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B Rachet,
L M Woods,
E Mitry,
M Riga,
N Cooper,
M J Quinn,
J Steward,
H Brenner, J Estève,
R Sullivan,
M P Coleman
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ABSTRACT: Survival has risen steadily since the 1970s for most cancers in adults in England and Wales, but persistent inequalities exist between those living in affluent and deprived areas. These differences are not seen for children. For many of the common adult cancers, these inequalities in survival (the 'deprivation gap') became more marked in the 1990s. This volume presents extended analyses of survival for adults diagnosed during the 14 years 1986-1999 and followed up to 2001, including trends in overall survival in England and Wales and trends in the deprivation gap in survival. The analyses include individual tumour data for 2.2 million cancer patients. This article outlines the structure of the supplement - an article for each of the 20 most common cancers in adults, followed by an expert commentary from one of the leading UK clinicians specialising in malignancies of that organ or system. The available data, quality control and methods of analysis are described here, rather than repeated in each of the 20 articles. We open the discussion between clinicians and epidemiologists on how to interpret the observed trends and inequalities in cancer survival, and we highlight some of the most important contrasts in these very different points of view. Survival improved substantially for adult cancer patients in England and Wales up to the end of the 20th century. Although socioeconomic inequalities in survival are remarkably persistent, the overall patterns suggest that these inequalities are largely avoidable.
British Journal of Cancer 09/2008; 99 Suppl 1:S2-10. · 5.04 Impact Factor
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A Belot,
P Grosclaude,
N Bossard,
E Jougla,
E Benhamou,
P Delafosse,
A-V Guizard,
F Molinié,
A Danzon,
S Bara, [......],
I Janoray,
P Arveux,
A Buemi,
N Raverdy,
C Schvartz,
M Bovet,
L Chérié-Challine, J Estève,
L Remontet,
M Velten
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ABSTRACT: The objective of this study was to provide updated estimates of national trends in cancer incidence and mortality for France for 1980-2005.
Twenty-five cancer sites were analysed. Incidence data over the 1975-2003 period were collected from 17 registries working at the department level, covering 16% of the French population. Mortality data for 1975-2004 were provided by the Inserm. National incidence estimates were based on the use of mortality as a correlate of incidence, mortality being available at both department and national levels. Observed incidence and mortality data were modelled using an age-cohort approach, including an interaction term. Short-term predictions from that model gave estimates of new cancer cases and cancer deaths in 2005 for France.
The number of new cancer cases in 2005 was approximately 320,000. This corresponds to an 89% increase since 1980. Demographic changes were responsible for almost half of that increase. The remainder was largely explained by increases in prostate cancer incidence in men and breast cancer incidence in women. The relative increase in the world age-standardised incidence rate was 39%. The number of deaths from cancer increased from 130,000 to 146,000. This 13% increase was much lower than anticipated on the basis of demographic changes (37%). The relative decrease in the age-standardised mortality rate was 22%. This decrease was steeper over the 2000-2005 period in both men and women. Alcohol-related cancer incidence and mortality continued to decrease in men. The increasing trend of lung cancer incidence and mortality among women continued; this cancer was the second cause of cancer death among women. Breast cancer incidence increased regularly, whereas mortality has decreased slowly since the end of the 1990s.
This study confirmed the divergence of cancer incidence and mortality trends in France over the 1980-2005 period. This divergence can be explained by the combined effects of a decrease in the incidence of the most aggressive cancers and an increase in the incidence of less aggressive cancers, partly due to changes in medical practices leading to earlier diagnoses.
Revue d Épidémiologie et de Santé Publique 07/2008; 56(3):159-75. · 0.78 Impact Factor
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N. Bossard,
M. Velten,
L. Remontet,
A. Belot,
S. Bara,
A. -M. Bouvier,
A. -V. Guizard,
B. Tretarre,
G. Launoy,
M. Colonna, [......],
P. -M. Carli,
A. Jaffré,
C. Bessaguet,
E. Sauleau,
C. Schvartz,
P. Arveux,
M. Maynadié,
P. Grosclaude, J. Estève,
J. Faivre
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ABSTRACT: Nous rapportons ici les principaux résultats de la première étude de survie portant sur l’ensemble des données des registres
de cancers du réseau Francim. Les données de survie de 205 562 cas enregistrés entre 1989 et 1997 ont été analysées. La survie
relative à cinq ans standardisée pour l’âge était la suivante: 84 % pour le cancer du sein, 77 % pour le cancer de la prostate,
et chez l’homme, et la femme respectivement, 55 et 57 % pour le cancer du côlon, 12 et 16 % pour le cancer du poumon. Le pronostic
était souvent meilleur chez la femme. Pour certains cancers, les cas les plus récents avaient un meilleur pronostic (notamment
sein, prostate, thyroïde). Un âge avancé au diagnostic s’accompagnait d’une mortalité en excès plus importante que celle observée
chez les sujets jeunes. Cet effet s’observait cependant souvent au cours de la première année suivant le diagnostic et beaucoup
moins au-delà.
We present the main results of the first population-based survival study gathering all the French cancer registries (Francim
network). Survival data on 205,562 cancer cases registered between 1989 and 1997 were analyzed. For breast and prostate cancer,
the age-standardized five-year relative survivals (RS) were 84 and 77 % respectively. For colon cancer, RS was 55 % in men
and 57 % in women. The corresponding results for lung cancer were 12 and 16 %. For most cancer sites, survival was better
in women. For breast, prostate, and thyroid cancers, the more recently diagnosed tumours were of better prognosis. For most
cancer sites, the excess mortality rate increased with age at diagnosis, but this effect was often limited to the first year
after diagnosis.
Oncologie 07/2007; 9(7):574-580. · 0.17 Impact Factor
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ABSTRACT: Relative survival provides a measure of the proportion of patients dying from the disease under study without requiring the knowledge of the cause of death. We propose an overall strategy based on regression models to estimate the relative survival and model the effects of potential prognostic factors. The baseline hazard was modelled until 10 years follow-up using parametric continuous functions. Six models including cubic regression splines were considered and the Akaike Information Criterion was used to select the final model. This approach yielded smooth and reliable estimates of mortality hazard and allowed us to deal with sparse data taking into account all the available information. Splines were also used to model simultaneously non-linear effects of continuous covariates and time-dependent hazard ratios. This led to a graphical representation of the hazard ratio that can be useful for clinical interpretation. Estimates of these models were obtained by likelihood maximization. We showed that these estimates could be also obtained using standard algorithms for Poisson regression.
Statistics in Medicine 06/2007; 26(10):2214-28. · 1.88 Impact Factor
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N Bossard,
M Velten,
L Remontet,
A Belot,
N Maarouf,
A M Bouvier,
A V Guizard,
B Tretarre,
G Launoy,
M Colonna, [......],
P M Carli,
A Jaffré,
C Bessaguet,
E Sauleau,
C Schvartz,
P Arveux,
M Maynadié,
P Grosclaude, J Estève,
J Faivre
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ABSTRACT: We present the main results of the first population-based cancers survival study gathering all French registry data. Survival data on 205,562 cancer cases diagnosed between 01/01/1989 and 31/12/1997 were analysed. Relative survival was estimated using an excess rate model. The evolution of the excess mortality rate over the follow-up period was graphed. The analysis emphasised the effect of age at diagnosis and its variation with time after diagnosis. For breast and prostate cancers, the age-standardised five-year relative survivals were 84% and 77%, respectively. The corresponding results in men and women were 56% versus 58% for colorectal cancer and 12% versus 16% for lung cancer. For some cancer sites, the excess mortality rate decreased to low values by five years after diagnosis. For most cancer sites, age at diagnosis was a negative prognostic factor but this effect was often limited to the first year after diagnosis.
