Global burden of cancers attributable to infections in 2012:a synthetic analysis

Background Infections with certain viruses, bacteria, and parasites are strong risk factors for specifi c cancers. As new cancer statistics and epidemiological fi ndings have accumulated in the past 5 years, we aimed to assess the causal involvement of the main carcinogenic agents in diff erent cancer types for the year 2012. Methods We considered ten infectious agents classifi ed as carcinogenic to human beings by the International Agency for Research on Cancer. We calculated the number of new cancer cases in 2012 attributable to infections by country, by combining cancer incidence estimates (from GLOBOCAN 2012) with estimates of attributable fraction (AF) for the infectious agents. AF estimates were calculated from the prevalence of infection in cancer cases and the relative risk for the infection (for some sites). Estimates of infection prevalence, relative risk, and corresponding 95% CIs for AF were obtained from systematic reviews and pooled analyses. Findings Of 14 million new cancer cases in 2012, 2·2 million (15·4%) were attributable to carcinogenic infections. The most important infectious agents worldwide were Helicobacter pylori (770 000 cases), human papillomavirus (640 000), hepatitis B virus (420 000), hepatitis C virus (170 000), and Epstein-Barr virus (120 000). Kaposi’s sarcoma was the second largest contributor to the cancer burden in sub-Saharan Africa. The AFs for infection varied by country and development status—from less than 5% in the USA, Canada, Australia, New Zealand, and some countries in western and northern Europe to more than 50% in some countries in sub-Saharan Africa. Interpretation A large potential exists for reducing the burden of cancer caused by infections. Socioeconomic development is associated with a decrease in infection-associated cancers; however, to reduce the incidence of these cancers without delay, population-based vaccination and screen-and-treat programmes should be made accessible and available

How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis

Background: The objective of this HERO study was to assess the number of new cancer patients that will 29 require at least one course of radiotherapy by 2025. 30 Methods: European cancer incidence data by tumor site and country for 2012 and 2025 was extracted 31 from the GLOBOCAN database. The projection of the number of new cases took into account demographic 32 factors (age and size of the population). Population based stages at diagnosis were taken from four 33 European countries. Incidence and stage data were introduced in the Australian Collaboration for 34 Cancer Outcomes Research and Evaluation (CCORE) model. 35 Results: Among the different tumor sites, the highest expected relative increase by 2025 in treatment 36 courses was prostate cancer (24%) while lymphoma (13%), head and neck (12%) and breast cancer 37 (10%) were below the average. Based on the projected cancer distributions in 2025, a 16% expected 38 increase in the number of radiotherapy treatment courses was estimated. This increase varied across 39 European countries from less than 5% to more than 30%. 40 Conclusion: With the already existing disparity in radiotherapy resources in mind, the data provided here 41 should act as a leverage point to raise awareness among European health policy makers of the need for 42 investment in radiotherapy

International variation in oesophageal and gastric cancer survival 2012–2014: differences by histological subtype and stage at diagnosis (an ICBP SURVMARK-2 population-based study)

Objective To provide the first international comparison of oesophageal and gastric cancer survival by stage at diagnosis and histological subtype across high-income countries with similar access to healthcare. Methods As part of the ICBP SURVMARK-2 project, data from 28 923 patients with oesophageal cancer and 25 946 patients with gastric cancer diagnosed during 2012–2014 from 14 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were included. 1-year and 3-year age-standardised net survival were estimated by stage at diagnosis, histological subtype (oesophageal adenocarcinoma (OAC) and oesophageal squamous cell carcinoma (OSCC)) and country. Results Oesophageal cancer survival was highest in Ireland and lowest in Canada at 1 (50.3% vs 41.3%, respectively) and 3 years (27.0% vs 19.2%) postdiagnosis. Survival from gastric cancer was highest in Australia and lowest in the UK, for both 1-year (55.2% vs 44.8%, respectively) and 3-year survival (33.7% vs 22.3%). Most patients with oesophageal and gastric cancer had regional or distant disease, with proportions ranging between 56% and 90% across countries. Stage-specific analyses showed that variation between countries was greatest for localised disease, where survival ranged between 66.6% in Australia and 83.2% in the UK for oesophageal cancer and between 75.5% in Australia and 94.3% in New Zealand for gastric cancer at 1-year postdiagnosis. While survival for OAC was generally higher than that for OSCC, disparities across countries were similar for both histological subtypes. Conclusion Survival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future

Progress in cancer survival, mortality, and incidence in seven high-income countries 1995–2014 (ICBP SURVMARK-2): a population-based study

© 2019 World Health Organization Background: Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends. Methods: In this longitudinal, population-based study, we collected patient-level data on 3·9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control. Findings: In 19 eligible jurisdictions, 3 764 543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995–2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010–14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer. Interpretation: The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival. Funding: Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; and Wales Cancer Network

Spanish Mediterranean diet and other dietary patterns and breast cancer risk: case–control EpiGEICAM study

