Changing pattern of age-specific breast cancer incidence in the Swiss canton of Geneva

Hormone replacement therapy (HRT) use declined sharply after mid-2002, when the Women's Health Initiative trial reported an association between breast cancer occurrence and HRT. Hypothesized mechanism behind this association is that HRT promotes growth of pre-existing small tumors, leading to earlier tumor detection. We evaluated the impact of the sudden decline in HRT use on age distribution of breast cancer in Geneva. We included all incident breast cancer cases recorded from 1975 to 2006 at the Geneva cancer registry. We calculated mean annual incidence rates per 100,000 for 2year periods for three age groups and assessed temporal changes by joinpoint regression. We compared age-specific incidence curves for different periods, reflecting different prevalence rates of HRT use. After increasing constantly between 1986 and 2002 among women aged 50-69years [annual percent change (APC): +4.4, P<0.0001], rates declined sharply after 2003 (APC: −6.0; P=0.0264). Age-specific breast cancer rates changed dramatically with changes in prevalence of HRT use. During low HRT prevalence, breast cancer incidence increased progressively with age, when HRT prevalence was reaching its maximum (1995-2002), higher rates were seen in 60- to 64-year-old women, with a concomitant decrease in risk among elderly. After the sudden decline in HRT use, the incidence peak diminished significantly and incidence increased again with age. Following the abrupt decline in HRT use in Geneva, breast cancer incidence rates among post-menopausal women decreased considerably with striking changes in age-specific incidence rates before, during and after the peak in HRT prevalenc

Impact of obesity on diagnosis and treatment of breast cancer

In this population-based study, we evaluated the impact of obesity on presentation, diagnosis and treatment of breast cancer. Among all women diagnosed with invasive breast cancer in the canton Geneva (Switzerland) between 2003 and 2005, we identified those with information on body mass index (BMI) and categorized them into normal/underweight (BMI <25kg/m2), overweight (BMI ≥-<30kg/m2) and obese (BMI ≥30kg/m2) women. Using multivariate logistic regression, we compared tumour, diagnosis and treatment characteristics between groups. Obese women presented significantly more often with stage III-IV disease (adjusted odds ratio [ORadj]: 1.8, 95% CI: 1.0-3.3). Tumours ≥1cm and pN2-N3 lymph nodes were significantly more often impalpable in obese than in normal/underweight patients (ORadj 2.4, [1.1-5.3] and ORadj 5.1, [1.0-25.4], respectively). Obese women were less likely to have undergone ultrasound (ORadj 0.5, [0.3-0.9]) and MRI (ORadj 0.3, [0.1-0.6]) and were at increased risk of prolonged hospital stay (ORadj 4.7, [2.0-10.9]). This study finds important diagnostic and therapeutic differences between obese and lean women, which may impair survival of obese women with breast cancer. Specific strategies are needed to optimize the care of obese women with or at risk of breast cance

Le Cancer à Genève: Incidence, mortalité, survie et prévalence 2007-2010

Tous les quatre ans, le Registre genevois des tumeurs, crée en 1970, publie un rapport sur l'incidence, la mortalité et la survie par cancer dans la population genevoise. Il a pour objectif de recenser l'ensemble des cancers diagnostiqués dans la population résidente du canton

Planning for the future: cancer incidence projections in Switzerland up to 2019

Projections of the national burden of cancer play a key role in planning cancer control programmes and investments. We present projections of cancer incidence rates and cases for the period up to 2015-2019 in Switzerland

Abstract P3-07-09: Trends and determinants of breast cancer survival among unscreened women: A population-based study

