Reliability of recording uterine cancer in death certification in France and age-specific proportions of deaths from cervix and corpus uteri

French uterine cancer recordings in death certificates include 60% of "uterine cancer, Not Otherwise Specified (NOS)"; this hampers the estimation of mortalities from cervix and corpus uteri cancers. The aims of this work were to study the reliability of uterine cancer recordings in death certificates using a case matching with cancer registries and estimate age-specific proportions of deaths from cervix and corpus uteri cancers among all uterine cancer deaths by a statistical approach that uses incidence and survival data. Deaths from uterine cancer between 1989 and 2001 were extracted from the French National database of causes of death and case-to-case matched to women diagnosed with uterine cancer between 1989 and 1997 in 8 cancer registries. Registry data were considered as "gold-standard". Among the 1825 matched deaths, cancer registries recorded 830 cervix and 995 corpus uteri cancers. In death certificates, 5% and 40% of "true" cervix cancers were respectively coded "corpus" and "uterus, NOS" and 5% and 59% of "true" corpus cancers respectively coded "cervix" and "uterus, NOS". Miscoding cervix cancers was more frequent at advanced ages at death and in deaths at home or in small urban areas. Miscoding corpus cancers was more frequent in deaths at home or in small urban areas. From the statistical method, the estimated proportion of deaths from cervix cancer among all uterine cancer deaths was higher than 95% in women aged 30-40 years old but declined to 35% in women older than 70 years. The study clarifies the reason for poor encoding of uterus cancer mortality and refines the estimation of mortalities from cervix and corpus uteri cancers allowing future studies on the efficacy of cervical cancer screening.     

Influence of the war in Croatia on the frequency of gynecological cancer in the University Hospital Osijek in the period from 1985 to 2002

The aim of this study is to estimate the influence of war in Croatia on the frequency of gynecological cancer (cancer of corpus and cervix uteri and ovary) in the Clinical Hospital Osijek, particularly the relation between the pre-war and post-war period. We analyzed 1455 patients with corpus uteri and cervix uteri cancer and ovarian cancer treated in the Clinical Hospital Osijek in the period 1985-2002 (group I). Patients from Osjecko-Baranjska County were analyzed separately--1273 women, (group II) and in the group III there were 182 patients from other counties. The analyzed period was divided into: pre-war 1985-1990, war 1991-1993 and post-war period 1997-2002. In all three groups the number of patients treated for gynecological cancer was significantly larger in the post-war period (group I, N = 611, group II, N = 498, group III, N = 113) than in the pre-war period (group I, N = 457, group II, N = 433, group III, N = 24). The analysis of cancer frequency in relation to the site shows that a total number of patients treated for cervical cancer was larger in the post-war (N = 229) than in the pre-war period (N = 214), but the difference wasn't significant. However, the number of patients from Osjecko-baranjska County treated for cervical cancer was larger in the pre-war (N = 207) than in the post-war period (N = 178) but still, the difference wasn't significant. The number of patients treated for corpus uteri cancer and ovarian cancer was significantly larger for the I group in the post-war (N = 225 and N = 157 respectively) than in the pre-war period (N = 136, and N = 107 respectively). In the group II the number of patients treated for corpus uteri cancer and ovarian cancer was larger in the post-war (N = 196 and N = 124 respectively) than in the pre-war period (N = 130 and N = 96 respectively) but the difference was significant only for corpus uteri cancer. Significantly more women were treated for gynecological cancer in the post-war than in the pre-war period. However, the war had probably an indirect influence on the increased number of patients treated for gynecological cancer mainly because many more women arrived from other counties.     

Increasing incidence and survival of corpus uteri cancer in Estonia over the past two decades

