Predicting mortality from cervical cancer after negative smear test results.

OBJECTIVE--To assess the relative protection against death from cervical cancer after two or more negative smear test results and compare it with the protection against invasive cancer estimated by an International Agency for Research on Cancer (IARC) working group in an analysis of data from 10 large screening programmes. DESIGN--Comparison of risk of death from cervical cancer after two or more negative smear results with the risk in unscreened women by using a model constructed with data from the British Columbia screening programme. MAIN OUTCOME MEASURES--Mortality from and incidence of invasive cancer. RESULTS--In women with two negative smear results estimates of protection against cervical cancer were about 50% higher when lethal invasive cancer was used as the criterion rather than all invasive cancer. This difference was due to these women being more likely to attend for further tests at which invasive cancer could be detected: screen detected cancer has a better prognosis than clinically diagnosed cancer. Screening intervals could be longer than three years: screening women aged 35-64 every five years was predicted to result in a 90% reduction in mortality from cervical cancer. CONCLUSION--Because protection from mortality is higher than protection from disease and because of the high costs and negative side effects of frequent screening, screening intervals should be longer than three years.     

Organisation and results of the cervical cytology screening programme in British Columbia, 1955-85

A screening programme to detect preinvasive carcinoma of the cervix was started in British Columbia in 1949. Since 1970 the number of women who have been screened at least once has been maintained at about 85% of the population at risk. More than 500 000 cervical smears are being examined each year in the central laboratory. There has been an appreciable increase in the number of cases and rates of carcinoma in situ seen since 1970, particularly in women between 20 and 30 years of age. Since the programme started over 26 000 cases of squamous carcinoma in situ have been detected and treated. The incidence of clinically invasive squamous carcinoma of the cervix has fallen by 78% during the period under review, and mortality from squamous carcinoma of the cervix has fallen by 72%. A colposcopy programme, introduced throughout British Columbia over the past 12 years, has been important in reducing the problems of managing preinvasive lesions, particularly in younger women.It is concluded that the reduction in morbidity and mortality from invasive squamous cancer of the cervix in British Columbia over the past 30 years is directly attributable to the province wide screening programme and that a large potential increase in invasive cervical cancer rates among younger women is being prevented.     

Problems in determining the incidence of cervical cancer.

Since cancer registries have different recording practices, the incidence rates that they report must be compared with caution. Indexes of reliability of recording indicated that in 1971 the reported incidence of cervical cancer in Ontario was too high. In 1971 Ontario used a method of passive reporting of cancer cases: the Ontario Cancer Registry linked hospital reports, death certificates and reports from the Ontario Cancer Treatment and Research Foundation''s treatment centres to produce a single record for each case. Pathological confirmation was requested for cases thus recorded by the registry. In 26% of cases a diagnosis other than cervical cancer was indicated. With these cases omitted, the incidence rate became 15.1/100 000, as opposed to the 20.5/100 000 reported by the registry.     