European Journal of Cancer 02/2007; 43(1):149-60. · 5.54 Impact Factor
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ABSTRACT: We examined national trends and socioeconomic inequalities in cancer survival in England and Wales during the 1990s, using population-based data on 2.2 million patients who were diagnosed with one of the 20 most common cancers between 1986 and 1999 and followed up to 2001. Patients were assigned to one of five deprivation categories (from 'affluent' to 'deprived') using characteristics of their electoral ward of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting separately in each deprivation category for background mortality by age, sex and calendar period. We estimated trends in survival and in the difference in survival between deprivation categories ('deprivation gap') over the periods 1986-90, 1991-95 and 1996-99. We used period analysis to examine likely survival rates in the near future. Survival improved for most cancers in both sexes during the 1990s, and appears likely to continue improving for most cancers in the near future. The deprivation gap in survival between rich and poor was wider for patients diagnosed in the late 1990s than in the late 1980s. Increases in cancer survival in England and Wales during the 1990s are shown to be significantly associated with a widening deprivation gap in survival.
British Journal of Cancer 05/2004; 90(7):1367-73. · 5.04 Impact Factor
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N Bossard,
F Descotes,
A G Bremond,
Y Bobin,
P De Saint Hilaire,
F Golfier,
A Awada,
P M Mathevet,
L Berrerd,
Y Barbier, J Estève
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ABSTRACT: The prognostic value of cathepsin D has been recently recognized, but as many quantitative tumor markers, its clinical use remains unclear partly because of methodological issues in defining cut-off values. Guidelines have been proposed for analyzing quantitative prognostic factors, underlining the need for keeping data continuous, instead of categorizing them. Flexible approaches, parametric and non-parametric, have been proposed in order to improve the knowledge of the functional form relating a continuous factor to the risk. We studied the prognostic value of cathepsin D in a retrospective hospital cohort of 771 patients with breast cancer, and focused our overall survival analysis, based on the Cox regression, on two flexible approaches: smoothing splines and fractional polynomials. We also determined a cut-off value from the maximum likelihood estimate of a threshold model. These different approaches complemented each other for (1) identifying the functional form relating cathepsin D to the risk, and obtaining a cut-off value and (2) optimizing the adjustment for complex covariate like age at diagnosis in the final multivariate Cox model. We found a significant increase in the death rate, reaching 70% with a doubling of the level of cathepsin D, after the threshold of 37.5 pmol mg(-1). The proper prognostic impact of this marker could be confirmed and a methodology providing appropriate ways to use markers in clinical practice was proposed.
Breast Cancer Research and Treatment 12/2003; 82(1):47-59. · 4.43 Impact Factor
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ABSTRACT: It is thought that the risk of atypical hyperplasia (AH) increases with age, particularly among postmenopausal women. Three hypotheses were investigated to try to explain this phenomena: use of hormone replacement therapy (HRT), increased breast cancer screening and improvements in radiological quality. Data were collected from the Bouches du Rhône breast cancer screening programme database and from the pathological registry of all women operated on for breast diseases in the district. The AH incidence rate was studied using a Poisson regression analysis. The change in the profile of breast diseases was explored through studying changes in the proportion of AH among benign lesions and malignant diseases. The AH incidence rate significantly increased over time (13.6% per year). The proportion of AH among the benign diseases increased with time and was significantly higher for HRT users (Odds Ratio (OR)=2.05; 95% Confidence Interval (CI): 1.43-2.93). While AH decreased with age among HRT non-users, it increased among users as a proportion of both benign and malignant lesions. The AH incidence rate significantly increased among pre- and postmenopausal women. Our study suggests that this increase is partly explained by the incidental discovery of these lesions by mammography and partly by a real increase of the disease among HRT users.
European Journal of Cancer 09/2003; 39(12):1738-45. · 5.54 Impact Factor
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L Remontet, J Estève,
A-M Bouvier,
P Grosclaude,
G Launoy,
F Menegoz,
C Exbrayat,
B Tretare,
P-M Carli,
A-V Guizard, [......],
J Peng,
A Buemi,
M Velten,
E Jougla,
P Arveux,
L Le Bodic,
E Michel,
M Sauvage,
C Schvartz,
J Faivre
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ABSTRACT: Monitoring cancer incidence and mortality time trends is essential for cancer research and health-care planning. French cancer registries do not cover the entire population and do not provide a representative sample of the national population. Our study aimed at estimating national cancer incidence and mortality trends over the longest period available.
