Defining the roadmap towards revision of ENCR coding standards and training for cancer registries

The European Network of Cancer Registries (ENCR) and the Joint Research Centre (JRC) jointly support harmonising the activities of the European population-based cancer registries (CR) in providing reliable and valid data on cancer. The process to supply valid, complete and comparable data in different European Countries, implies that CR implement common rules to define and code cancer and receive similar training. For this reason, one of the main activities of the ENCR-JRC is to provide CR staff with specific recommendations on coding along with training. For ENCR-JRC the objective of this workshop was to collate previous and current requests from CR and provide advice on the most pressing issues relating to recommendations and training. The workshop was planned during the ENCR Steering Committee (SC) meeting, which took place on November 2014, and JRC (the Secretariat of ENCR) was requested to organise it. A group of experts on cancer registration was identified. This group included the ENCR-SC members, representatives from Institutions and cancer research projects which collaborate with CR (i.e. IARC, Eurocare, Concord, Rarecare), representatives from national networks of CR, members of the Cancer Information group at the JRC, and other specialists in the field. Prior to the workshop, an anonymous questionnaire was sent to the group of experts. Moreover, all directors and staff of CR were invited to complete the questionnaire and provide comments in order for ENCR- JRC to get a more comprehensive overview of the situation. The questionnaire invited respondents to specify the five most urgent topics, to be addressed, on both recommendations and training. During the workshop, participants (around 30 people) were split into two groups: one to focus on recommendations and the other to focus on training. For each group a moderator facilitated the debate presented the responses to the questionnaire, which were discussed in detail using the Metaplan method. The results of the discussion were summarized in a final plenary section, where further clarifications were given and all the participants were involved in the discussion. In summary, the topics to be addressed by the ENCR-SC, in relation to recommendations, either as updates of current recommendations or for new specific ones, were: Multiple primary rules; Staging; Registration/reportability criteria; Death Certificate Only cases (DCO) – Death Certificate Notified cases (DCN); Date of incidence in relation to diagnosis; 'Complicated' cancers (e.g. bladder, etc.); Haematological cancers; and coding of borderline malignancies. The group on training suggested that all the issues that were raised (Cancer Registration; Haematological malignancies; Analysis; Stage; Quality; Multiple primaries; many on Specific cancer types; and Grading) should be addressed making available on the web high quality, reliable and training-oriented documentations. JRC offered to translate these documents, if necessary, into other European languages. For training on specific technical methodology (analysis, data quality) it was suggested that traditional face-to-face courses be provided. The workshop highlighted that recommendations and training are interlinked and this implies that, in the future, any new recommendation should be issued together with training documentation to explain its practical application. The technical proposals made at the workshop will help the ENCR-SC to prioritize the future supporting activities to the real needs of CR.JRC.I.2-Public Health Policy Suppor

Short-term associations between fine and coarse particulate matter and hospitalizations in Southern Europe: results from the MED-PARTICLES project

BACKGROUND: Evidence on the short-term effects of fine and coarse particles on morbidity in Europe is scarce and inconsistent. OBJECTIVES: We aimed to estimate the association between daily concentrations of fine and coarse particles with hospitalizations for cardiovascular and respiratory conditions in eight Southern European cities, within the MED-PARTICLES project. METHODS: City-specific Poisson models were fitted to estimate associations of daily concentrations of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10), and their difference (PM2.5-10) with daily counts of emergency hospitalizations for cardiovascular and respiratory diseases. We derived pooled estimates from random-effects meta-analysis and evaluated the robustness of results to co-pollutant exposure adjustment and model specification. Pooled concentration-response curves were estimated using a meta-smoothing approach. RESULTS: We found significant associations between all PM fractions and cardiovascular admissions. Increases of 10 μg/m3 in PM2.5, 6.3 μg/m3 in PM2.5-10, and 14.4 μg/m3 in PM10 (lag 0-1 days) were associated with increases in cardiovascular admissions of 0.51% (95% CI: 0.12, 0.90%), 0.46% (95% CI: 0.10, 0.82%), and 0.53% (95% CI: 0.06, 1.00%), respectively. Stronger associations were estimated for respiratory hospitalizations, ranging from 1.15% (95% CI: 0.21, 2.11%) for PM10 to 1.36% (95% CI: 0.23, 2.49) for PM2.5 (lag 0-5 days). CONCLUSIONS: PM2.5 and PM2.5-10 were positively associated with cardiovascular and respiratory admissions in eight Mediterranean cities. Information on the short-term effects of different PM fractions on morbidity in Southern Europe will be useful to inform European policies on air quality standards.This research was supported by the European Union under the grant agreement LIFE+ ENV/IT/327.S