Abstract Background: Breast cancer mortality has been declining in many western countries, including Switzerland,since the late 1980s. This has largely been credited to mammography screening and improved treatment. However, mortality trends are also decreasing among unscreened women, though most breast cancer deaths still occur in that population. Objective: The objective of this study was to analyse trends in,and factors affecting the survival of, women whose breast cancer was not detected by screening in the Geneva female population from 1990 to 2007. In Geneva an organized screening programme started in 2001 while opportunistic screening has existed since the beginning of the 1990s. Methods: The study population comprised1696 women aged 50-69 years oldwith invasive breast cancer that was not detected by screening and that was recorded at the population-based Geneva cancer registry. We studied tumour characteristics and prognostic factors across 6 time periods through chi square and trend tests. To assess whether breast cancer specific survival had improved over time, we calculated 5-year specific survival and performed multivariate Cox proportional hazard models to assess independent determinants of mortality. Results:Median age of the women at diagnosis was 59 years. During the 18 year study periodthere was a decrease in the proportion of diagnoses among women of low social class (25.8% in 1990-92 vs 17.3% in 2005-07, p=0.001). No change in the distribution of stage at diagnosisor hormone receptor status was observed, while between the first and last period there was an increase in cancers with lobular morphology (6.8% vs. 19.0%, p&amp;lt;0.001), and a decrease in poorly or undifferentiated cancers (36.7% vs 28.7%, p&amp;lt;0.001). The use of breast conserving surgery with radiotherapy (BCS), chemotherapy and endocrine therapy increased significantly along the period (41.2% to 58.8%, p&amp;lt;0.001; 41.6% to 52.8, p=0.030; and 34% to 69.9%, p&amp;lt;0.001, respectively). Five year breast cancer-specific survival was 82% in 1990-92 (95% Confidence Intervals [95%CI] 77-87) and 89% in 2005-07 (95% CI: 83-92; log rank test=8.68, p=0.122). In the Cox multivariate model there was a trend towards improved survival, but it was only statistically significant when comparing the period 2005-07 to the first period (Hazard Ratio 0.47, 95%CI: 0.22-0.98). Increasing age, stage, and grade, hormone receptor–negative disease, and not receiving BCS or endocrine therapy were all independently associated with a worse breast cancer–specific survival. Conclusions:We observed an improvement in survival only in recent years among women whose breast cancers were not detected by screening; this appears to be associated with improved treatment. This suggests that the breast cancer mortality reduction observed in Switzerland since the late 1980s is not likely attributable to changes in treatment before 2005, but rather to the generalization of screening. Citation Format: Elisabetta Rapiti, Thomas Agoritsas, Massimo Usel, Robin Schaffar, Hyma Schubert, Christine Bouchardy. Trends and determinants of breast cancer survival among unscreened women: A population-based study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-09.</jats:p

The incidence of colon cancer among patients diagnosed with left colonic or sigmoid acute diverticulitis is higher than in the general population

Background: Considering the low incidence of colon cancer after an initial episode of colonic diverticulitis in some categories of patients, some authors suggested to exempt them from colonoscopy. However, this incidence has never been compared to that of a reference population, and predictors of cancer are still poorly investigated. We aimed to determine the 1-year incidence of colon cancer at the site of diverticulitis in patients diagnosed with left colonic or sigmoid acute diverticulitis, to compare this incidence to a reference population to state whether endoscopy is required or not, and to identify predicting factors of cancer to better target subpopulations needing that examination. Methods: All patients admitted at the University Hospitals of Geneva for left colonic or sigmoid acute diverticulitis were included. Patients with a previous history of colon cancer or non-available for follow-up were excluded. Demographic data, haemoglobin values, and the Hinchey score were documented. This cohort was matched with the Geneva Cancer Registry to look for cancer occurrence at the site of diverticulitis within 1year. Predictors of cancer were assessed using univariate logistic regression and the risk of cancer by comparing observed cases to a reference population using standardized incidence ratios. Results: The final cohort included 506 patients. Eleven (2.2%) had a diagnosis of cancer at the site of diverticulitis within 1year. The mean age was significantly different between patients with cancer and others. No predictor of cancer could be identified, except a trend for an increased risk with advancing age (p=0.067). The standardized incidence ratios showed a 44-fold increased risk of cancer among the cohort compared to the reference population. Conclusions: Colonoscopy should be continued after an initial diagnosis of left colonic or sigmoid acute diverticulitis, irrespective of the clinical or radiological presentations