Cancer incidence in Nigeria: A report from population-based cancer registries

Introduction: Cancer has become a major source of morbidity and mortality globally. Despite the threat that cancer poses to public health in sub-Saharan Africa (SSA), few countries in this region have data on cancer incidence. In this paper, we present estimates of cancer incidence in Nigeria based on data from 2 population-based cancer registries (PBCR) that are part of the Nigerian national cancer registry program. Materials and methods: We analyzed data from 2 population based cancer registries in Nigeria, the Ibadan Population Based Cancer Registry (IBCR) and the Abuja Population Based Cancer Registry (ABCR) covering a 2 year period 2009-2010. Data are reported by registry, gender and in age groups. We present data on the age specific incidence rates of all invasive cancers and report age standardized rates of the most common cancers stratified by gender in both registries. Results: The age standardized incidence rate for all invasive cancers from the IBCR was 66.4 per 100000 men and 130.6 per 100000 women. In ABCR it was 58.3 per 100000 for men and 138.6 per 100000 for women. A total of 3393 cancer cases were reported by the IBCR. Of these cases, 34% (1155) were seen among males and 66% (2238) in females. In Abuja over the same period, 1128 invasive cancers were reported. 33.6% (389) of these cases were in males and 66.4% (768) in females. Mean age of diagnosis of all cancers in men for Ibadan and Abuja were 51.1 and 49.9 years respectively. For women, mean age of diagnosis of all cancers in Ibadan and Abuja were 49.1 and 45.4 respectively. Breast and cervical cancer were the commonest cancers among women and prostate cancer the most common among men. Breast cancer age standardized incidence rate (ASR) at the IBCR was 52.0 per 100000 in IBCR and 64.6 per 100000 in ABCR. Cervical cancer ASR at the IBCR was 36.0 per 100000 and 30.3 per 100000 at the ABCR. The observed differences in incidence rates of breast, cervical and prostate cancer between Ibadan and Abuja, were not statistically significant. Conclusion: Cancer incidence data from two population based cancer registries in Nigeria suggests substantial increase in incidence of breast cancer in recent times. This paper highlights the need for high quality regional cancer registries in Nigeria and other SSA countries.     

Screening for cervical intraepithelial neoplasia in north east Scotland shows fall in incidence and mortality from invasive cancer with concomitant rise in preinvasive disease.

OBJECTIVE--To assess the effect of screening for cervical intraepithelial neoplasia on the incidence of and mortality from invasive squamous cell carcinoma of cervix in north east Scotland and to discover why cases of invasive cancer still occur. DESIGN--(a) Analysis of data on cases of cervical intraepithelial neoplasia obtained from the cytology data bank; (b) analysis of data on 612 women presenting with invasive squamous cancer during 1968-91, obtained from cancer registry and hospital records; (c) analysis of death rates obtained from the registrar general''s (Scotland) annual reports, the Information Services Division of the Home and Health Department (Scotland), and local records for 1974-91; (d) case-control studies on 282 cases of invasive cancer and 108 deaths which occurred in 1982-91. Cases were matched with two controls both for age and for having a negative smear test result at the time of presentation of the case. SETTING--North east Scotland (Grampian region, Orkney, and Shetland). SUBJECTS--Women (n = 306,608) who had had cervical smear tests between 1960 and 1991. RESULTS--There had been a substantial increase in cases of cervical intraepithelial neoplasia grade III since 1982. The incidence of invasive cancer has fallen since the start of screening in 1960, the fall occurring mainly in the well screened age group 40-69 years. There was a rise in women aged under 40 and over 70. Women with invasive disease seen between 1982 and 1991 mostly presented at stage I. Of these, half were unscreened, one third were poorly screened, 11% were found in retrospect to have had abnormal cells, 3% had recurrence of disease after treatment for cervical intraepithelial neoplasia grade III, and 3% were lost to follow up. Death rates had fallen, most noticeably in women aged 45-64, who had had the opportunity to be screened and rescreened. There was a disturbing rise in deaths among women under 45. Most deaths (65%) occurred in unscreened women. Case-control studies showed that the longer the time and absence of a smear test before presentation the higher was the risk of invasive cancer and of death. CONCLUSIONS--Screening has been effective in reducing the incidence of and mortality from cervical cancer in north east Scotland. Most cases and deaths occurred in unscreened women or in those who had had few smears at long intervals. An increase in cases of cervical intraepithelial neoplasia grade III in women screened for the first time occurred during 1982-91.     