Number of Nevi at a Specific Anatomical Site and Its Relation to Cutaneous Malignant Melanoma

The risk of cutaneous malignant melanoma (CMM) is strongly associated with total number of nevi. Scanty information is available on the association between CMM at a specific anatomical site and number of nevi at the same site. We analyzed data from a case–control study conducted in Italy between 1992 and 1994, on 542 cases of CMM and 538 hospital controls. Cases and controls were examined by trained dermatologists who counted the number of melanocytic nevi. We derived multivariate odds ratios (ORs) and 95% confidence intervals (95% CIs) of site-specific risk of CMM for high versus low number of nevi at the corresponding site. The ORs of CMM for the highest versus the lowest tertile of number of nevi at the corresponding site was 1.4 (95% CIs: 0.7–2.8) at face and neck, 2.3 (95% CIs: 1.1–4.9) at anterior trunk, 4.9 (95% CIs: 2.9–8.4) at posterior trunk, 2.9 (95% CIs: 1.2–6.6) at upper limbs and 5.0 (95% CIs: 2.9–8.5) at lower limbs. In a case–case analysis, comparing CMM cases at a specific site and CMM cases at all other sites, the only excess risk was found for the posterior trunk, the ORs being 2.1 (95% CIs: 1.2–3.6) for the highest versus the lowest tertile of number of nevi. Our data do not support the hypothesis of a specific effect of nevi at each single anatomical site

The European Cancer Information System: exploring linkages between indoor radon concentrations and data on cancer burden

Exposure to radon over time has significant detrimental effects on human health. Approximately 226,000 annual radon-related deaths have been reported from 66 countries (1). Many countries have a radon action plan, in order to reduce the harmful effects of radon exposure on the general public. Maps are routinely used to assist with mitigation strategies and delineate areas of priority regulation. Standard regulations in the European Union include the requirement for workplaces to test and the requirement to have reduction methods in newly built homes. Such laws are assigned systematically to areas that are understood to have high values of indoor radon. This article demonstrates that the boundaries of radon priority areas may vary, depending on the data set and methods used. We propose a table and a decision matrix to assist in choosing the most appropriate visual aid according to the purpose for which the map is to be used. We conclude that no single radon map is suitable to fit all objectives, and some maps are more suitable than others depending on the purpose

Dotting the “i” of Interoperability in FAIR Cancer-Registry Data Sets

To conform to FAIR principles, data should be findable, accessible, interoperable, and reusable. Whereas tools exist for making data findable and accessible, interoperability is not straightforward and can limit data reusability. Most interoperability-based solutions address semantic description and metadata linkage, but these alone are not sufficient for the requirements of inter-comparison of population-based cancer data, where strict adherence to data-rules is of paramount importance. Ontologies, and more importantly their formalism in description logics, can play a key role in the automation of data-harmonization processes predominantly via the formalization of the data validation rules within the data-domain model. This in turn leads to a potential quality metric allowing users or agents to determine the limitations in the interpretation and comparability of the data. An approach is described for cancer-registry data with practical examples of how the validation rules can be modeled with description logic. Conformance of data to the rules can be quantified to provide metrics for several quality dimensions. Integrating these with metrics derived for other quality dimensions using tools such as data-shape languages and data-completion tests builds up a data-quality context to serve as an additional component in the FAIR digital object to support interoperability in the wider sense

