Descriptive epidemiology of vulvar and vaginal cancers in Vaud, Switzerland, 1974-1994

Background: To analyse trends in incidence, survival and risk of second neoplasms following vaginal and vulvar cancers using data collected by the Swiss Cancer Registry of Vaud over the 21-year period 1974-1994. Materials and methods: Subjects were 257 vulvo-vaginal cancers. Of these, 69 were vaginal, 153 vulvar cancers, and 35 non-specified lower genital tract neoplasms; 94 in situ neoplasms were also registered (85 for the vulva). Results: Invasive vaginal cancer incidence decreased from 0.8 in 1974-1984 to 0.4/100,000 women in 1985-1994, while invasive vulvar cancer incidence remained approximately stable around 1.2/100,000 (world standard); incidence of in situ vulvar cancer increased from 0.8 to 1.3/100,000, the rise being larger in younger women. Significant excesses for second primary neoplasms were observed for oro-pharyngeal and lung cancer, and for non-melanomatous skin neoplasms, as well as for invasive vulvar cancers following in situ cancers. Conclusions: This population-based dataset confirms that the incidence of in situ vulvar (but not invasive vulvar or vaginal cancer) has been increasing over the last 20 years. The excess second primary neoplasms supports the hypotheses that human papillomavirus and cigarette smoking are related to vulvo-vaginal neoplasm

Incidence of invasive cancers following carcinoma in situ of the cervix.

Women with carcinoma in situ (CIS) of the cervix uteri, notified to the population-based Cancer Registry of the Swiss Canton of Vaud between 1974 and 1993, were actively followed up to 31 December 1993 for the occurrence of subsequent invasive neoplasms. Among 2190 incident cases of CIS, followed for a total of 22,225 person-years, 95 metachronous cancers were observed vs 77.9 expected, corresponding to a significant standardised incidence ratio (SIR) of 1.2. Ten cases of invasive cervical cancer were observed vs 3.0 expected (SIR = 3.4, P < 0.01), the excess being larger in the first 10 years since CIS diagnosis. A total of 11 cases of four major tobacco-related sites (lung, mouth or pharynx, oesophagus and urinary bladder) were observed vs 5.1 expected, corresponding to a significant SIR of 2.2. The excess was observed > or = 10 years after CIS diagnosis. There was also an excess of non-melanomatous skin cancers (29 observed, 16.9 expected, SIR = 1.7; P < 0.01), but not of skin melanoma and of any of the other neoplasms considered, including breast and corpus uteri. This population-based study, therefore, finds an excess of invasive cervical cancer in the short term after CIS diagnosis, and a medium- to long-term excess risk of tobacco-related and non-melanomatous skin neoplasms. These findings are discussed in terms of increased surveillance and case ascertainment after CIS, and of potential shared risk factors (tobacco and/or viral infections)

Trends in cancer incidence and mortality in Vaud, Switzerland, 1974-1993

Background: Comparing incidence of and mortality from cancer within a given population yields several benefits. One of these is the opportunity, when trends in incidence differ from those in mortality, to derive inferences about the potential role of improved diagnosis in the rise of incidence rates, and about therapeutic advancements in reducing mortality. Materials and methods: Trends in incidence of and mortality from various cancers or groups of cancers (comprising 55,682 new malignant tumours and 26,528 certified cancer deaths) over the period 1974-1993 were compared using, respectively, data from the Cancer Registry of the Swiss Canton of Vaud (with about 600,000 inhabitants) and those provided by the Swiss Federal Statistical Office. Results: The overall cancer incidence increased by 10% to 30% in both sexes and various age groups, whereas mortality remained approximately the same. The sites primarily responsible for these divergent trends were breast, prostate and colorectal, three sites where cancers have been less frequently diagnosed since the advent of certain technical advancements and the introduction of screening. Other contributors to the divergent trends were testicular cancer, Hodgkin's disease and leukaemias, i.e., the sites for which the most substantial therapeutic advancements have been achieved. Conclusions: These data are fairly reassuring, since they are inconsistent with an ongoing cancer epidemic in this European population. However, they are also incompatible with the presence of major advancements in the prevention and treatment of cance

