International smoking-related burden of cancer and chronic obstructive pulmonary disease at the turn of the twenty-first century

While smoking prevalence has declined or remained stable in most countries thanks to public awareness of the health hazard of smoking and the implementation of tobacco control policies, the burden of smoking-related diseases remains colossal and underestimated. Therefore, in this thesis, Joannie Lortet-Tieulent assesses the international burden of two smoking-related diseases —cancer and chronic obstructive pulmonary disease (COPD)— at the turn of the twenty-first century, with a special focus on Europe and the USA. This burden is examined through the gender (social norms on smoking), race (associated with socioeconomic status in the USA) and geographic location (impact of tobacco control policies and country income level) perspectives. First, the impact of gender on incidence trends of the four cancers that are the most associated with smoking are examined in Europe. Incidence trends reflect the delayed adoption of smoking by women compared with men, and the large declines in smoking prevalence in men. Second, cigarette design and content have evolved over time and the impact of these changes on the distribution of lung cancer types (histologies) on each sex is tracked. Having massively started to smoke when filtered/low tar cigarettes were made available, women mainly developed a different type of lung cancer (adenocarcinoma) compared with men (squamous cell carcinoma). However, as men switched to those so-called light cigarettes, more men developed adenocarcinomas. Third, in the USA, racial and ethnic disparities in the smoking-attributable burden of cancer are explored. Blacks have a higher burden of cancer than Whites, but the smoking-attributable fraction of cancer of Blacks is similar to that of Whites. The smoking-attributable fraction of the cancer burden of Asians and Hispanics is the smallest of all races/ethnicities. Geographical differences in the USA are also investigated, by comparing state-level smoking-attributable cancer deaths. At national-level, 29% of cancer deaths are attributable to cigarette smoking. The highest proportion of smoking-related cancer deaths are observed in the South of the USA (up to 34%), where tobacco is grown, tobacco control policies are weaker, cigarettes are more affordable, and large populations with low socioeconomic status (in whom smoking prevalence is the highest) live. Finally, international trends of COPD and lung cancer mortality rates are contrasted to better understand the role of smoking in COPD mortality. COPD mortality rates are decreasing globally, but for different reasons depending on the country income level. In high-income countries, COPD is probably declining due to the decrease in smoking prevalence and the improvement of COPD management. Meanwhile, progress in middle-income countries likely reflects declines in poverty (a risk factor for developing COPD), particularly among women, who seldom smoke cigarettes. In conclusion, while decreasing in some populations, the smoking-related burden of cancer and COPD is large and there is still a great potential to reduce it. Those health gains can be achieved by strengthening tobacco control. We have the ability to end the smoking epidemic during the twenty-first century

Minimaliai invazyvi chirurgija ir sarginio limfmazgio biopsija – šiuolaikinis lokaliai neišplitusio endometriumo vėžio gydymo standartas: literatūros apžvalga ir Nacionalinio vėžio instituto patirtis

Objectives. To find out sentinel lymph node detection rate of low-risk endometrial cancer patients. To compare postoperative complications rate, lenght of a surgery, lenght of hospital stay and sensitivity of detecting lymph node metastasis between minimally invasive surgery with sentinel lymph node biopsy and abdominal surgery with systemic pelvic lymphadenectomy. Methods. Retrospective analysis of low-risk endometrial cancer patients, treated in National Cancer Institute (n = 103) history cases from 2018 10 untill 2019 12. I group – laparoscopic hysterectomy with sentinel lymph node biopsy (n = 35); II group – abdominal hysterectomy with systemic pelvic lymphadenectomy (n = 68). Both groups were homogeneous according to clinicopathological features. Results. Sentinel lymph node were detected in 97.1% cases. Sentinel lymph nodes in both sides were detected in 85.7% cases. Metastasis in regional lymph nodes were detected in 2 cases (5.7%) in group I and none group II. Postoperative complications rate in group I were 3.8% and 13% in group II. Conclusions. There are significantly less postoperative complications in endoscopic surgery with sentinel node biopsy for low-risk endometrial cancer treatment, also this method is more accurate in surgical staging in National Cancer Institute.Sarginio limfmazgio biopsija – saugus ir efektyvus endometriumo vėžio gydymo metodas, taikytinas už gimdos ribų neišplitusios ligos atvejais. Tikslas. Išsiaiškinti pacienčių, kurioms diagnozuotas mažos rizikos endometriumo vėžys, sarginio limfmazgio nustatymo dažnį, palyginti minimaliai invazyvios chirurgijos su sarginio limfmazgio biopsija ir atvirųjų operacijų su sistemine dubens limfonodektomija komplikacijų dažnį, operacijų trukmę, lovadienių skaičių ir metodų jautrumą, nustatant metastazes limfmazgiuose. Tyrimo metodai. Atlikta retrospektyvioji ligos istorijų analizė. Tiriamąją imtį sudarė mažos rizikos endometriumo vėžiu sergančios pacientės (n = 103), gydytos Nacionaliniame vėžio institute nuo 2018 m. spalio mėn. iki 2019 m. gruodžio mėn. Tiriamosios suskirstytos į dvi grupes: I grupės pacientėms atlikta laparoskopinė histerektomija ir sarginio limfmazgio biopsija (n = 35); II grupės pacientėms – atviroji histerektomija ir sisteminė dubens limfonodektomija (n = 68). Abi grupės, palyginus jų klinikines ir patologines charakteristikas, buvo tolygios. Rezultatai. Sarginis limfmazgis nustatytas 97,1 proc. pacienčių. Sarginis limfmazgis abiejose dubens pusėse identifikuotas 85,7 proc. atvejų. Sritiniuose limfmazgiuose metastazių nustatyta dviem I grupės pacientėms (5,7 %), II grupėje – nenustatyta. Pooperacinės komplikacijos I grupėje sudarė 3,8 proc., II grupėje – 13 proc.Išvados. Pacientėms, kurioms diagnozuotas mažos rizikos endometriumo vėžys, taikant endoskopinę chirurgiją ir sarginio limfmazgio biopsiją, nustatoma statistiškai reikšmingai mažiau pooperacinių komplikacijų. Analizuojant Nacionaliniame vėžio institute gydytų pacienčių duomenis, pastebėtas didesnis kalbamojo chirurginio metodo jautrumas nustatant metastazes limfmazgiuose