Background:Although there are solid findings regarding the detrimental effect of alcohol consumption, the existing evidence on the effect of other dietary factors on breast cancer (BC) risk is inconclusive. This study aimed to evaluate the association between dietary patterns and risk of BC in Spanish women, stratifying by menopausal status and tumour subtype, and to compare the results with those of Alternate Healthy Index (AHEI) and Alternate Mediterranean Diet Score (aMED).Methods:We recruited 1017 incident BC cases and 1017 matched healthy controls of similar age (±5 years) without a history of BC. The association between ‘a priori' and ‘a posteriori' developed dietary patterns and BC in general and according to menopausal status and intrinsic tumour subtypes (ER+/PR+ and HER2− HER2+ and ER−/PR− and HER2−) was evaluated using logistic and multinomial regression models.Results:Adherence to the Western dietary pattern was related to higher risk of BC (OR for the top vs the bottom quartile 1.46 (95% CI 1.06–2.01)), especially in premenopausal women (OR=1.75; 95% CI 1.14–2.67). In contrast, the Mediterranean pattern was related to a lower risk (OR for the top quartile vs the bottom quartile 0.56 (95% CI 0.40–0.79)). Although the deleterious effect of the Western pattern was similarly observed in all tumour subtypes, the protective effect of our Mediterranean pattern was stronger for triple-negative tumours (OR=0.32; 95% CI 0.15–0.66 and Pheterogeneity=0.04). No association was found between adherence to the Prudent pattern and BC risk. The associations between ‘a priori' indices and BC risk were less marked (OR for the top vs the bottom quartile of AHEI=0.69; 95% CI 0.51–0.94 and aMED=0.74; 95% CI 0.46–1.18)).Conclusions:Our results confirm the harmful effect of a Western diet on BC risk, and add new evidence on the benefits of a diet rich in fruits, vegetables, legumes, oily fish and vegetable oils for preventing all BC subtypes, and particularly triple-negative tumours

Using State Space Exploration to Determine How Gene Regulatory Networks Constrain Mutation Order in Cancer Evolution

Cancer develops via the progressive accumulation of somatic mutations, which subvert the normal operation of the gene regulatory network of the cell. However, little is known about the order in which mutations are acquired in successful clones. A particular sequence of mutations may confer an early selective advantage to a clone by increasing survival or proliferation, or lead to negative selection by triggering cell death. The space of allowed sequences of mutations is therefore constrained by the gene regulatory network. Here, we introduce a methodology for the systematic exploration of the effect of every possible sequence of oncogenic mutations in a cancer cell modelled as a qualitative network. Our method uses attractor identification using binary decision diagrams and can be applied to both synchronous and asynchronous systems. We demonstrate our method using a recently developed model of ER-negative breast cancer. We show that there are differing levels of constraint in the order of mutations for different combinations of oncogenes, and that the effects of ErbB2/HER2 over-expression depend on the preceding mutations

Atención al paciente oncológico en tiempos de COVID-19

Introduction: with the emergence of the new coronavirus and the wide worldwide distribution, its effects in people with some comorbidities are a global concern. Cancer is a disease with a high incidence and prevalence in society, included among the main causes of mortality.Objective: to describe the management of cancer patients during COVID-19Method: a literature review of articles published up to June 2020 was carried out, using the Pubmed / Medline, SCOPUS and SciELO databases. 28 references were selected for the preparation of the present.Development: cancer has variable clinical and prognostic behaviors that generally lead to states of immunosuppression caused by the therapeutics used for its treatment; Therefore, they are more vulnerable to infectious diseases. The proper care of this group of people is the responsibility of the health systems. Some measures are based on social distancing, either in reducing the number of companions of the patient in the consultation or chemotherapy sessions, the prohibition of visits to hospitalized patients and the use of technologies with the use of teleconsultations for routine follow-up, as well as the change from intravenous to oral treatmentsConclusions: the study of the behavior of COVID-19 in cancer patients is under development. The measures that the institutions take to achieve quality care for people with cancer are varied and are based mainly on social distancing.Introducción: con el surgimiento del nuevo coronavirus y la amplia distribución mundial, es una preocupación global sus efectos en personas con algunas comorbilidades. El cáncer es una enfermedad con alta incidencia y prevalencia en la sociedad, incluida entre las principales causas de mortalidad.Objetivo: describir el manejo del paciente oncológico durante la COVID-19Método: se realizó una revisión de la literatura de artículos publicados hasta junio del 2020, utilizando las bases de datos de Pubmed/Medline, SCOPUS y SciELO. Se seleccionaron 28 referencias para la elaboración de la presente.Desarrollo: el cáncer posee comportamientos clínicos y pronóstico variables que generalmente conllevan a estados de inmunosupresión causada por la terapéutica empleada para su tratamiento; por lo cual presentan mayor vulnerabilidad ante enfermedades infecciosas. Es responsabilidad de los sistemas de salud la correcta atención a este grupo de personas. Algunas medidas se basan en el distanciamiento social, ya sea en la reducción de la cantidad de acompañantes del paciente en la consulta o las sesiones de quimioterapia, la prohibición de las visitas a los pacientes hospitalizados y el empleo de las tecnologías con el uso de las teleconsultas para el seguimiento rutinario, así como el cambio de tratamientos por vía intravenosa a vía oralConclusiones: el estudio del comportamiento de la COVID-19 en pacientes oncológicos está en desarrollo. Las medidas que tomen las instituciones para lograr una atención de calidad a las personas que poseen cáncer son variadas y se basan sobre todo en el distanciamiento social

