Descriptive epidemiology and aetiology of endometrial cancer

The International Agency for Research on Cancer (IARC) has estimated that endometrial cancer is the commonest gynaecological cancer in the developed countries, with an increasing incidence in postmenopausal women [1]. It is estimated that in 2019, there will be about 62 000 new cases and 12 000 deaths from endometrial cancer in the USA, making it the fourth most common cancer in women after breast, lung and colorectal cancers [2]. The cervical and endometrial cancers originate in the uterus, but differ drastically in terms of aetiology, clinical presentation and characteristics, prognosis and survival. Cervical cancer is a model of viral carcinogenesis, namely human papilloma virus, and most common in developing countries; whereas, endometrial cancer is a model of hormonal carcinogenesis, and most common in developed countries. The aim of this chapter is to provide an overview of key concepts in cancer epidemiology and to describe the global patterns and trends in incidence and mortality, aetiology and prevention of endometrial cancer

Increasing incidence of colorectal cancer in young adults aged <50 years in England over the last 20 years

Introduction: Worldwide, colorectal cancer (CRC) is the 3rd most common cancer and the 2nd leading cause of cancer mortality – with an estimated 1.9 million new cases (10% of all cancers) and 935,000 deaths (9.4% of all cancers) in the year 2020. In recent decades, the incidence of early-onset CRC, (i.e., in persons aged Material and method: Individual-level data for patients diagnosed with CRC during 1985-2019 were obtained from Public Health England. Average annual incidence rates (AAIRs) were calculated by sex and two age categories (Results and discussion: During the 35-year study period, a total of 1,048,935 patients (54% males, 46% females) with CRC were registered in England. In young adults aged Conclusion: This large population-based study of over 1 million patients shows that the incidence of CRC in older adults aged 50+ years in England has stabilised (or levelled off) during the last 20 years, whereas there has been a steady increase in incidence in young adults aged <50 years during this period. It is suggested that the rising incidence of early-onset CRC in young adults aged <50 years may be attributed to diet, lifestyle factors, microbiome composition and genetic factors. This study supports the debate for lowering the bowel cancer screening age to facilitate early diagnosis and treatment of pre-malignant lesions in young adults aged <50 years.</p

Exceptionally high prevalence of iron deficiency anaemia in children residing in rural areas in Pakistan

Introduction: Despite a reduction in the global prevalence of anaemia over the past three decades (from 28.2% to 24.3%), anaemia in children aged ≤15 years remains a major public health challenge in sub-Saharan Africa and south Asia. In these regions, there is substantial variation in anaemia burden by age, sex, and socioeconomic status – the highest prevalence is observed in children aged ≤5 years and females. The condition is attributed to a complex interplay of several interconnected causes, including nutritional deficiencies (i.e., iron, vitamin B12, folate), poor and/or cultural child feeding practices, parasitic infections, high birth rates, and short birth intervals. We examined children presenting with signs/symptoms of anaemia at SHINE Humanity primary healthcare clinics in rural settings in the Sindh province, Pakistan, to ascertain the prevalence of anaemia in children aged ≤15 years to inform the development of targeted interventions to reduce the associated morbidity – [e.g. impaired development, years lived with disability (YLDs)] and premature mortality.Methods: All children aged ≤15 years, presenting with pallor and complaints from parents of weakness, fatigue, and decreased concentration were subject to laboratory investigation for complete blood count examination. A haemoglobin (Hb) level of ≤11.4 g/dL was considered diagnostic for anaemia. Informed consent was obtained from all parents.Results: During the study period (July-November 2023), a total of 593 children aged ≤15 years (45.9% males, 54.1% females) were examined for anaemia – of these, 74.4% (n=441) were diagnosed with anaemia (mean Hb 10.3 g/dL; standard deviation=1.8; range, 4.7-15.0). The prevalence of anaemia was 73.5% in males and 75.1% in females. With regard to age, the highest prevalence (86.5%, 64/74) was observed in children aged ≤5 years (mean Hb 9.7 g/dL; standard deviation=1.7; range, 6.3-13.6), followed by 75.8% (266/351) in those aged 6-10 years and 66.1% (111/168) in those aged 11-15 years.Conclusion: Compared with the World Health Organisation (WHO) Global Anaemia estimates (2021 Edition) for South-East Asia, this is the highest recorded prevalence of anaemia in children (86.5 % in those aged ≤5 years) in the region. Considering the morbidity (e.g. poor cognitive and motor development) associated with the duration and severity of anaemia and subsequent YLDs, this study informs formulation of targeted multifaceted interventions, including early diagnosis, combating iron and nutrient deficiencies, promoting hygiene, and health education to reduce the burden of anaemia in children residing in rural areas in Pakistan.</p

Exceptionally high prevalence of iron deficiency anaemia in children residing in rural areas in Pakistan

Introduction: Despite a reduction in the global prevalence of anaemia over the past three decades (from 28.2% to 24.3%), anaemia in children aged ≤15 years remains a major public health challenge in sub-Saharan Africa and south Asia. In these regions, there is substantial variation in anaemia burden by age, sex, and socioeconomic status – the highest prevalence is observed in children aged ≤5 years and females. The condition is attributed to a complex interplay of several interconnected causes, including nutritional deficiencies (i.e., iron, vitamin B12, folate), poor and/or cultural child feeding practices, parasitic infections, high birth rates, and short birth intervals. We examined children presenting with signs/symptoms of anaemia at SHINE Humanity primary healthcare clinics in rural settings in the Sindh province, Pakistan, to ascertain the prevalence of anaemia in children aged ≤15 years to inform the development of targeted interventions to reduce the associated morbidity – [e.g. impaired development, years lived with disability (YLDs)] and premature mortality.Methods: All children aged ≤15 years, presenting with pallor and complaints from parents of weakness, fatigue, and decreased concentration were subject to laboratory investigation for complete blood count examination. A haemoglobin (Hb) level of ≤11.4 g/dL was considered diagnostic for anaemia. Informed consent was obtained from all parents.Results: During the study period (July-November 2023), a total of 593 children aged ≤15 years (45.9% males, 54.1% females) were examined for anaemia – of these, 74.4% (n=441) were diagnosed with anaemia (mean Hb 10.3 g/dL; standard deviation=1.8; range, 4.7-15.0). The prevalence of anaemia was 73.5% in males and 75.1% in females. With regard to age, the highest prevalence (86.5%, 64/74) was observed in children aged ≤5 years (mean Hb 9.7 g/dL; standard deviation=1.7; range, 6.3-13.6), followed by 75.8% (266/351) in those aged 6-10 years and 66.1% (111/168) in those aged 11-15 years.Conclusion: Compared with the World Health Organisation (WHO) Global Anaemia estimates (2021 Edition) for South-East Asia, this is the highest recorded prevalence of anaemia in children (86.5 % in those aged ≤5 years) in the region. Considering the morbidity (e.g. poor cognitive and motor development) associated with the duration and severity of anaemia and subsequent YLDs, this study informs formulation of targeted multifaceted interventions, including early diagnosis, combating iron and nutrient deficiencies, promoting hygiene, and health education to reduce the burden of anaemia in children residing in rural areas in Pakistan.</p