Convergence of decreasing male and increasing female incidence rates in major tobacco-related cancers in Europe in 1988-2010

Introduction: Smoking prevalence has been declining in men all over Europe, while the trend varies in European regions among women. To study the impact of past smoking prevalence, we present a comprehensive overview of the most recent trends in incidence, during 1988-2010, in 26 countries, of four of the major cancers in the respiratory and upper gastro-intestinal tract associated with tobacco smoking. Methods: Data from 47 population-based cancer registries for lung, laryngeal, oral cavity and pharyngeal, and oesophageal cancer cases were obtained from the newly developed data repository within the European Cancer Observatory (http://eco.iarc.fr/). Truncated age-standardised incidence rates (35-74 years) by calendar year, average annual percentage change in incidence over 1998-2007 were calculated. Smoking prevalence in selected countries was extracted from the Organisation for Economic Co-operation and Development and the World Health Organization databases. Results:

Polygenic risk score opportunities for early detection and prevention strategies in endometrial cancer

From Springer Nature via Jisc Publications RouterHistory: received 2020-04-08, rev-recd 2020-06-03, accepted 2020-06-10, registration 2020-06-12, pub-electronic 2020-07-06, online 2020-07-06, pub-print 2020-09-29Publication status: PublishedSummary: Recent large-scale genetic studies, particularly genome-wide association studies (GWAS), have emphasised the importance of common genetic variation in endometrial cancer susceptibility. Although each of these variants only confer modest effects on endometrial cancer risk, together they are likely to explain a substantial amount of the familial relative risk of the disease. Therefore, methods to combine genetic risk variants, such as polygenic risk scores (PRS) have gained traction as an attractive method for individualised risk prediction and management. Here, we discuss the benefits of a PRS for endometrial cancer and considerations required for clinical implementation

Normative misperceptions of tobacco use among university students in seven European countries: Baseline findings of the 'Social Norms Intervention for the prevention of Polydrug usE' study.

Research conducted in North America suggests that students tend to overestimate tobacco use among their peers. This perceived norm may impact personal tobacco use. It remains unclear how these perceptions influence tobacco use among European students. The two aims were to investigate possible self-other discrepancies regarding personal use and attitudes towards use and to evaluate if perceptions of peer use and peer approval of use are associated with personal use and approval of tobacco use

Risk factors for endometrial cancer : An umbrella review of the literature

Although many risk factors could have causal association with endometrial cancer, they are also prone to residual confounding or other biases which could lead to over- or underestimation. This umbrella review evaluates the strength and validity of evidence pertaining risk factors for endometrial cancer. Systematic reviews or meta-analyses of observational studies evaluating the association between non-genetic risk factors and risk of developing or dying from endometrial cancer were identified from inception to April 2018 using PubMed, the Cochrane database and manual reference screening. Evidence was graded strong, highly suggestive, suggestive or weak based on statistical significance of random-effects summary estimate, largest study included, number of cases, between-study heterogeneity, 95% prediction intervals, small study effects, excess significance bias and sensitivity analysis with credibility ceilings. We identified 171 meta-analyses investigating associations between 53 risk factors and endometrial cancer incidence and mortality. Risk factors were categorised: anthropometric indices, dietary intake, physical activity, medical conditions, hormonal therapy use, biochemical markers, gynaecological history and smoking. Of 127 meta-analyses including cohort studies, three associations were graded with strong evidence. Body mass index and waist-to-hip ratio were associated with increased cancer risk in premenopausal women (RR per 5 kg/m(2) 1.49; CI 1.39-1.61) and for total endometrial cancer (RR per 0.1unit 1.21; CI 1.13-1.29), respectively. Parity reduced risk of disease (RR 0.66, CI 0.60-0.74). Of many proposed risk factors, only three had strong association without hints of bias. Identification of genuine risk factors associated with endometrial cancer may assist in developing targeted prevention strategies for women at high risk.Peer reviewe

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

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition - in which increasing sociodemographic status brings structured change in disease burden - is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks