective cohort study

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