Cancer Incidence among Adolescents and Young Adults in Urban Shanghai, 1973-2005

Background

Lack of cancer incidence information for adolescents and young adults led us to describe incidence trends within the young population of 15 to 49 year-olds in urban Shanghai between 1973 and 2005.

Methods

During 1973 to 2005, data on 43,009 (45.8%) male and 50,828 (54.2%) female cancer cases aged 15–49 years from the Shanghai Cancer Registry were analyzed. Five-year age-specific rates, world age-standardized rates, percent change (PC), and annual percent change (APC) were calculated using annual data on population size and its estimated age structure.

Results

During the 33-year study period, overall cancer incidence of adolescents and young adults among males marginally decreased by 0.5% per year (P<0.05). However, overall cancer incidence for females slightly increased by 0.8% per year (P<0.05). The leading cancer for males in rank were liver, stomach, lung, colorectal, and nasopharyngeal cancers and for females were breast, stomach, colorectal, thyroid, and ovarian cancers. Among specific sites, incidence rates significantly decreased for cancers of the esophagus, stomach, and liver in both sexes. In contrast, incidence rates significantly increased for kidney cancers, non-Hodgkin lymphoma, and brain and nervous system tumors in both sexes and increased for breast and ovarian cancers among females.

Conclusions

Overall cancer incidence rates of adolescents and young adults decreased in males whereas they increased in females. Our findings suggest the importance of further epidemiology and etiologic studies to further elucidate factors contributing to the cancer incidence trends of adolescents and young adults in China.     

Incidence,Trends and Ethnic Differences of Oropharyngeal,Anal and Cervical Cancers: Singapore, 1968-2012

In recent decades, several Western countries have reported an increase in oropharyngeal and anal cancers caused by human papillomavirus (HPV). Trends in HPV-associated cancers in Asia have not been as well described. We describe the epidemiology of potentially HPV-related cancers reported to the Singapore Cancer Registry from 1968–2012. Analysis included 998 oropharyngeal squamous cell carcinoma (OPSCC), 183 anal squamous cell carcinoma (ASCC) and 8,019 invasive cervical cancer (ICC) cases. Additionally, 368 anal non-squamous cell carcinoma (ANSCC) and 2,018 non-oropharyngeal head and neck carcinoma (non-OP HNC) cases were included as comparators. Age-standardized incidence rates (ASR) were determined by gender and ethnicity (Chinese, Malay and Indian). Joinpoint regression was used to evaluate annual percentage change (APC) in incidence. OPSCC incidence increased in both genders (men 1993–2012, APC = 1.9%, p<0.001; women 1968–2012, APC = 2.0%, p = 0.01) and was 5 times higher in men than women. In contrast, non-OP HNC incidence declined between 1968–2012 among men (APC = -1.6%, p<0.001) and women (APC = -0.4%, p = 0.06). ASCC and ANSCC were rare (ASR = 0.2 and 0.7 per 100,000 person-years, respectively) and did not change significantly over time except for increasing ANSCCs in men (APC = 2.8%, p<0.001). ICC was the most common HPV-associated cancer (ASR = 19.9 per 100,000 person-years) but declined significantly between 1968–2012 (APC = -2.4%). Incidence of each cancer varied across ethnicities. Similar to trends in Western countries, OPSCC incidence increased in recent years, while non-OP HNC decreased. ICC remains the most common HPV-related cancer in Singapore, but Pap screening programs have led to consistently decreasing incidence.     

Alnus Pollen Incidence in the Stockholm Area, 1973-1976

Alder (Alnus) pollen in Stockholm, central Sweden, was sampled by means of a Burkard Volumetric Spore Trap and analysed during four consecutive years, 1973 to 1976. The start of the season and the main pollen season occurred in March during the first three years and much later in 1976. The difference between any two years seems to be related to differences in temperature, pollen incidence being initiated by a steady increase. A mild decade followed by a marked temperature increase seems to favour the initiation of the main pollen season. More than 50% of the total pollen amount was found between 10 a.m. and 6 p.m. Differences in the amounts of pollen over the years could not be explained by contemporary climatic changes.     