Patterns of initial management of node-negative breast cancer in two Canadian provinces

OBJECTIVE: To describe the patterns of initial management of node-negative breast cancer in Ontario and British Columbia and to compare the characteristics of the patients and tumours and of the physicians and hospitals involved in management. DESIGN: Retrospective, population-based, cohort study. PARTICIPANTS: All 942 newly diagnosed cases of node-negative breast cancer in 1991 in British Columbia and a random sample of 938 newly diagnosed cases in Ontario in the same year. OUTCOME MEASURES: Number and proportion of patients with newly diagnosed node-negative breast cancer who received breast-conserving surgery (BCS) or mastectomy and who received radiation therapy after BCS. RESULTS: BCS was used in 413 cases (43.8%) in British Columbia and in 634 cases (67.6%) in Ontario (p < 0.001). After BCS, radiation therapy was received by 378 patients (91.5% of those who had undergone BCS) in British Columbia and 479 patients (75.6% of those who had undergone BCS) in Ontario (p < 0.001). In both provinces, lower patient age, smaller tumour size, a noncentral unifocal tumour, absence of extensive ductal carcinoma in situ and initial surgery by a surgeon with an academic affiliation were associated with greater use of BCS. Lower patient age and larger tumour size were associated with greater use of radiation therapy after BCS in both provinces. CONCLUSION: Patient, tumour and physician factors are associated with the choice of initial management of breast cancer in these two Canadian provinces. However, the differences in management between the two provinces are only partly explained by these factors. Other possible explanations, such as the presence of provincial guidelines, differences in the organization of the health care system or differences in patient preference, require further research.     

Preventive practice among primary care physicians in British Columbia: relation to recommendations of the Canadian Task Force on the Periodic Health Examination.

OBJECTIVES: To compare the current practice of preventive medicine in British Columbia with the recommendations of the Canadian Task Force on the Periodic Health Examination. Four common, preventable forms of cancer (cervical, breast, lung and colorectal) were used as sentinel conditions. DESIGN: Random sample mailed survey. SETTING: Private primary care practices in British Columbia. PARTICIPANTS: A sample of 300 primary care physicians in 1991; of 285 eligible physicians 185 (65%) responded. OUTCOME MEASURE: Compliance with preventive practices recommended by the task force. RESULTS: Preventive practice complied with the task force''s recommendations for breast examinations, mammography, cervical smears and initial counselling against smoking; over 90% of the physicians performed these manoeuvres in all or most cases. However, less than half performed two recommended manoeuvres for all or most patients who smoke: advice to follow a diet high in beta-carotene (reported by 10%) and scheduling of follow-up visits to reinforce antismoking counselling (by 46%). Most of the physicians stated that they perform preventive manoeuvres in the context of an annual general physical examination rather than integrating them into routine patient care. CONCLUSIONS: The task force''s carefully constructed recommendations are incompletely followed. Overall, there appears to be a high level of compliance with traditional and recommended manoeuvres but also widespread persistence in performing traditional manoeuvres no longer recommended and failure to adopt new recommendations.     

Accuracy and completeness of the New Zealand Cancer Registry for staging of invasive breast cancer

PurposePopulation based cancer registries are an invaluable resource for monitoring incidence and mortality for many types of cancer. Research and healthcare decisions based on cancer registry data rely on the case completeness and accuracy of recorded data. This study was aimed at assessing completeness and accuracy of breast cancer staging data in the New Zealand Cancer Registry (NZCR) against a regional breast cancer register.MethodologyData from 2562 women diagnosed with invasive primary breast cancer between 1999 and 2011 included in the Waikato Breast Cancer Register (WBCR) were used to audit data held on the same individuals by the NZCR. WBCR data were treated as the benchmark.ResultsOf 2562 cancers, 315(12.3%) were unstaged in the NZCR. For cancers with a known stage in the NZCR, staging accuracy was 94.4%. Lower staging accuracies of 74% and 84% were noted for metastatic and locally invasive (involving skin or chest wall) cancers, respectively, compared with localized (97%) and lymph node positive (94%) cancers. Older age (>80 years), not undergoing therapeutic surgery and higher comorbidity score were significantly (p < 0.01) associated with unstaged cancer. The high proportion of unstaged cancer in the NZCR was noted to have led to an underestimation of the true incidence of metastatic breast cancer by 21%. Underestimation of metastatic cancer was greater for Māori (29.5%) than for NZ European (20.6%) women. Overall 5-year survival rate for unstaged cancer (NZCR) was 55.9%, which was worse than the 5-year survival rate for regional (77.3%), but better than metastatic (12.9%) disease.ConclusionsUnstaged cancer and accuracy of cancer staging in the NZCR are major sources of bias for the NZCR based research. Improving completeness and accuracy of staging data and increasing the rate of TNM cancer stage recording are identified as priorities for strengthening the usefulness of the NZCR.     