BackgroundCorpus uteri cancer has become the fourth most common female cancer in Europe. In Estonia, the prevalence of obesity is increasing, and corpus uteri cancer survival has been relatively low. The aim of the study was to evaluate incidence, mortality and survival trends of corpus uteri cancer in Estonia by age, stage and histological subtypes with an emphasis on surgical treatment.MethodsEstonian Cancer Registry data on incident cases of corpus uteri cancer were used to examine incidence trends (1995–2016) and calculate relative survival ratios (RSR) (1996–2016). Cases were classified by morphology and FIGO stage. Causes of Death Registry data were used to analyse corrected mortality (1995–2017).ResultsA total of 4281 cases were diagnosed in 1996–2016. A significant increase was seen in age-standardized incidence from 2009, while mortality remained stable throughout the study period. Significant increases were observed for type I cancers and age groups ≥65 years. Overall age-standardized 5-year RSR improved from 70% in 1996–2002 to 78% in 2010–2016. Survival increased for type I cancers, all age groups and all stages (significantly for stage IV). The proportion of surgically treated cases increased significantly from 85% to 89%, with the largest increases seen in older age groups and later stages.DiscussionThe rising corpus uteri cancer incidence in Estonia is driven by the type I cancer trend. Survival gain for later stages and older age groups likely reflected more frequent surgical treatment. To reduce mortality, further efforts are necessary to ensure appropriate care for all patients.     

Precancerous lesions of the cervix uteri in infertile women.

A study of 318 patients with tubal infertility and a control group of 200 unselected infertile women yielded 14 (4.4%) and 1 (0.5%), respectively, with precancerous lesions of the cervix uteri. The one patient in the control group with severe dysplasia was later shown to have tubal infertility. The overall incidence of premalignant lesions of the cervix uteri as reported to the National Cancer Registry of Norway was 0.1% for the age group and period studied. Women with tubal infertility represent a small but comparatively high risk group for the development of precancerous lesions of the cervix uteri.     

Median age at death as an indicator of premature mortality

The median age at death from certain diseases was calculated for each year for 1969-85 and compared with that at death from all causes. The results indicated the impact of these diseases in terms of premature mortality and changes over time. Cancer was a more important cause of premature mortality among women than among men. For cancer of the cervix the median age at death increased appreciably whereas for cancer of the lung in women it slightly decreased. The median age at death is easy to calculate, does not require standardisation, and has a useful role.     

Educational inequalities in cancer incidence and mortality in Lithuania: A record linkage study

BackgroundThe aim of this study is to describe associations between incidence and mortality by major cancer sites and education in Lithuania.MethodsThe study is based on the linkage between all records of the 2001 population census and all records from Lithuanian Cancer Registry (cancer incidence) and Statistics Lithuania (deaths) for the period between 1 July 2001 and 31 December 2004. Education-specific incidence and mortality rate ratios were estimated by means of multivariate Poisson regression models.ResultsWe found both the positive and inverse educational gradients in cancer incidence and mortality. The risk of developing cancer (all sites) was lower among men and women with the lowest education, whereas cancer mortality was higher among lower educated men. The higher educational level was also associated with an increased risk of prostate cancer among men and an increased risk of breast cancer among women. However, prostate cancer mortality was the highest in the lowest education group, whereas breast cancer mortality among women did not show any statistically significant differences. Lower educated men had significantly higher incidence and mortality due to lung and stomach cancers. Strikingly high incidence and mortality due to cervix cancer was observed among women with secondary and lower than secondary education.ConclusionThe results point to inequalities in early diagnosis and survival from cancer and failures ensuring equal access to medical care. Further more in-depth studies are needed in order to understand the nature and determinants of these inequalities.     

Effect of screening on the incidence of cervical cancer in Alberta.

The rates of registration of cases of in-situ and invasive cancer of the cervix in Alberta have fallen for women aged 35 and over since the introduction of screening in the early 1960s, as predicted by theory and described in Finland. However, for women aged 15 to 34 years of age the predicted pattern was followed only initially: the registration rate for in-situ and probably also invasive cancer increased after 1973. This could be due to an actual increase in the incidence of in-situ cancer of the cervix among younger women, as might be expected from the epidemiologic aspects of the disease, but it might also be due to increased recruitment of younger women to the screening program.     

Women cancers in India: Incidence,trends and their clinical extent from the National Cancer Registry Programme

BackgroundTo provide a comprehensive assessment of women cancer in India utilizing the systematically collected data on all cancers by the National Cancer Registry Programme (NCRP).MethodsThe study examined 10,2287 cancer cases among women cancers providing cancer burden for major anatomical sites. Aggregated data of 28 PBCRs and 58 HBCRs under NCRP for 2012–16 was analysed for incidence rates, trends, cumulative risk of developing cancer, stage at detection and treatments offered.ResultsStudy results have found region –wide variation of women cancers by indicating highest proportions in western followed by southern region of India. North-Eastern region had lowest proportion. It was observed that breast is highest ranking cancer in most registry areas of urban agglomerations of country while cancer cervix was leading site in registries of rural areas like Barshi (15.3) and Osmanabad &Beed (13.1). States of Mizoram (23.2) and Tripura (9.5) along with Pasighat, Cachar and Nagaland. Median age of occurrence for women for these anatomical sites ranged from 45 to 60 years of age. For cancer breast, cervix and ovary –most cases were detected with regional spread. These findings were different for cancer corpus uteri where registries have reported higher proportions (49.3 %) of localized stage at detection. Loco regional cancers had higher proportions of multimodality treatments.ConclusionStudy provides a foundation for assessing the status of women cancers in the country. Variations between geographies would guide appropriate support for action to strengthen efforts to improve cancer prevention and control in underserved areas of the country. This would facilitate advocacy for better investments and research on women cancers.     

Strains of human gastrointestinal and uterine tumors transplantable into athymic mice and rats

The authors describe strains of human cancer of the stomach, colon, cervix and corpus uteri as well as uterine chorionepitheliomas transplanted into nude mice and rats. The histological appearance of these strains is in full accordance with that of primary tumors. Electrophoresis of lactate dehydrogenase isozymes indicates that the strains mainly consist of human cells. The strains are transplanted in nude animals at various time intervals. The strains of human gastric cancer are transplanted from animal to animal in a month and those of corpus uteri in a week.     

Plasma cholesterol,coronary heart disease,and cancer in the Renfrew and Paisley survey.

The relation between plasma cholesterol concentration and mortality from coronary heart disease, incidence of and mortality from cancer, and all cause mortality was studied in a general population aged 45-64 living in the west of Scotland. Seven thousand men (yielding 653 deaths from coronary heart disease, 630 new cases of cancer, and 463 deaths from cancer) and 8262 women (322 deaths from coronary heart disease, 554 new cases of cancer, and 395 deaths from cancer) were examined initially in 1972-6 and followed up for an average of 12 years. All cause mortality was not related to plasma cholesterol concentration. This was largely a consequence of a positive relation between cholesterol values and mortality from coronary heart disease being balanced by inverse relations between cholesterol and cancer and between cholesterol and other causes of death. These changes were highly significant for coronary heart disease and cancer in men and significant for coronary heart disease and other causes of death in women. The inverse association between cholesterol concentration and cancer in men was strongest for lung cancer, was not merely a function of the age at which a subject died, was present for the incidence of cancer as well as mortality from cancer, and persisted when new cases or deaths occurring within the first four years of follow up were excluded from the analysis.     

Trends in cancer incidence in the Republic of Mauritius, 1991–2015

IntroductionMauritius, a small state, is among the few African countries where cancer registration is population based and nationwide. We reported trends in cancer incidence for twenty five years as well as the mortality to incidence ratio (MIR) as main quality indicator of the Mauritius National Cancer Registry (MNCR).Materials and methodsWe calculated age standardised incidence rates (ASRs) of cancers by sex and by 5 year age group for five successive year periods from 1991 to 2015. The average annual percentage change (AAPC) were determined by sex and cancer sites. MIRs were compared for the period 2001–2004 and 2012–2015.ResultsIn males, the most common cancer sites (in terms of ASRs per 100,000) were those of the colon-rectum (17.0), prostate (16.5), trachea-bronchus-lung (13.0), stomach (8.4) and lip-oral cavity-pharynx (7.7). The AAPC were +3.9%, +4.2%, +0.5%, -0.1% and -1.3% respectively. In females, the most frequent sites were breast (53.7), colon-rectum (13.2), cervix uteri (11.2), corpus uteri (7.7) and ovary (5.7). The AAPC were +3.4%, +4.4%, -2%, +5.2% and -0.1% respectively. The most significant decrease in MIRs among males were liver (1.9 to 1.0), stomach (1.3 to 0.8) and lung (1.7 to 1.2) cancers while among females, they were pancreas (3.4 to 1.3), liver (1.8 to 1.2) and stomach (1.5 to 0.8) cancers.ConclusionThe most common cancers were those associated with 'westernisation' of lifestyle. Our figures contrast with other Sub-Saharan Africa countries where infection related cancers are most predominant. The MNCR has also improved its data quality over time.     