Urban and Suburban Differences in Hypertension Trends and Self-Care: Three Population-Based Cross-Sectional Studies from 2005-2011

ObjectivesThis study aimed to compare hypertension trends in the urban and suburban population, and to examine the use of several self-care behaviors among patients who were aware of their hypertension.MethodsWe examined the data from three cross-sectional adult populations obtained in 2005, 2008, and 2011, in Beijing.ResultsOur analyses indicated that from 2005 to 2011 the standardized rate of hypertension increased from 31.9% to 36.0% (P <0.001) among urban adults, and was relatively stable (40.8% -40.2%) among suburban adults (P = 0.02). About 10% of the patients reported having taken measures to control their weight for hypertension management. As compared to the other patients, the female patients in the urban areas reported the highest rate of regular BP measurement (52.6%). In addition, the patients who reported taking medication regularly increased among the males and females. Most of the women reported nonsmoking (≥95%) and alcohol abstinence (≥90%). The trend of nonsmoking decreased among the urban males. In contrast, the prevalence of nonsmoking increased among the suburban males, though the trend was not statistically significant (P = 0.055). Further, the patient-reported alcohol abstinence was found to exhibit a decreasing trend among the males.ConclusionsWe observed an increase in the hypertension prevalence from 2005 to 2011. The rates remained higher for suburban adults than for urban adults. Females generally had better self-care ability as compared to male patients. Further research is needed to promote self-care behaviors in hypertensive patients, especially for male patients.     

Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder

Background

European treatment guidelines of TaT1 urinary bladder urothelial carcinomas depend highly on stage and WHO1973-grade but grading reproducibility is wanting. The newer WHO2004 grading system is still debated and both systems are currently used.

Aims

To compare reproducibility and prognostic value (of stage progression) of the WHO1973 and WHO2004.

Methods

One hundred and ninety-three primary urothelial carcinomas were reviewed. Follow-up data were retrieved from the patient records. Kappa statistics and Harrell''s C-index were used.

Results

Median follow-up was 75 months (range 1–127). 17 patients (9%) progressed, 82% of these within and 18% after 60 months. The distribution of WHO73-grades 1, 2 and 3 was 23%, 51% and 26%, interobserver agreement for each individual grade was 66% (kappa = 0.68), while for grades 1&2 versus 3 89% (kappa = 0.68). Intraobserver reproducibility was 68–63% for WHO73 and 88–89% for WHO73 as 1&2 vs.3. Progression free survival rates at 5 years were 95% (grade 1), 98% (grade 2) and 82% (grade 3) and 96% and 82% for grades 1&2 versus 3 (Hazard Ratio, HR, 5.4, p = 0.003). Using WHO2004, 62% were low grade and 38% high grade, inter-observer agreement 87% (kappa = 0.70), intraobserver reproducibility 93%, and progression free 5-year survival rates 97% and 85% (HR 6.6, p = 0.004). Positive and negative predictive values for stage progression within 5 years for the WHO73 (1&2 vs. 3) were 18% and 96%, and 15% and 97% for the WHO04. Using Harrell''s C-index, none of the grading systems was prognostically superior.

Conclusion

None of the grading systems is prognostically stronger than the others. Most importantly, inter-observer reproducibility and sensitivities for stage progression of both systems are low and need improvement for optimal treatment.     

The Association of Pioglitazone and Urinary Tract Disease in Type 2 Diabetic Taiwanese: Bladder Cancer and Chronic Kidney Disease

Objective

Although studies have shown an association between pioglitazone and bladder cancer, the associated factors have not been identified. The aim of this study was to investigate the factors that may link pioglitazone to bladder cancer.

Materials and Methods

In total, 34,970 study subjects were identified from the National Health Insurance Research Database in 2003 with follow-up from 2005 to 2009. The demographic characteristics of patients who had used and had never used pioglitazone, including age, sex, diabetes duration, urinary tract disease, nephropathy, bladder cancer, and cumulative dose and duration of pioglitazone therapy, were analyzed using the χ2 test. Cox proportional hazard regression models were used to determine the independent effects of pioglitazone on bladder cancer and newly developed chronic kidney disease.

Results

Among 3,497 ever users and 31,473 never users of pioglitazone, the respective incident cases of bladder cancer were 12 (0.4%) and 72 (0.2%), and for newly developed chronic kidney disease 245 (8.1%) and 663 (2.3%), respectively. Ever use of pioglitazone [1.59(1.32–1.91)], cumulative dose of pioglitazone <10,500 mg [1.69 (1.37–2.01)] and >10,500 mg [1.34 (1.04–1.73)], and duration of therapy <12 months [1.68 (1.36–2.08)] and >12 months [1.39 (1.09–1.76)] were associated with the development of chronic kidney disease.