Incidence and mortality data were collected over the period 1978-1997. Twenty-seven cancer sites were selected and age, sex and site specific incidence and mortality rates were estimated for each year from 1978 up to 2000. Observed incidence and mortality data in the population covered by cancer registries were modelled using age-cohort methods. An estimation of the incidence/mortality ratio was obtained from these models and applied to the mortality rates predicted from an age-cohort model for the entire French population. The person-years of observation were calculated cohort-wise from census data provided by the national institute of statistics
Cancer incidence increased by 63% throughout the study period, from 170,000 new cases in 1980 to 278,000 in 2000. This evolution was due to demographic changes but also to an increase in the risk of cancer which was estimated to more than 35% during the same period. In men, this change is largely explain by the increase of prostate cancer incidence. Among women, the increase was dominated by the continuing increase in breast cancer incidence. Large increases were also seen for non-Hodgkin lymphoma, melanoma, and thyroid cancer in both genders and for lung cancer in women. Cancer mortality increased by 20% from 125,000 deaths in 1980 to 150,000 in 2000. This increase is less than that predicted from changes in demographic factors and corresponds in fact to a decrease in the risk of death estimated to about 8%, slightly greater for women than for men. This decrease is associated with a decreasing incidence for stomach cancers for both sexes, alcohol-related cancer for men and cervical cancer for women. Colo-rectal cancer decreasing mortality contributes to this improvement despite an incidence increase.
Between 1980 and 2000, the study showed a large change in the cancer burden both quantitatively and qualitatively. Decrease in exposure, earlier diagnosis and therapeutic improvement explained part of this change, but overall the distribution of cancer cases shifted toward a distribution including less aggressive cancers. A striking divergence between incidence and mortality trends is observed for a great number of cancers. Prostate cancer shares with breast cancer the same pattern of a severe increasing incidence and a stable mortality. This points to important changes in medical practice and needs further analysis. The trend of lung cancer mortality among women should be emphasised since the situation will inevitably worsen in the coming years. It is already the third cause of cancer death among women.
Revue d Épidémiologie et de Santé Publique 03/2003; 51(1 Pt 1):3-30. · 0.78 Impact Factor
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Annals of Oncology 02/2003; 14 Suppl 5:v128-49. · 6.43 Impact Factor
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ABSTRACT: In epidemiology, standardized Incidence Ratio (SIR) can have large variance and it is then difficult to distinguish random fluctuations from real spatial variations when describing spatial variations in the rate of cancer. In this context, hierarchical model produce smoothed relative risks estimations helpful for solving this problem. The main advantage of these methods is to combine information of each geographical area with that obtained from prior assumption on the similarity between geographical sub-units. Nevertheless different assumptions produce different geographical maps of incidence of cancer, and the purpose of the present study was the development of a strategy to choose the most satisfactory description of the incidence of digestive cancer in a French department.
The strategy to choose the most satisfactory geographical map depends on the following criteria: variability between geographical sub-units, auto-correlation, and variability within geographical sub-unit. These criteria have been estimated from observed data for each site of cancer.
This strategy was applied to digestive tract cancers diagnosed between 1976 and 1997 in the department of Côte-d'Or, France. High-risk areas were often detected in the urban zone of the department, but without autocorrelation in most cases.
This strategy permitted to describe cancers in very small areas, avoiding to a large extent the danger of focusing on falsely positive high-risk areas.
Revue d Épidémiologie et de Santé Publique 11/2002; 50(5):413-25. · 0.78 Impact Factor
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ABSTRACT: OBJECTIVE: To compare the prognostic factor of breast cancer survival between breast cancer diagnosed in subjects receiving hormone replacement therapy (HRT) before diagnosis to those without such a therapy. Subjects and methods: All breast cancers diagnosed between 1993 and 2000 within the breast cancer screening programme in Bouches du Rhône (France) were analysed for size, node status, and grade according to use, or not, of HRT. Univariate and multivariate analyses were carried out taking into account age, density of the breast, and mode of detection. RESULTS: The breast tumours diagnosed among HRT users had a lower grade whatever the mode of detection. The proportion of node positive tumours was identical in the two groups after adjustment for age. The smaller size of the tumours among HRT users is partly explained by the lower grade of these tumours Conclusion: Although tumours occurring in HRT users have a lower chance of being detected by screening, their prognostic factors, especially the grade of the tumour, are better than in non-users. More work is needed to find which part of this advantage is attributable to better surveillance of women treated with HRT
Journal of Medical Screening 02/2002; 9(2):70-3. · 1.69 Impact Factor
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ABSTRACT: Ranking maternity hospitals on prophylactic caesarean section rates.