Cancer burden indicators in Europe: insights from national and regional information

With more than 3 million new cases and 1.4 million deaths estimated for 2018 , cancer represents the second most important cause of death and morbidity in the EU-28 . Population-based cancer registration represents the 'gold' standard for the provision of unbiased information on cancer burden in a defined population and how it is changing over time. Population-based cancer registries (PBCRs) collect, manage and analyse data on patients diagnosed with cancer within a defined geographical area over a certain calendar period. They are invaluable resources for the clinical and epidemiological investigation of cancer and have a unique role in supporting public health officials and agencies in the planning and evaluation of cancer prevention and control programmes. The European Network of Cancer Registries (ENCR) , in operation since 1990, was established within the framework of the Europe Against Cancer Programme of the European Commission. The ENCR promotes collaboration between cancer registries, defines data collection standards, and supports cancer registries as data providers for the supply of information necessary to quantify and monitor the burden of cancer in the European Union and Europe .JRC.F.1-Health in Societ

Inquinamento atmosferico e ricoveri ospedalieri urgenti in 25 citt? italiane: risultati del progetto EpiAir2 Air pollution and urgent hospital admissions in 25 Italian cities: results from the EpiAir2 project

OBJECTIVE: to evaluate the relationship between air pollution and hospital admissions in 25 Italian cities that took part in the EpiAir (Epidemiological surveillance of air pollution effects among Italian cities) project. DESIGN: study of time series with case-crossover methodology, with adjustment for meteorological and time-dependent variables. The association air pollution hospitalisation was analyzed in each of the 25 cities involved in the study; the overall estimates of effect were obtained subsequently by means of a meta-analysis. The pollutants considered were PM10, PM2.5 (in 13 cities only), NO2 and ozone (O3); this last pollutant restricted to the summer season (April-September). SETTING AND PARTICIPANTS: the study has analyzed 2,246,448 urgent hospital admissions for non-accidental diseases in 25 Italian cities during the period 2006- 2010; 10 out of 25 cities took part also in the first phase of the project (2001-2005). MAIN OUTCOME MEASURES: urgent hospital admissions for cardiac, cerebrovascular and respiratory diseases, for all age groups, were considered. The respiratory hospital admissions were analysed also for the 0-14-year subgroup. Percentage increases risk of hospitalization associated with increments of 10 μg/m3 and interquartile range (IQR) of the concentration of each pollutant were calculated. RESULTS: reported results were related to an increment of 10 μg/m3 of air pollutant. The percent increase for PM10 for cardiac causes was 0.34% at lag 0 (95%CI 0.04-0.63), for respiratory causes 0.75%at lag 0-5 (95%CI 0.25-1.25). For PM2.5, the percent increase for respiratory causes was 1.23% at lag 0- 5 (95%CI 0.58-1.88). For NO2, the percent increase for cardiac causes was 0.57%at lag 0 (95%CI 0.13-1.02); 1.29% at lag 0-5 (95%CI 0.52-2.06) for respiratory causes. Ozone (O3) did not turned out to be positively associated neither with cardiac nor with respiratory causes as noted in the previous period (2001-2005). CONCLUSION: the results of the study confirm an association between PM10, PM2.5, and NO2 on hospital admissions among 25 Italian cities. No positive associations for ozone was noted in this period.OBIETTIVO: valutare la relazione tra inquinamento atmosferico e ricoveri ospedalieri nelle citt? italiane partecipanti alla seconda fase del progetto EpiAir (Sorveglianza epidemiologica dell\u27inquinamento atmosferico: valutazione dei rischi e degli impatti nelle citt? italiane). DISEGNO: studio di serie temporali con metodologia case-crossover, con aggiustamento per i fattori temporali e meteorologici rilevanti. L\u27associazione inquinamento atmosferico- ospedalizzazioni ? stata analizzata in ciascuna delle 25 citt? in studio, le stime complessive di effetto sono state ottenute successivamente mediante una metanalisi. Gli inquinanti considerati sono stati il particolato (PM10), il biossido di azoto (NO2) e l\u27ozono (O3), quest\u27ultimo limitatamente al semestre estivo (da aprile a settembre). In 13 citt? in cui i dati erano disponibili ? stata analizzata anche la frazione fine del particolato (PM2.5). SETTING E PARTECIPANTI: lo studio ha esaminato 2.246.448 ricoveri ospedalieri urgenti per cause naturali di pazienti residenti e ricoverati, nel periodo 2006-2010, in 25 citt? italiane, di cui 10 gi? partecipanti alla prima fase del progetto EpiAir (2001-2005). PRINCIPALIMISURE DI OUTCOME: sono stati considerati i ricoveri ospedalieri urgenti per malattie cardiache, cerebrovascolari e respiratorie per tutte le fasce di et?. I ricoveri per cause respiratorie sono stati analizzati separatamente anche per la fascia di et? 0-14 anni. L\u27esposizione ? stata valutata per incremento sia di 10 μg/m3 sia pari all\u27intervallo interquartile (IQR) della concentrazione di ciascun inquinante. RISULTATI: considerando un incremento di 10 μg/m3 per inquinante, per il PM10 ? stato osservato un incremento percentuale di rischio per patologie cardiache dello 0,34%a lag 0 (IC95% 0,04-0,63), e per patologie respiratorie dello 0,75% a lag 0-5 (IC95% 0,25-1,25). Per il PM2.5 l\u27incremento percentuale di rischio per patologie respiratorie ? risultato dell\u271,23%a lag 0-5 (IC95%0,58-1,88). Per l\u27NO2 la stima di effetto per patologie cardiache ? risultata dello 0,57% a lag 0 (IC95% 0,13-1,02), e per patologie respiratorie dell\u271,29% a lag 0-5 (IC95% 0,52-2,06). L\u27ozono non ? risultato positivamente associato n? alle patologie cardiache n? a quelle respiratorie (a differenza del periodo 2001-2005). CONCLUSIONE: i risultati dello studio confermano l\u27effetto a breve termine dell\u27inquinamento atmosferico da PM10, PM2.5 e NO2 sulla morbosit?, in particolare respiratoria, nelle citt? italiane. Non sono state rilevate associazioni positive per l\u27O3