Cancer risk after radiotherapy for breast cancer

Among women with breast cancer, we compared the relative and absolute rates of subsequent cancers in 1541 women treated with radiotherapy (RT) to 4570 women not so treated (NRT), using all registered in the Swiss Vaud Cancer Registry in the period between 1978 and 1998, and followed up to December 2002. Standardised incidence ratios (SIRs) and the corresponding 95% confidence intervals (CIs) were based on age- and calendar year-specific incidence rates in the Vaud general population. There were 11 lung cancers in RT (SIR=1.40; 95% CI: 0.70–2.51) and 17 in NRT women (SIR=0.76; 95% CI: 0.44–1.22), 72 contralateral breast cancers in RT (SIR=1.85; 95% CI: 1.45–2.33) and 150 in NRT women (SIR=1.38; 95% CI: 1.16–1.61), and 90 other neoplasms in RT (SIR=1.37; 95% CI: 1.10–1.68) and 224 in NRT women (SIR=1.05; 95% CI: 0.91–1.19). Overall, there were 173 second neoplasms in RT women (SIR=1.54, 95% CI: 1.32–1.78) and 391 among NRT women (SIR=1.13, 95% CI: 1.02–1.25). The estimates were significantly heterogeneous. After 15 years, 20% of RT cases vs 16% of NRT cases had developed a second neoplasm. The appreciable excess risk of subsequent neoplasms after RT for breast cancer must be weighed against the approximately 5% reduction of breast cancer mortality at 15 years after RT

Trends of skin cancer in the Canton of Vaud, 1976-92.

Trends in incidence and mortality for basal cell carcinomas (BCC), squamous cell carcinomas (SCC) and cutaneous malignant melanoma (CMM) for the period 1976-92 were analysed using data from the Cancer Registry of the Swiss Canton of Vaud. Among the 12,473 cases registered, 63% were basal cell carcinomas, 25% squamous cell cancers, 9% cutaneous malignant melanomas and 3% other miscellaneous histological types. Age-standardised incidence rates increased substantially for all histological types considered, from 44% increase for BCC in males to a more than 3-fold increase for SCC in females, with only signs of a levelling off in 1991-92, following a peak of incidence rates in 1986-90. From 1976-80 to 1991-92 CMM incidence increased by approximately 80% in both sexes. In 1991-92, age-standardised (world) incidence rates per 100,000 were 69.3 for basal cell, 29.1 for squamous cell cancers and 11.5 for melanomas in males, and, respectively, 62.2, 18.0 and 12.3 in females. With respect to mortality, in males rates increased for both non-melanocytic cancer (> 40%) and CMM (> 53%) whereas in females CMM, BCC and SCC rates remained approximately stable over the calendar periods examined. In 1991-92, age-standardised mortality rates per 100,000 were 2.6 for melanoma and 0.7 for other skin cancers in males, and, respectively, 1.6 and 0.2 in females. Upward trends in incidence were also present, and relatively homogeneous across, various age groups examined. However, SCC and CMM levelled off over the last period, and some decline was apparent in males below age 45. Separate analysis by anatomical site showed substantial increases in the head and neck for SCC and BCC, and in the trunk for CMM. In 1991-92, middle-aged women had almost equalled male incidence rates of BCC and SCC. A female excess of CMM incidence seemed to have disappeared since 1981-86. The increase in skin cancer incidence thus continued in this population up to the late 1980s, with a plateau only after 1990

Trends in survival for patients diagnosed with cancer in Vaud, Switzerland, between 1974 and 1993

Background Analysis of trends in cancer survival in defined well surveilled populations can provide useful indications on advancements in cancer management and treatment. Patients and methods Survival rates from the Vaud Cancer Registry were computed for 31,158 cases registered in 1984-1993, and compared with those registered in 1974-1978 and 1979-1983. Results A systematic, albeit generally moderate, tendency towards increasing five-year relative survival was observed for both sexes and most major cancer sites, including oral cavity and pharynx (0.38-0.43), stomach (0.21-0.26), colon (0.49-0.55), rectum (0.45-0.51), lung (0.08-0.12), skin melanoma (0.67-0.89), female breast (0.67-0.80), endometrium (0.72-0.84), ovary (0.28-0.37), prostate (0.44-0.66), testis (0.73-0.96), bladder (0.31-0.50), kidney and renal pelvis (0.41-0.59), thyroid (0.73-0.81), non-Hodgkin's lymphomas (0.37-0.63), Hodgkin's disease (0.61-0.81), and leukaemias (0.27-0.39). Survival for all cancers and both sexes combined, rose from 0.51-0.64 (0.57 for males, 0.71 for females). No appreciable change in survival was observed for cancers of oesophagus, liver, gallbladder, pancreas, larynx, cervix uteri, brain, multiple myeloma, as well as unidentified or unknown origin neoplasms. Conclusions Survival estimates for most cancer sites are comparable to the US SEER dataset, and their pattern of trends are discussed in terms of improved diagnosis and treatment for various neoplasm