Conclusions

There was no association of pioglitazone use with bladder cancer development, however, there was an association with an increased risk of newly developed chronic kidney disease.     

Similarities in the Age-Specific Incidence of Colon and Testicular Cancers

Colon cancers are thought to be an inevitable result of aging, while testicular cancers are thought to develop in only a small fraction of men, beginning in utero. These models of carcinogenesis are, in part, based upon age-specific incidence data. The specific incidence for colon cancer appears to monotonically increase with age, while that of testicular cancer increases to a maximum value at about 35 years of age, then declines to nearly zero by the age of 80. We hypothesized that the age-specific incidence for these two cancers is similar; the apparent difference is caused by a longer development time for colon cancer and the lack of age-specific incidence data for people over 84 years of age. Here we show that a single distribution can describe the age-specific incidence of both colon carcinoma and testicular cancer. Furthermore, this distribution predicts that the specific incidence of colon cancer should reach a maximum at about age 90 and then decrease. Data on the incidence of colon carcinoma for women aged 85–99, acquired from SEER and the US Census, is consistent with this prediction. We conclude that the age specific data for testicular cancers and colon cancers is similar, suggesting that the underlying process leading to the development of these two forms of cancer may be similar.     

Urinary Prostaglandin E2 Metabolite and Pancreatic Cancer Risk: Case-Control Study in Urban Shanghai

Pancreatic cancer has been increasing in importance in Shanghai over the last four decades. The etiology of the disease is still unclear. Evidence suggests that the COX-2 pathway, an important component of inflammation, may be involved in the disease. We aimed to evaluate the association between urinary prostaglandin E₂ metabolite (PGE-M) level and risk of pancreatic cancer. From a recent population-based case-control study in Shanghai, 200 pancreatic ductal adenocarcinoma cases and 200 gender- and age- frequency matched controls were selected for the present analysis. Urinary PGE-M was measured with a liquid chromatography/mass spectrometric assay. Adjusted unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A positive association was observed between PGE-M leve and pancreatic cancer risk: OR = 1.63 (95% CI 1.01–2.63) for the third tertile compared to the first. Though the interactions were not statistically significant, the associations tended to be stronger among subjects with diabetes history (OR = 3.32; 95% CI 1.20–9.19) and higher meat intake (OR = 2.12; 95% CI 1.10–4.06). The result suggests that higher urinary PGE-M level may be associated with increased risk of pancreatic ductal adenocarcinoma.     

Infant Cancer in Taiwan: Incidence and Trends (1995-2009)

Background

Current information about cancer incidence patterns among infants in East Asia is rare. The objective of this study was to report the first population-based cancer surveillance of infants in Taiwan.

Methods

Cancer frequencies and incidence rates among subjects aged <1 year for the period 1995-2009 were obtained from the Taiwan Cancer Registry. Types of cancers were grouped according to the International Classification of Childhood Cancer. Rates and trends were analyzed by sex and disease groups and further compared with that of other countries.

Results

A total of 900 infants were diagnosed with cancers, giving an incidence rate of 250.7 per million person-years from 1995 to 2009. The male-to-female incidence rate ratio was 1.22. Overall, leukemias (56.3 per million) were the most common cancer, followed by germ cell neoplasms (43.2) and neuroblastomas (41.8). The incidence increased by 2.5% annually during the 15-year study period and was predominantly contributed by male infants (3.5%). Compared with other countries, the rate of hepatoblastoma in Taiwan was second to that from Beijing (China) and 2 to 5 times greater compared with the US, France, the North of England and Osaka (Japan). The rates of germ cell neoplasms were 2 to 4 times greater in Taiwan.

Conclusions

The current data suggests that cancer incidence rate among male infants was rising in Taiwan. The factors associated with higher rates of hepatoblastoma and germ cell neoplasms warrant further investigation on similar ethnic groups of different areas to elucidate the potential environmental impacts while controlling for race.     