HPV type infection in different anogenital sites among HIV-positive Brazilian women

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Computed Tomography Measurement of Rib Cage Morphometry in Emphysema

Background: Factors determining the shape of the human rib cage are not completely understood. We aimed to quantify the contribution of anthropometric and COPD-related changes to rib cage variability in adult cigarette smokers. Methods: Rib cage diameters and areas (calculated from the inner surface of the rib cage) in 816 smokers with or without COPD, were evaluated at three anatomical levels using computed tomography (CT). CTs were analyzed with software, which allows quantification of total emphysema (emphysema%). The relationship between rib cage measurements and anthropometric factors, lung function indices, and %emphysema were tested using linear regression models. Results: A model that included gender, age, BMI, emphysema%, forced expiratory volume in one second (FEV1)%, and forced vital capacity (FVC)% fit best with the rib cage measurements (R2  = 64% for the rib cage area variation at the lower anatomical level). Gender had the biggest impact on rib cage diameter and area (105.3 cm2; 95% CI: 111.7 to 98.8 for male lower area). Emphysema% was responsible for an increase in size of upper and middle CT areas (up to 5.4 cm2; 95% CI: 3.0 to 7.8 for an emphysema increase of 5%). Lower rib cage areas decreased as FVC% decreased (5.1 cm2; 95% CI: 2.5 to 7.6 for 10 percentage points of FVC variation). Conclusions: This study demonstrates that simple CT measurements can predict rib cage morphometric variability and also highlight relationships between rib cage morphometry and emphysema