An overview of prognostic factors for long-term survivors of breast cancer

Background Numerous studies have examined prognostic factors for survival of breast cancer patients, but relatively few have dealt specifically with 10+-year survivors. Methods A review of the PubMed database from 1995 to 2006 was undertaken with the following inclusion criteria: median/mean follow-up time at least 10 years; overall survival and/or disease-specific survival known; and relative risk and statistical probability values reported. In addition, we used data from the long-standing Eindhoven Cancer Registry to illustrate survival probability as indicated by various prognostic factors. Results 10-year breast cancer survivors showed 90% 5-year relative survival. Tumor size, nodal status and grade remained the most important prognostic factors for long-term survival, although their role decreased over time. Most studies agreed on the long-term prognostic values of MI (mitotic index), LVI (lymphovascular invasion), Her2-positivity, gene profiling and comorbidity for either all or a subgroup of breast cancer patients (node-positive or negative). The roles of age, socioeconomic status, histological type, BRCA and p53 mutation were mixed, often decreasing after correction for stronger prognosticators, thus limiting their clinical value. Local and regional recurrence, metastases and second cancer may substantially impair long-term survival. Healthy lifestyle was consistently related to lower overall mortality. Conclusions Effects of traditional prognostic factors persist in the long term and more recent factors need further follow-up. The prognosis for breast cancer patients who have survived at least 10 years is favourable and increases over time. Improved long-term survival can be achieved by earlier detection, more effective modern therapy and healthier lifestyle

Rapid and continuous increases in incidence rates of basal cell carcinoma in the Southeast Netherlands since 1973

This study is aimed to determine the characteristics of the trends in incidence of basal cell carcinoma (BCC) in the Netherlands. We used incidence data of BCC from the Eindhoven Cancer Registry (Comprehensive Cancer Centre South) in the south of the Netherlands from 1973 to 2000. Data were age-adjusted and age-specific rates were calculated. Joinpoint and age-period-birth cohort modelling were applied. Between 1973 and 2000, age-adjusted incidence rates of BCC increased in both sexes, most markedly among (young) females. Recent increases were most marked on the trunk. The male data fitted age-drift models, suggesting a linear increase in rates over time, not attributable to either period- or cohort effects. In females, age-cohort-drift models described the data adequately, suggesting changes in intermittent UV exposures in subsequent cohorts. Incidence of BCC in the Netherlands is increasing rapidly, especially at body sites that are not chronically exposed to sunlight. The most likely explanation is an increased intermittent overexposure to UV radiation. This could have introduced an equal fractional increase in risk at all ages in all cohorts. There is no indication of an end to this trend in BCC

Increasing incidence and decreasing mortality of colorectal cancer due to marked cohort effects in southern Netherlands

In preparation for any type of forthcoming colorectal cancer (CRC) mass screening we examined trends in CRC incidence and mortality according to sex, subsite and age in southern Netherlands. Population-based data from the Eindhoven Cancer Registry during the period 1975-2004 were used. Age-period-cohort analyses were performed to investigate possible aetiologic, diagnostic or therapeutic origins of the trends. Age-adjusted (European Standardized Rates) incidence rates for colon cancer increased since 1975 from 23 in 100 000 for both sexes to about 38 in 100 000 for males and 30 in 100 000 for females in 2004. Incidence of rectal cancer remained relatively stable at about 25 in 100 000 males and 15 in 100 000 females. The incidence of CRC increased for male patients from birth cohorts between 1900 and 1955 (P = 0.010), especially in left-sided colon cancer in the younger birth cohorts [RR1900: 0.8 (95% confidence interval, CI: 0.6, 1.0), RR1960: 1.6 (95% CI: 0.9, 2.8), reference: 1910-1919]. For women a similar, although weaker increase in CRC incidence was found. Mortality rates for CRC started to decrease in 1975, more pronounced for rectal than for colon cancer. The relative risk for dying in men with CRC decreased from 1.3 (95% CI: 1.0, 1.6) in the 1900 birth cohort to 0.1 (95% CI: 0.1, 0.4) in the 1960 birth cohort, reference 1910-1919 birth cohort. The increasing incidence and decreasing mortality in CRC is largely affected by birth cohort effects. Changes in CRC incidence are likely to be attributed to lifestyle factors and decreasing mortality is due to earlier detection and improved treatment, especially among younger patients. European Journal of Cancer Prevention 18:145-152 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins