Epidemiological Aspects in Nasopharyngeal Cancer

AbstractNasopharyngeal cancer (NPC) is an uncommon cancer. According to the Global Cancer Observatory, of the 129,000 new diagnoses in 2018, 85% has been made in the Asiatic population. In males the annual age adjusted rate of incidence (per 100,000) dramatically varied between 8 in South-Eastern Asia and <1 in Europe. In Europe (period of diagnosis 1999–2007), the annual incidence rate varied between 0.7 (South of Europe) and 0.2 (North of Europe). Incidence is three time higher in men than women. Elderly are more affected than young people. Five-year survival, from European population based cancer registries was 49% (period 1999–2007), survival was better in younger than in older patients (73% vs. 31%), prognosis was more favorable in women than men (54% vs. 47%). Geographical variation of survival was reported, with poor 5-year in the Eastern European countries (36%).Incidence and population based survival are crucial for public health and planning clinical study. Lifestyle and environmental factors are responsible of the decreasing trend of incidence in quite all the world countries.Being one of the rare diseases, NPC need to be centralized for diagnosis and treatment. In Europe, the European Joint Action of Rare Cancers and the European Reference Network for rare disease will play an important role to make progress and reduce geographical disparities

Childhood cancer and environmental integrity: a commentary and a proposal

Improvements in the health standards of developed and developing societies depend primarily on the relationships between economy and environment. Recent long-term changes in the chemical composition of man-made environments may be linked to changes in the biology of human beings. Here we argue that children are at the greatest risk of being affected by the dangerous effects of these changes, with particular reference to cancer. The concept of cancer risk must be extended to new contexts. Considering the increasing rates of chemical pollution and its spreading in the environment, we illustrate a proposal aiming to protect the human health, in an intra- and intergenerational perspective. A surveillance system of occupational and residential exposures should be implemented to prevent cancer risk in embryos and children

Substantial variation in therapy for colorectal cancer across Europe: EUROCARE analysis of cancer registry data for 1987

To provide a quantitative description of the treatments applied to malignant colorectal cancer across Europe, we analysed all cases (11 333) of colorectal cancer registered in 1987 by 15 Cancer Registries in eight European countries. In a third of cancer registries, therapy was known for all cases, in the others 1-15% of registrations lacked treatment information. Eighty per cent of all patients received surgical resection, ranging from 58% (Estonia) to 92% (Tarn). The proportion of resections decreased with advancing age (85-73% for colon cancer; 85-70% for rectal cancer for 74 years, respectively). Only 4% of colon cancer patients received adjuvant or palliative chemotherapy, range 1-12%. Sixteen per cent of rectal cancer patients received radiotherapy with great inter-registry variability (1-43%). Since the proportion of surgically resected patients correlated positively with the 5-year relative survival probability reported by the recently published EUROCARE study, this may be part of the explanation for the major differences in survival for these cancers among different European populations. The most likely determinant of this correlation is stage at diagnosis, but, quality of, and access to surgery, as well as access to endoscopy, may differ among countries and registry areas, and these may also contribute to inter-country survival differences. Copyrigh

International benchmarking of childhood cancer survival by stage at diagnosis: The BENCHISTA project protocol

BACKGROUND: Several studies have shown significant variation in overall survival rates from childhood cancer between countries, using population-based cancer registry (PBCR) data for all cancers combined and for many individual tumour types among children. Without accurate and comparable data on Tumour stage at diagnosis, it is difficult to define the reasons for these survival differences. This is because measurement systems designed for adult cancers do not apply to children's cancers and cancer registries often hold limited information on paediatric tumour stage and the data sources used to define it. AIMS: The BENCHISTA project aims to test the application of the international consensus "Toronto Staging Guidelines" (TG) for paediatric tumours by European and non-European PBCRs for six common paediatric solid tumours so that reliable comparisons of stage at diagnosis and survival rates by stage can be made to understand any differences. A secondary aim is to test the data availability and completeness of collection of several 'Toronto' consensus non-stage prognostic factors, treatment types given, occurrence of relapse/progression and cause of death as a descriptive feasibility study. METHODS: PBCRs will use their permitted data access channels to apply the Toronto staging guidelines to all incident cases of six solid childhood cancers (medulloblastoma, osteosarcoma, Ewings sarcoma, rhabdomyosarcoma, neuroblastoma and Wilms tumour) diagnosed in a consecutive three-year period within 2014-2017 in their population. Each registry will provide a de-identified patient-level dataset including tumour stage at diagnosis, with only the contributing registry holding the information that would be needed to re-identify the patients. Where available to the registry, patient-level data on 'Toronto' non-stage prognostic factors, treatments given and clinical outcomes (relapse/progression/cause of death) will be included. More than 60 PBCRs have been involved in defining the patient-level dataset items and intend to participate by contributing their population-level data. Tumour-specific on-line training workshops with clinical experts are available to cancer registry staff to assist them in applying the Toronto staging guidelines in a consistent manner. There is also a project-specific help desk for discussion of difficult cases and promotion of the CanStaging online tools, developed through the International Association of Cancer Registries, to further ensure standardisation of data collection. Country-specific stage distribution and observed survival by stage at diagnosis will be calculated for each tumour type to compare survival between countries or large geographical regions. DISCUSSION: This study will be promote and enhance the collection of standardized staging data for childhood cancer by European and non-European population-based cancer registries. Therefore, this project can be seen as a feasibility project of widespread use of Toronto Staging at a population-level by cancer registries, specifying the data sources used and testing how well standardized the processes can be. Variation in tumour stage distribution could be due to real differences, to different diagnostic practices between countries and/or to variability in how cancer registries assign Toronto stage. This work also aims to strengthen working relationships between cancer registries, clinical services and cancer-specific clinical study groups, which is important for improving patient outcomes and stimulating research