The study population was a sample of 8470 women having delivered in the 86 maternity hospitals of the Rhône-Alpes region (France) in 1990. A two-level logistic model and the Gibbs sampling method were used to estimate the adjusted rate and rank of each maternity hospital with their 95% credible interval.
Ranking of maternity hospitals was substantially modified after adjusting for differences in case-mix. The 95% credible intervals of the ranks were generally wide and overlapping. No maternity hospital could be confidently placed in the upper quarter nor in the lower quarter of the league table.
The use of ranks based on rates to compare hospitals may be seriously misleading; thus, league tables need an accompanying reading guide. Furthermore, some rules should be respected, including the need to make accurate case-mix adjustments, to reduce the rate instability in smaller hospitals, and to highlight the uncertainty associated with ranks.
European Journal of Obstetrics & Gynecology and Reproductive Biology 02/2001; 94(1):139-44. · 1.97 Impact Factor
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ABSTRACT: The sentinel lymph node (SLN) procedure has been proposed to women with breast cancer with clinically negative axillary lymph nodes, in order to avoid conventional axillary lymph node dissection and its associated side-effects. Methodological aspects of the validation of the SLN procedure are questioned here.
The results of relevant published studies are reviewed, with emphasis on pathological techniques. The ability of the SLN procedure to diagnose lymph node metastases, the extent to which axillary lymph node dissection contributes to treatment, apart from identification of the stage, and the effect of a modified staging procedure on treatment strategies are analyzed.
Both the sensitivity and the negative predictive value of the SLN procedure are overestimated if the probability of missing lymph node metastases is not taken into account, even when a complete axillary dissection is performed as a control. The SLN strategy and its effects on staging and treatment cannot be evaluated by comparison with conventional axillary lymph node dissection in a one-arm study but require carefully designed randomized trials.
Annals of Oncology 12/2000; 11(11):1381-5. · 6.43 Impact Factor
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ABSTRACT: To evaluate the effectiveness of a mass screening programme for breast cancer in a French population where hormone replacement therapy (HRT) is common and where mammography is prescribed outside the programme for asymptomatic women.
From 1993 to 1996 inclusive, 41,062 women underwent a first test and 48,275 a second or third test in the Bouches du Rhône programme. Their HRT status was ascertained at the time of the test. False positive and false negative tests were identified at one year follow up. The incidence of interval cancers was estimated up to three years after the screening test.
The odds of being detected at screening rather than as an interval cancer within one year of the test was five times greater among non-users of HRT than among users (odds ratio (OR) 5.14 (confidence interval 2.5 to 11.8)). This high reduction in sensitivity among users (71% v 92%) was associated with a very small reduction in specificity at the incident screen only. The incidence of interval cancers among HRT users was 3.5 times that of non-users within the first year after the test and 1.7 times during the following two years.
When the early results of a programme have been used to measure its effectiveness they should be reassessed in populations where HRT is in widespread use. As interval cancers had better prognostic factors in HRT users than in non-users, the efficacy of a screening programme in such populations should be the subject of further studies.
