Practical implications of imposing a new world standard population.

OBJECTIVE: The World Health Organization (WHO) has recently introduced a new world standard population for the production of age-standardized rates. In this study we compare cancer rates standardized to this population with those computed using reference populations in current practice, particularly the world standard of Segi (1960), in order to evaluate their adequacy as estimators of relative risk in diverse population groups and over time. METHODS: Incidence and mortality rates standardized using these reference populations were calculated and compared for various cancers. Standardized rate ratios were compared with more efficient methods of approximating relative risk, the Mantel & Haenszel and maximum-likelihood estimators. The differences were tested by taking a synthesis of the relative risks and by taking into account whether effects were homogeneous across age strata or not. RESULTS: There were no statistically significant differences between the relative risk estimates based on direct standardization and those obtained using Mantel & Haenszel (p 0.99), regardless of whether the Segi or the WHO world population was used as the standard. CONCLUSIONS: Ratios of rates age-standardized using the world standard of Segi approximate relative risk as precisely as the WHO standard. For this, and important practical reasons, it is considered unnecessary to replace the Segi standard population for comparisons between cancer rates

Breast cancer incidence and mortality trends in 16 European countries.

Trends in the incidence of and mortality from breast cancer result from a variety of influences including screening programmes, such as those introduced in several European countries in the late 1980s. Incidence and mortality rates for 16 European countries are analysed. Incidence increased in all countries. The estimated annual percent change (EAPC) varied from 0.8 to 2.8% in prescreening years in 6 'screened' countries and from 1.2 to 3.0% in 10 'non-screened' countries. Screening related temporary increases were visible. Earlier mortality trends were maintained in the most recent decade in Estonia (EAPC +1.8%) and Sweden (-1.2%). In other countries, previously increasing trends changed. Trends flattened in Finland, Denmark, France, Italy and Norway (EAPC 0.0 to -0.3%), while they declined in England and Wales (-3.1%), Scotland (-2.0%), and The Netherlands (-1.0%), all of which have national screening programmes, and in Slovakia (-1.1%), Spain (-0.7%), and Switzerland (-1.1%). In some countries with screening programmes, declines in mortality started before screening was introduced, and declines also occurred in non-screened age groups and in some countries without national screening programmes. This suggests that the major determinants of the observed trends vary among the countries and may include earlier detection through screening in countries where this has been introduced, but also improvements in therapy, in countries with or without screening

Interpreting international comparisons of cancer survival: the effects of incomplete registration and the presence of death certificate only cases on survival estimates.

We have assessed the impact on survival estimates based on cancer registry data of incomplete ascertainment of cancer cases and the presence of cases registered purely from death certificate information (DCO cases). Using data from the Thames and Finnish Cancer Registries we obtained five-year relative survival estimates for 12 cancer sites, excluding DCOs as usual. We then made adjustments to allow for the effects of both the known proportion of DCOs and the estimated proportion of missing cases for each site. In general, adjusting for DCOs led to lower survival estimates, whilst adjusting for incompleteness had the opposite effect. The Finnish data were largely complete and had small proportions of DCOs, and hence the adjustments had little effect on estimated survival. The changes in the Thames estimates were more marked. When performing cohort survival analysis (based on diagnoses between 1990 and 1994), the increases in the survival estimates gained from adjusting for incompleteness were for the most part offset by the decrease produced when adjusting for DCOs. However, when performing period survival analysis based on the period 1997-2001 (when the DCO rate at Thames had fallen by around a half relative to the earlier period), the final estimates (adjusted for both effects) were generally higher than the unadjusted values--thus reducing the apparent difference between the two countries. It is important to take variations in DCO proportion and/or completeness into consideration when comparing survival estimates between different populations

Late and very late mortality in 5-year survivors of childhood cancer: Changing pattern over four decades. Experience from the Nordic countries.

Long-term survivors of childhood cancer suffer from a higher mortality than the general population. Here we evaluate late and very late mortality, and patterns of causes of death, in five year survivors after childhood and adolescent cancer in cases diagnosed during four decades in the five Nordic countries. The study is population-based and uses data of the nationwide cancer registries and the cause of death registers. There were in all 37,515 incident cases, diagnosed with cancer before the age of 20 years, between 1960 and 1999. The 5-year survivor cohort used in the mortality analyses consisted of 21,984 patients who were followed-up for vital status until December 31, 2005 (Norway, Sweden) or 2006 (Denmark, Finland, Iceland). At the latest follow-up, 2,324 patients were dead. The overall standardized mortality ratio was 8.3 and the absolute excess risk was 6.2 per 1,000 person-years. The pattern of causes of death varied markedly between different groups of primary cancer diagnosis, and was highly dependent on time passed since diagnosis. With shorter follow-up the mortality was mainly due to primary cancer, while with longer follow-up, mortality due to second cancer and non-cancer causes became more prominent. Mortality between 5 and 10 years after diagnosis continued to decrease in patients treated during the most recent period of time, 1990-99, compared to previous periods, while mortality after 10 years changed very little with time period. We conclude that improvement of definite survival demands not only reducing early but also late and very late mortality

Edital n. 7 de 2 de dezembro de 2014

Torna pública a realização de processo seletivo para formação de cadastro de reserva para estágio remunerado no STJ

Lifelong cancer incidence in 47,697 patients treated for childhood cancer in the Nordic countries.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldBACKGROUND: The pattern of cancer in long-term survivors from childhood cancer has not been investigated comprehensively. METHODS: We obtained a cohort of 47,697 children and adolescents aged 0-19 years with cancer as defined by the country-wide cancer registries of Denmark, Finland, Iceland, Norway, and Sweden during 1943-2005. Cohort members were followed through age 79 years for subsequent primary cancers notified to the registries, and the age-specific risk pattern of the survivors was compared with that of the national populations using country and sex standardized incidence ratios (SIRs). We used a multiplicative Poisson regression model to estimate relative risk of cancer for attained age, with adjustment for calendar period and age at diagnosis of primary cancer. We also calculated excess absolute risk (EAR) attributable to status as childhood cancer survivor and determined the cumulative incidence of second primary cancer as a function of attained age for three subcohorts defined by period of treatment for childhood cancer. RESULTS: A total of 1180 asynchronous second primary cancers were observed in 1088 persons, yielding an overall SIR of 3.3 (95% confidence interval = 3.1 to 3.5). The relative risk was statistically significantly increased in all age groups, even for cohort members approaching 70 years of age. The EAR for second primary cancer among survivors increased gradually from one additional case per 1000 person-years of observation in early life to six additional cases per 1000 person-years in the age group 60-69 years. For children treated in the prechemotherapy era (1943-1959), the cumulative risk for a second primary cancer reached 18%, 34%, and 48% at ages 60, 70, and 80 years, respectively. The age-specific incidence rates were highest for cohort members treated in the era of intensive, multiple-agent chemotherapy (1975-2005). CONCLUSION: Survivors of childhood cancer have a persistent excess risk for a second primary cancer throughout their lives, accompanied by continuous changes in the risk of cancers at specific sites