Increasing Gap Between Thyroid Cancer Incidence and Mortality in Urban Shanghai,China: An Analysis Spanning 43 Years

ObjectiveTo examine the secular trends of thyroid cancer incidence and mortality and to estimate the proportion of thyroid cancer cases potentially attributable to overdiagnosis.MethodsData on thyroid cancer cases from 1973 to 2015 were obtained from the Shanghai Cancer Registry. The average annual percent change (AAPC) was evaluated using the joinpoint regression analysis. The age, period, and birth cohort effects were assessed using an age-period-cohort model. The overdiagnosis of thyroid cancer cases was estimated based on the difference between observed and expected incidences using the rates of Nordic countries as reference.ResultsFrom 1973 to 2015, the number of thyroid cancer cases was 23 117, and 75% of the patients were women. The age-standardized rates were seven- to eightfold higher from 2013 to 2015 than from 1973 to 1977. Compared with relatively stable mortality, thyroid cancer incidence was dramatically increased from 2002 to 2015 in both sexes, with significant trends (men: AAPC = 21.84%, 95% CI: 18.77%-24.98%, P < .001; women: AAPC = 18.55%, 95% CI: 16.49%-20.64%, P < .001). The proportion of overdiagnosis has gradually increased over time, rising from 68% between 2003 and 2007 to more than 90% between 2013 and 2015. This increasing trend appeared to be similar between men and women.ConclusionAn increasing gap between thyroid cancer incidence and mortality was observed in Shanghai, and overdiagnosis has contributed substantially to the rise of incidence, which calls for an urgent update on the practice of thyroid examination.     

Trends in Educational Attainment by Race/Ethnicity, Nativity, and Sex in the United States, 1989-2005

Despite the importance of education for shaping individuals' life chances, little research has examined trends and differences in educational attainment for detailed demographic subpopulations in the United States. We use labor market segmentation and cohort replacement theories, linear regression methods, and data from the National Health Interview Survey to understand educational attainment by race/ethnicity, nativity, birth cohort, and sex between 1989 and 2005 in the United States. There have been significant changes in educational attainment over time. In support of the cohort replacement theory, we find that across cohorts, females have enjoyed greater gains in education than men, and for some race/ethnic groups, recent cohorts of women average more years of education than comparable men. And in support of labor market segmentation theories, foreign-born Mexican Americans continue to possess relatively low levels of educational attainment. Our results can aid policymakers in identifying vulnerable populations, and form the base from which to better understand changing disparities in education.     

Suprapubic Bladder Aspiration in Diagnosis of Urinary Tract Infection

Suprapubic aspiration of the bladder has proved a safe and reliable method of collecting urine for culture. It avoids contamination of the specimen and dispenses with the need for colony counts, because the isolation of any organism indicates bladder bacteriuria. In addition, urine collected in this way can be kept at 4°C. or at room temperature for up to 10 days before it is cultured.     

Helicobacter pylori Induces Inflammation in Mouse Urinary Bladder and Pelvis

Helicobacter pylori was transurethrally inoculated into the mouse urinary tract. The organism established infection and induced inflammation in the urinary bladder and pelvis. During the infection, urinary pH was elevated, probably due to the production of NH3 by bacterial urease. H. pylori was recovered from the urinary bladder, kidney and urine of the infected mice. Histopathologically, severe neutrophil infiltration was observed in the mucosal layer of both organs. H. pylori was detected on the surface of the epithelial cells. These results indicate that low pH and bacterial flora were not essential factors in establishing the mucosal infection with H. pylori. This experimental system is useful to investigate the pathogenicity of H. pylori in mucosal organs.     

The Epidemiology of Influenza in California, 1968-1973

Influenza is one of the most common acute febrile respiratory diseases in adults. Epidemics caused by influenza viruses occur every few years. When such epidemics are in progress, the medical community, the general public and the news media seek information regarding the presence, spread and severity of influenza. The methods and findings of the Influenza Surveillance System in California for the years 1968 through 1973 should be of interest generally. This period spans the total California experience with the type A Hong Kong variant (A/Hong Kong/1/68 [H₃N₂]), and the first appearance of the English strain of type A influenza virus (A/England/42/72 [H₃N₂]).The surveillance of influenza during this period showed that there were major epidemics in Calfornia only during the state''s first experience with the type A Hong Kong variant in 1968-69, and with the English strain in 1972-73. Problems and limitations in influenza surveillance do exist. Nonetheless, the major surveillance indices used (school absenteeism, laboratory data and deaths from pneumonia and influenza) are reliable and sensitive indicators of general trends of influenza virus activity. These indices are most useful in comparing the relative severity of influenza epidemics. However, since these indices usually lag several weeks behind the occurrence of disease, this lag must be considered in making estimates of current incidence trends based on these indices.