Estimating country-specific incidence rates of rare cancers: comparative perfomance analysis of modeling approaches using European cancer registry data

Estimating incidence of rare cancers is challenging for exceptionally rare entities and in small populations. In a previous study, investigators in the Information Network on Rare Cancers (RARECARENet) provided Bayesian estimates of expected numbers of rare cancers and 95% credible intervals for 27 European countries, using data collected by population-based cancer registries. In that study, slightly different results were found by implementing a Poisson model in integrated nested Laplace approximation/WinBUGS platforms. In this study, we assessed the performance of a Poisson modeling approach for estimating rare cancer incidence rates, oscillating around an overall European average and using small-count data in different scenarios/computational platforms. First, we compared the performance of frequentist, empirical Bayes, and Bayesian approaches for providing 95% confidence/credible intervals for the expected rates in each country. Second, we carried out an empirical study using 190 rare cancers to assess different lower/upper bounds of a uniform prior distribution for the standard deviation of the random effects. For obtaining a reliable measure of variability for country-specific incidence rates, our results suggest the suitability of using 1 as the lower bound for that prior distribution and selecting the random-effects model through an averaged indicator derived from 2 Bayesian model selection criteria: the deviance information criterion and the Watanabe-Akaike information criterion

Quality of care indicators for head and neck cancers: The experience of the European Project RARECAREnet

Background: Monitoring and improving quality of cancer care has become pivotal today. This is especially relevant for head and neck cancers since the disease is complex, it needs multi therapy, patients tend to be older, they tend to have comorbidities and limited social support. However, information on quality of care for head and neck cancers is scarce. In the context of the project "Information Network on Rare Cancers" we aimed to identify indicators of quality of care specific for the head and neck cancers management and to measure the quality of care for head and neck cancers in different EU Member States. Methods: We defined indicators of quality of care for head and neck cancers based on a multidisciplinary and expert-based consensus process at a European level. To test the proposed indicators, we performed an observational population-based retrospective study in four countries (Ireland, Italy, Netherlands, and Slovenia) in the years 2009-2011. Results: The main quality indicators identified are: availability of formalized multidisciplinary team, participation in clinical and translational research; timeliness of care, high quality of surgery and radiotherapy, and of pathological reporting. For head and neck cancers, the quality of care did not reach the optimal standards in most of the countries analyzed. A high proportion of patients was diagnosed at an advanced disease stage, showed delays in starting treatment (especially for radiotherapy), and there was only a very limited use of multi therapy. Conclusions: According to the achieved consensus, indicators of quality of care for head and neck cancers have to cover the patient journey (i.e., diagnosis and treatment). Our results, showed suboptimal quality of care across countries and call for solutions for ensuring good quality of care for head and neck cancer patients in all EU countries. One possible option might be to refer head and neck cancer patients to specialized centers or to networks including specialized centers

Worldwide comparison of survival from childhood leukaemia for 1995-2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries.

Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia. Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0-14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995-99, 2000-04, and 2005-09), sex, and age at diagnosis (&lt;1, 1-4, 5-9, and 10-14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). We analysed data from 89 828 children from 198 registries in 53 countries. During 1995-99, 5-year age-standardised net survival for all lymphoid leukaemias combined ranged from 10·6% (95% CI 3·1-18·2) in the Chinese registries to 86·8% (81·6-92·0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005-09, when age-standardised survival for lymphoid leukaemias ranged from 52·4% (95% CI 42·8-61·9) in Cali, Colombia, to 91·6% (89·5-93·6) in the German registries, and for AML ranged from 33·3% (18·9-47·7) in Bulgaria to 78·2% (72·0-84·3) in German registries. Survival from precursor-cell ALL was very close to that of all lymphoid leukaemias combined, with similar variation. In most countries, survival from AML improved more than survival from ALL between 2000-04 and 2005-09. Survival for each type of leukaemia varied markedly with age: survival was highest for children aged 1-4 and 5-9 years, and lowest for infants (younger than 1 year). There was no systematic difference in survival between boys and girls. Global inequalities in survival from childhood leukaemia have narrowed with time but remain very wide for both ALL and AML. These results provide useful information for health policy makers on the effectiveness of health-care systems and for cancer policy makers to reduce inequalities in childhood cancer survival. Canadian Partnership Against Cancer, Cancer Focus Northern Ireland, Cancer Institute New South Wales, Cancer Research UK, US Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, and the University of Kentucky