Cervical cancer incidence and mortality in New Mexico's Hispanics,American Indians,and non-Hispanic whites.

High rates of cervical cancer were reported in New Mexico in the early 1970s, with especially high rates for minority women. We examined data collected from 1970 to 1987 for invasive cervical cancer and cervical carcinoma in situ for New Mexico''s Hispanic, American Indian, and non-Hispanic white women to determine whether changes had occurred in cervical cancer rates since earlier reports. To further characterize the epidemiology of cervical cancer in New Mexico, we reviewed state vital statistics for cervical cancer deaths occurring between 1958 and 1987. From 1970 to 1987, the incidence for invasive cervical cancer among Hispanic (18.9 per 100,000 person-years) and American Indian women (22.0 per 100,000 person-years) was about double that for non-Hispanic white women (10.3 per 100,000). The incidence in each ethnic group decreased over time for both invasive cancer and carcinoma in situ when the data were examined by 2 time periods (1970 to 1978 and 1979 to 1987). These decreases were most dramatic for invasive cervical cancer. Cervical cancer-related death rates for Hispanics and non-Hispanic whites also decreased from 1958 to 1987. Although our data reflect declines in cervical cancer rates during the study period, further rate decreases, especially for minority women, remain an important public health goal in New Mexico.     

Adjusting for reporting delay in cancer incidence when combining different sets of cancer registries

Cancer registries collect cancer incidence data that can be used to calculate incidence rates in a population and track changes over time. For incidence rates to be accurate, it is critical that diagnosed cases be reported in a timely manner. Registries typically allow a fixed amount of time (e.g. two years) for diagnosed cases to be reported before releasing the initial case counts for a particular diagnosis year. Inevitably, however, additional cases are reported after the initial counts are released; these extra cases are included in subsequent releases that become more complete over time, while incidence rates based on earlier releases will underestimate the true rates. Statistical methods have been developed to estimate the distribution of reporting delay (the amount of time until a diagnosed case is reported) and to correct incidence rates for underestimation due to reporting delay. Since the observed reporting delays must be less than the length of time the registry has been collecting data, most methods estimate a truncated delay distribution. These methods can be applied to a group of registries that began collecting data in the same diagnosis year. In this paper, we extend the methods to two groups of registries that began collecting data in two different diagnosis years (so that the delay distributions are truncated at different times). We apply the proposed method to data from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program, a consortium of U.S. cancer registries that includes nine registries with data collection beginning in 1981 and four registries with data collection beginning in 1992. We use the method to obtain delay‐adjusted incidence rates for melanoma, liver cancer, and Hodgkin lymphoma.     

The burden of cervical cancer in Vietnam: Synthesis of the evidence

There is currently no national cervical screening or HPV immunization program in Vietnam. This study aims to synthesize available data on the burden of disease and to project the burden of cervical cancer to 2049 if no major interventions are implemented. We reviewed published data sources on risk factors for HPV prevalence, high-grade lesions, cervical cancer incidence and mortality in Vietnam from 1990 to 2017. We then used the available data to project the number of new cervical cancer cases for the period 2013–2049. Data on cervical cancer incidence and mortality in Vietnam are limited; two Vietnamese cancer registries have been reported on by the International Agency for Research on Cancer, which cover urban populations representing ∼20% of the national population. The reported age-standardized cervical cancer incidence in Hanoi was 6.7 (1993–1997), compared to 28.8 and 14.1 per 100,000 women in Ho Chi Minh City (1995–1998 and 2009–2012, respectively). Cancer mortality data are not uniformly available from cancer registries or mortality surveys in Vietnam because cause of death has not been routinely ascertained. Based on available urban population registry data, estimated rates in the rural population, and forward projection of existing trends, we estimate that without any further intervention, the number of new cases will increase from 6930 (range 5671–8493) in 2012 to 8562 (range 5775–12,762) in 2049, giving a total of 379,617 (range 276,879–542,941) new cases over the period 2013–2049. These findings help underpin the case for the delivery of HPV vaccination and cervical screening in Vietnam, and support similar initiatives in other low- and middle-income countries.     

Cancer incidence in Cotonou (Benin), 2014–2016: First results from the cancer Registry of Cotonou

Incidence data from the population cancer registry of Cotonou (Benin) for the three year period 2014–2016 are presented.1086 cancer cases were recorded, 608 cases (56.0%) in women (corresponding to an age standardized incidence rate (ASR) of 78.4 per 100,000) and 478 cases (44.0%) in men (ASR 91.8 per 100,000).Breast and cervical cancer accounted for 49.2% of all cancers in women. Breast cancer (ASR 22.6 per 100,000) was more common than cervical cancer (ASR 14.9 per 100,000) and the mean age of cases was lower. The incidence of prostate cancer (one quarter of all cancers in men), 30.5 per 100,000, was similar to that in other West African registries. Cancers of the liver and digestive tract were also relatively common in both sexes.These are the first data on cancer incidence in Benin, and will be invaluable for the development and evaluation of the National Cancer Control plan.     

Measuring the effect of including multiple cancers in survival analyses using data from the Canadian Cancer Registry

Background: In survival analyses using cancer registry data, second and subsequent primary cancers diagnosed in individuals are typically excluded. However, this approach may lead to biased comparisons of survival between cancer registries, or over time within a single registry. Purpose: To examine the impact of including multiple primary cancers in the derivation of survival estimates using data from a population-based national cancer registry. Methods: Five-year relative survival estimates for persons aged 15–99 years at diagnosis were derived using all eligible primary cases from the Canadian Cancer Registry (CCR)—a population-based registry containing information on cases diagnosed from 1992 onward—and then again using first primary cases only. Any pre-1992 cancer history of persons on the CCR was obtained by using auxiliary information. Results: The inclusion of multiple cancers resulted in lower estimates of 5-year relative survival for virtually all cancers studied. The effect was somewhat attenuated by age-standardization (e.g., from 1.3% to 1.0% for all cancers combined), and was greatest for bladder cancer (?2.4%) followed by oral cancer (?1.9%)—cancers that had the first and third lowest proportions of first cancers, respectively. For the majority of cancers the difference was less than 1.0%. Cancers for which there was virtually no difference (e.g., lung, pancreatic, ovarian and liver) tended to be those with a poor prognosis. Conclusion: Inclusion of second and subsequent primary cancers in the analysis tended to lower estimates of relative survival, the extent of which varied by cancer and age and depended in part on the proportion of first primary cancers.     

Cytological aspects of uterine cervical adenocarcinoma, adenosquamous carcinoma and combined adenocarcinoma-squamous carcinoma: appraisal of diagnostic criteria for in situ versus invasive lesions

Cytological aspects of uterine cervical adenocarcinoma, adenosquamous carcinoma and combined adenocarcinoma-squamous carcinoma: appraisal of diagnostic criteria for in situ versus invasive lesions
This paper reports the cytological findings based on air-dried smears in a retrospective series of 143 cases of endocervical adenocarcinoma, combined adenocarcinoma-squamous carcinoma and adenosquamous carcinoma drawn from the files of the BC Cancer Registry. Cervical cytology smears were available before biopsy in 131 patients, but in 18 cases the cytology showed no abnormality. Malignant changes or high-grade atypia of glandular and/or squamous cells (defined as moderate or severe dyskaryosis) were detected in 103 cases. In 46 cases, only a high-grade squamous abnormality was detected. Low-grade glandular and/or squamous lesions were detected in nine cases and one showed atypical endometrial-type glands. The cervical smears of 64 cases were reviewed in detail to determine the important cytomorphological criteria of in situ and invasive adenocarcinoma in air-dried smears, the technique used for preparing PAP smears in British Columbia. Endocervical cells were absent in four cases. Numerous (>10) groups of glandular cells were present in 51 cases. Important clues to the diagnosis of adenocarcinoma included crowding of nuclei, stratification of nuclei, loss of polarity, syncytial balls and papillary groups of glandular cells, nuclear enlargement, nuclear pleomorphism, and the presence of free-lying atypical glandular cells. Nuclear hyperchromatism, chromatin pattern, nuclear borders, nuclear membranes, and numbers and morphology of nucleoli were not helpful criteria in our material. Criteria enabling reliable distinction between in situ and invasive adenocarcinoma and/or mixed adenocarcinoma-squamous carcinoma could not be established.     

Characteristics of cases with unknown stage prostate cancer in a population-based cancer registry

BackgroundThe New South Wales Central Cancer Registry (NSW CCR) is the only population-based cancer registry in Australia that has routinely collected summary stage at diagnosis since its inception in 1972. However, a large proportion of prostate cancer cases have “unknown” stage recorded by the registry. We investigated the characteristics of prostate cancer cases with “unknown” stage recorded by the NSW CCR, and examined survival for this group.MethodsData were obtained from the NSW CCR for all first primary prostate cancer cases diagnosed in 1999–2007. Summary stage was recorded as localised, regional, distant or “unknown”. Associations between disease stage and patient characteristics (age, place of residence at diagnosis, year of diagnosis and country of birth) and prostate cancer specific survival were investigated using multivariable logistic regression and Cox proportional hazards models respectively.ResultsOf 39 852 prostate cancer cases, 41.8% had “unknown” stage recorded by the NSW CCR. This proportion decreased significantly over time, increased with increasing age at diagnosis and was higher for those living in socio-economically disadvantaged areas. The proportion with “unknown” stage varied across area health services. Prostate cancer specific survival for cases with “unknown” stage was significantly poorer than for those with localised stage but better than for those with regional or distant stage.ConclusionsResearchers or others using cancer registry stage data to examine prostate cancer outcomes need to consider the differences between cases with “unknown” stage at diagnosis and those with known stage recorded by the registry, and what impact this may have on their results.     

Prevalence and characteristics of cancer patients receiving care from single vs. multiple institutions

IntroductionPatients may receive cancer care from multiple institutions. However, at the population level, such patterns of cancer care are poorly described, complicating clinical research. To determine the population-based prevalence and characteristics of patients seen by multiple institutions, we used operations data from a state-mandated cancer registry.Methods and materials59,672 invasive cancers diagnosed in 1/1/2010-12/31/2011 in the Greater Bay Area of northern California were categorized as having been reported to the cancer registry within 365 days of diagnosis by: 1) ≥1 institution within an integrated health system (IHS); 2) IHS institution(s) and ≥1 non-IHS institution (e.g., private hospital); 3) 1 non-IHS institution; or 4) ≥2 non-IHS institutions. Multivariable logistic regression was used to characterize patients reported by multiple vs. single institutions.ResultsOverall in this region, 17% of cancers were reported by multiple institutions. Of the 33% reported by an IHS, 8% were also reported by a non-IHS. Of non-IHS patients, 21% were reported by multiple institutions, with 28% for breast and 27% for pancreatic cancer, but 19%% for lung and 18% for prostate cancer. Generally, patients more likely to be seen by multiple institutions were younger or had more severe disease at diagnosis.ConclusionsPopulation-based data show that one in six newly diagnosed cancer patients received care from multiple institutions, and differed from patients seen only at a single institution. Cancer care data from single institutions may be incomplete and possibly biased.     

Cancer in adolescents and young adults: National incidence and characteristics in Japan

ObjectiveAdolescents and young adults (AYA) with cancer are confronted with unique challenges in areas of paramount concern within their age group, such as fertility, education, career, and delayed and long-term effects of treatment. However, the extent and depth of the problem has never been examined in the Japanese population. The aim of this study was to describe the status of cancer patients in the AYA population, using data from the hospital-based cancer registry (HBCR).Study designPatients included in the HBCR from January 2011 to December 2014 were included in this study to evaluate the incidence and cancer distribution trends among AYA. The total number and the proportion of AYA (15–39 years of age) stratified by sex, age, and cancer type were obtained. The incidence of age-specific cancer among AYA was also calculated.ResultsWe identified 30,394 male (35.1%) and 56,100 female (64.9%) cancer patients in the population, which collectively constituted about 3% of all invasive cancer cases. The incidence of cancer in AYA was estimated as 86.2 per 100,000 per year, and increased with age. The most affected population was women between 35 and 39 years of age (35%). Breast cancer was the most common type of cancer, followed by cervical, uterine, and thyroid cancers.ConclusionA substantial number of AYA are diagnosed with cancer every year. The distribution of cancer types in AYA was dependent on age and sex. These diversities in cancer types can inform researchers and policy makers to fine-tune their studies and policies.     

Rabies in insectivorous bats of western Canada, 1979 to 1983

A total of 1,745, 362, and 536 bats collected in Alberta, British Columbia, and Saskatchewan, respectively, was tested for rabies virus between 1979 and 1983. Only one (0.1%) of 769 bats collected at random from buildings was infected with rabies virus in contrast to 95 (5%) of 1,874 symptomatic, rabies-suspect bats submitted for testing. The pattern of infection in the rabies-suspect bats was similar in Alberta and Saskatchewan, but differed in British Columbia. Rabies was diagnosed in four species of bats in each of Alberta and Saskatchewan, but in seven species in British Columbia. Annual prevalence in rabies-suspect bats was similar in colonial species within each province. Rabies was found rarely in suspect little brown bats (Myotis lucifugus) (less than 1%). In suspect big brown bats (Eptesicus fuscus), the prevalence was low in Saskatchewan (3%), moderate in Alberta (10%), and high in British Columbia (25%). Big brown bats accounted for over 55% of the rabid bats detected in each province. Annual prevalence reported in silver-haired bats (Lasionycteris noctivagans) and hoary bats (Lasiurus cinereus) was variable in all three provinces. Rabies is enzootic in northern insectivorous bats.     

Do the Japanese feel more suspicious about cancer registration than the British?

Background: Cancer registration is indispensable, providing useful statistical measures for the appropriate evaluation of cancer control programs and medical treatment or screening. Methods: Following the British national survey on attitudes toward cancer registration, we conducted an investigation to correctly evaluate the general opinion of the Japanese population in this regard. We randomly recruited 3000 men and women aged 20–69 years from a research database. Results: Only 4% of all respondents had heard about the cancer registry system before the investigation. However, 77% of respondents thought that cancer registration was useful. Forty-three percent of respondents answered, regardless of the strictness of the data protection, that privacy had been violated if the registration occurred without an individual explanation. Compared with the British survey results, Japanese people seemed to be more suspicious about the largely unknown system of cancer registry. Nonetheless, it is noteworthy that Japanese respondents did not show active opposition to cancer registration; they tended to choose “I don’t know” instead of “no” to questions asking if they supported the registry system. Multivariate analysis showed that male sex, older age, and living in the southern region were the factors significantly associated with support for cancer registration. Conclusions: We can seek society's understanding toward cancer registration by actively utilizing information from cancer registries, by using examples of how data are actually used that have wide appeal, and by educating the public on how the data are treated under the complete privacy policy.