Effect of hyperthermia on the frequency of sister-chromatid exchanges in patients with cancer of cervix uteri

The frequencies of sister-chromatid exchanges (SCE) were studied in patients with cancer of the cervix uteri and normal controls at 37 degrees C and 40 degrees C. At 37 degrees C the mean frequency of SCE was found to be 8.26 +/- 1.91 in untreated patients with cervical cancer and 7.91 +/- 1.68 in cancer patients treated with radiotherapy; these values were significantly higher than the control value of 5.34 +/- 1.28 exchanges. Increase of the growth temperature to 40 degrees C elevated the SCE frequency to 11.95 +/- 2.12 in patients without radiotherapy treatment, 13.37 +/- 2.17 in patients with radiotherapy treatment and 7.82 +/- 1.84 in normal controls. These data indicate that there is a differential induction of SCEs by hyperthermia in the lymphocytes of control women and patients with cancer of the cervix uteri.     

Cancer incidence and spectrum among Uygurs in Hotan District in China

Cancer is the leading cause of death in China and a significant public health problem with increasing incidence and fatality rates. The Han nationality is the main ethnic group in China, and many reports on the epidemiology of cancers in Han nationality are published. However no studies report the cancer spectrum of Uygurs which are one of the minority nationalities in China. Hence, we present incidence and mortality numbers of different cancers for the Uygur patients for the period 2018–2020 in Hotan District where Uygur population accounts for 99 %. During the 3-year study period, 2509 new Uygur cancer cases were registered, comprising 774 men and 1735 women. Cervical cancer was the most common, followed by esophageal, breast, gastric and colorectal cancers. The most common cancers in women and men were cervical cancer and esophageal cancer, respectively. In conclusion, the cancer spectrum in Hotan is different from other regions of China and our research revealed the cancer incidence in Hotan, which could help us to take appropriate measures to reduce the incidence rate.     

Potentialities of low-field magnetic resonance tomography in the diagnosis and treatment of invasive cancer of cervix uteri

The aim of the study was to evaluate the efficiency of low-field (0.14 T) magnetic resonance imaging (MRI) in the diagnosis and treatment of cancer of the cervix uteri. MATERIALS AND METHODS: Low-field MRI was performed in 39 patients with cancer of the cervix uteri to define the stage of the tumor and to follow up the outcomes of their treatment. Particular emphasis was laid on the determination of the size of the tumor and the presence of parametral invasion and on metastatic lesions of lymph nodes. MRI data were compared with clinical, morphological, and surgical staging results. In detecting the stage of cancer of the cervix uteri, the accuracy of MRI was 72% whereas that of clinical study was 51%. In determining parametral invasion, the accuracy of clinical study and low-field MRI was 71 and 90%, respectively. The sensitivity and specificity of MRI were 83 and 92%, respectively. The anterioposterior tumor size was an important prognostic factor in following up the outcomes of treatment as there was its close association and the incidence of tumor recurrences. The present study has indicated that the high efficiency of low-field MRI in detecting the stage of invasive cancer of cervix uteri makes it the method of choice in planning treatment and monitoring the outcomes of combined radiation therapy.     

Screening for cancer.

Screening has proved effective for only two cancer sites, the breast and the cervix uteri. Only for these, therefore, should screening be a part of routine clinical practice. The degree to which screening is effective depends on whether appropriate groups are screened. For cancer of the breast, current evidence justifies mammographic screening every two years only from the age of 50, continuing at least to the age of 70. The place of breast self-examination and physical examination of the breasts is under investigation, but these procedures should probably be used in all women after the age of 40. For cancer of the cervix, nearly maximal efficacy is obtained by screening sexually active women every three years from the age of 25 to 60. Older women who have not been screened regularly should be screened. Other screening techniques to detect cancers, such as the rectal examination, sigmoidoscopy, and fecal occult blood tests for colorectal cancer, are still experimental. Organizational and other difficulties will prevent screening programs from making a major contribution to reducing overall cancer mortality by the year 2000. If organizational problems can be overcome, however, screening may control invasive cancer of the cervix and make a major contribution in reducing breast cancer mortality in the future.     

Mormon mortality rates in Canada

Abstract

In the United States, Mormons have been shown to have lower incidence and mortality rates of cancer and other diseases than the general population, a fact which has been attributed to the life style prescribed by the Mormon Church, including abstinence from tobacco, alcohol, coffee, and tea. This study examines Mormon cause‐specific mortality rates in Alberta, Canada, compared to rates for the general population of Alberta and of all Canada. Mormon death rates for most causes were lower than those for Alberta, which are themselves lower than Canadian rates. Mormon death rates for males were higher than for females for most causes, but male and female death rates were more similar among Mormons than in the general population. Causes of death for which Mormons have an average or higher than average risk are either less frequent causes or are less clearly related to dietary habits. Mormons have disproportionately low death rates for many causes which are not clearly related to the use of tobacco, alcohol, coffee, or tea. Further research is needed on the specific effects of different life‐style components and on the possible biological selectivity of the group.     

Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis

Background

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It is unclear how county-level primary care physician (PCP) availability and socioeconomic deprivation affect the spatial and temporal variation of breast cancer incidence and mortality.

Methods

We used the 1988–2008 public-use county-based data from nine Surveillance, Epidemiology, and End Results (SEER) programs to analyze the temporal and spatial disparity of PCP availability and socioeconomic deprivation on early-stage incidence, advanced-stage incidence and breast cancer mortality. The spatio-temporal analysis was implemented by a novel structural additive modeling approach.

Results

Greater PCP availability was significantly associated with higher early-stage incidence, advanced-stage incidence and mortality during the entire study period while socioeconomic deprivation was significantly negatively associated with early-stage incidence, advanced-stage incidence, and mortality up to 1992. However, the observed influence of PCP availability and socioeconomic deprivation varied by county.

Conclusions

We showed important associations of PCP availability and socioeconomic deprivation with the three breast cancer indicators. However, the effect of these associations varied over time and across counties. The association of PCP availability and socioeconomic deprivation was stronger in selected counties.     

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.     

Risk of malignant neoplasms among Polish population in 1986

An analysis of the mortality for malignant tumors in Poland in 1986 is provided. The most frequent neoplasms noted in Poland were in 1986: in men cancer of the lungs (33.5% of all malignancies), cancer of the stomach (13.4%), prostate (4.8%), and pancreas (4.2%). In women the most frequent were: breast cancer (13.1%), cancer of the stomach (9.6%), lungs (7.8%), and cervix (6.7%). In 1986, significant difference in mortality rate was seen between men and women (prevalence of death in men) and between urban and rural areas (prevalence in urban areas). Moreover, persisting higher mortality rate for malignancies was noted in the western and central regions in comparison to eastern Poland. Mortality rate for malignancies in both men and women is higher in Poland than the average mortality rate in Europe.     

Cancer mortality in Itapúa—A rural province of Paraguay 2003–2012

BackgroundItapúa is a rural department in Paraguay with a population of about 500,000 and a high degree of agro-mechanization for the production of soybean and other crops. So far, only basic health care is provided. Here we analyzed the cancer mortality in this region as a first step towards epidemiological data for cancer prevention.MethodsWe calculated the age-adjusted mortality rates according to world standard (AMRWs) for the major cancer sites in both males and females between 2003 and 2012, and estimated the differences between the capital and more central districts of Itapúa vs. remote districts.ResultsThere were about 2000 cancer deaths in the decade studied, with AMRWs for all malignancies of 90.9/100,000 in males from central vs. 49.1/100,000 in remote districts and 69.0/100,000 vs. 45.0/100,000 in women. Cancer was mentioned in 12.4% of all death certificates and outweighed mortality from certain infectious and parasitic diseases (3.6%). Cause of death was ill-defined in 19.6% of all death certificates, especially in remote regions and among the elderly. The part of cancer located in the uterus (47.8%) or cell type of neoplasm of the lymphatic or hematopoietic system (73.1%) were often not specified. The uterus (mainly the cervix) (C53–C55) was the leading cancer site in women with AMRWs of 17.2/100,000 in central and 14.0/100,000 in remote districts, followed by the breast. Lung and prostate were the leading cancer sites among men. The lung cancer mortality rate was 19.3/100,000 in the central region but 9.5/100,000 in remote districts. Although children comprised 36% of the population, only 24 death certificates listed cancer as cause of death in this decade.ConclusionsAnalysis of cancer mortality in this rural region of Paraguay, which lacks resources for diagnostics and care, revealed an already large number of cases, with higher rates in the central region than in remote districts. Lung and uterus (primarily the cervix) are common cancer sites and indicate the potential for prevention. However, the quality of the vital statistics needs to be improved. The true cancer burden is most likely underestimated, especially in remote regions and children.