Lancet

BACKGROUND: In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival as a metric of the effectiveness of health systems and to inform global policy on cancer control. CONCORD-3 updates the worldwide surveillance of cancer survival to 2014. METHODS: CONCORD-3 includes individual records for 37.5 million patients diagnosed with cancer during the 15-year period 2000-14. Data were provided by 322 population-based cancer registries in 71 countries and territories, 47 of which provided data with 100% population coverage. The study includes 18 cancers or groups of cancers: oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast (women), cervix, ovary, prostate, and melanoma of the skin in adults, and brain tumours, leukaemias, and lymphomas in both adults and children. Standardised quality control procedures were applied; errors were rectified by the registry concerned. We estimated 5-year net survival. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: For most cancers, 5-year net survival remains among the highest in the world in the USA and Canada, in Australia and New Zealand, and in Finland, Iceland, Norway, and Sweden. For many cancers, Denmark is closing the survival gap with the other Nordic countries. Survival trends are generally increasing, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung. For women diagnosed during 2010-14, 5-year survival for breast cancer is now 89.5% in Australia and 90.2% in the USA, but international differences remain very wide, with levels as low as 66.1% in India. For gastrointestinal cancers, the highest levels of 5-year survival are seen in southeast Asia: in South Korea for cancers of the stomach (68.9%), colon (71.8%), and rectum (71.1%); in Japan for oesophageal cancer (36.0%); and in Taiwan for liver cancer (27.9%). By contrast, in the same world region, survival is generally lower than elsewhere for melanoma of the skin (59.9% in South Korea, 52.1% in Taiwan, and 49.6% in China), and for both lymphoid malignancies (52.5%, 50.5%, and 38.3%) and myeloid malignancies (45.9%, 33.4%, and 24.8%). For children diagnosed during 2010-14, 5-year survival for acute lymphoblastic leukaemia ranged from 49.8% in Ecuador to 95.2% in Finland. 5-year survival from brain tumours in children is higher than for adults but the global range is very wide (from 28.9% in Brazil to nearly 80% in Sweden and Denmark). INTERPRETATION: The CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed worldwide every year. It contributes to the evidence base for global policy on cancer control. Since 2017, the Organisation for Economic Co-operation and Development has used findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries worldwide. Governments must recognise population-based cancer registries as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems for all patients diagnosed with cancer. FUNDING: American Cancer Society; Centers for Disease Control and Prevention; Swiss Re; Swiss Cancer Research foundation; Swiss Cancer League; Institut National du Cancer; La Ligue Contre le Cancer; Rossy Family Foundation; US National Cancer Institute; and the Susan G Komen Foundation

Cancer incidence estimates at the national and district levels in Colombia Incidencia estimada de cáncer en Colombia a nivel departamental y nacional

OBJECTIVE: To estimate national and district cancer incidence for 18 major cancer sites in Colombia. MATERIAL AND METHODS: National and district incidence was estimated by applying a set of age, sex and site-specific incidence/mortality ratios, obtained from a population-based cancer registry, to national and regional mortality. The work was done in Bogotá (Colombia) and Lyon (France) between May 2003 and August 2004. RESULTS: The annual total number of cases expected (all cancers but skin) was 17 819 in men and 18 772 in women. Among males the most frequent cancers were those of the prostate (45.8 per 100 000), stomach (36.0), and lung (20.0). In females the most frequent were those of the cervix uteri (36.8 per 100 000), breast (30.0), and stomach (20.7). Districts with the lowest death certification coverage yielded the highest incidence rates. CONCLUSIONS: In the absence of national population-based cancer registry data, estimates of incidence provide valuable information at national and regional levels. As mortality data are an important source for the estimation, the quality of death certification should be considered as a possible cause of bias.OBJETIVOS: Determinar la incidencia nacional y departamental para 18 tipos de cáncer en Colombia. MATERIAL Y MÉTODOS: Se estimaron casos y tasas de incidencia ajustadas por edad a partir de razones incidencia/mortalidad según edad, sexo y tipo de cáncer. Los casos se tomaron de un registro poblacional y se usó la información oficial de mortalidad. El trabajo se realizó en Bogotá (Colombia) y en Lyon (Francia) entre mayo de 2003 y agosto de 2004. RESULTADOS: El número anual de casos esperados (todos los cánceres) fue 17 819 en hombres y 18 772 en mujeres. Los principales cánceres en hombres fueron los de próstata (45.8 por 100 000), estómago (36.0) y pulmón (20.0); en mujeres fueron los de cuello uterino (36.8 por 100 000), mama (30.0) y estómago (20.7). Los departamentos con baja cobertura del certificado de defunción presentaron tasas altas de incidencia. CONCLUSIONES: En ausencia de un registro nacional de tumores, la estimación de incidencia proporciona información valiosa a nivel nacional y departamental. La calidad y cobertura de los certificados de defunción puede ser una fuente de error en los datos calculados