Journal of Medical Screening 02/1999; 6(2):99-102. · 1.69 Impact Factor
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ABSTRACT: The EUROCARE study is a European Union project to collect survival data from population-based cancer registries and analyse them according to standardised procedures. We investigated and compared oesophageal and gastric cancer survival in 17 countries between 1985 and 1989. Time trends in survival over the 1978-1989 period were also investigated in 13 countries. The overall European 1-year relative survival rates were 33% for oesophageal cancer and 40% for gastric cancer. The corresponding 5-year relative survival rates were 10 and 21%, respectively. Important intercountry survival differences exist within Europe for oesophageal and gastric cancer. Taking the European average as the reference, the relative risk (RR) of death at 5 years was at least 30% higher in Denmark, Poland, Estonia and Slovenia for oesophageal cancer and in Denmark, England, Scotland and Poland for gastric cancer. In the other countries survival figures were close to the European average. Gender had little influence on survival, whilst age at diagnosis was inversely related to prognosis. There was a slight improvement between 1978 and 1989 in 5-year overall relative survival rates for both oesophageal cancer (RR = 0.80, 95% confidence interval (CI) 0.72-0.90) and gastric cancer (RR = 0.88, 95% CI 0.82-0.94). Differences in quality of care and stage at diagnosis can explain in part the differences in survival found in the EUROCARE countries. Significant improvement in prognosis has still to be achieved.
European Journal of Cancer 01/1999; 34(14 Spec No):2167-75. · 5.54 Impact Factor
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ABSTRACT: The EUROCARE Study is a European Union project to assemble survival data from population-based cancer registries and analyse them according to standard procedures. We investigated and compared liver, pancreatic and biliary tract cancer survival in 17 countries from 1985 to 1989. Time trends in survival over the 1978-1989 period were also investigated in 12 countries. The overall European mean 1 year relative survival was 16% for primary liver cancer, 26% for biliary tract cancer and 15% for pancreatic cancer. The corresponding 5-year relative survival was 5, 12 and 4%, respectively. Taking the European average as the reference, the relative risk (RR) of death was at least 20% higher for the three cancers in Denmark and Estonia. Survival tended to be higher in Spain for primary liver cancer and biliary tract cancer. Gender had little influence on survival whilst age at diagnosis was inversely related to prognosis. There was an improvement in 1-year relative survival rate for primary liver cancer: relative risk (RR) of 0.68 (95% confidence interval (CI) of 0.60-0.77) for 1987-1989 versus 1978-1980 and biliary tract cancer (RR 0.77, 95% CI 0.68-0.87). There was less variation in 5-year relative survival rate over time. Some intercountry survival differences for primary liver, biliary tract and pancreatic cancers exist over Europe. Differences in quality of care, in particular treatment aggressiveness, may explain some of these differences in survival. New approaches to the management of these cancers need to be found.
European Journal of Cancer 01/1999; 34(14 Spec No):2184-90. · 5.54 Impact Factor
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ABSTRACT: Breast cancer is the most frequent malignancy among women in developed countries. Prognosis is better than for other major cancers, and an improvement in survival has been reported for several populations in recent decades. Within the framework of EUROCARE, a population-based project concerned with the survival and care of cancer patients in Europe, we analysed data from 119,139 women diagnosed with breast cancer between 1978 and 1985 in 12 countries and followed for at least 6 years. Multiple regression models of relative survival, which take mortality from all other causes in each area into account, were used to estimate the effect of age, period of diagnosis and country on survival. For the comparison between countries, survival rates were age-standardised to the age structure of the entire study population. Women aged 40-49 years at diagnosis had the best prognosis in all countries and throughout the study period. Women younger than 30 years at diagnosis had a worse prognosis than those aged 30-39. The highest relative survival at 5 years was in Finland and Switzerland (about 74%), intermediate levels were found for Italy, France, The Netherlands, Denmark and Germany (about 70%) and the lowest rates were in Spain, the United Kingdom, Estonia and Poland (55-64%). During the 6 months following diagnosis, survival was highly dependent on age and was sharply lower in women older than 49 years. For women surviving more than 6 months after diagnosis, survival was similar for all ages, although women aged 40-49 still had the better prognosis. The average rate of death from breast cancer fell by about 2.5% for each year of diagnosis between 1978 and 1985. This improvement manifested mainly in younger and older women, for whom survival was initially less good. The largest improvement was seen in Poland (-15% death risk per year). We suggest that the better survival of women aged 40-49 at diagnosis is related to lower levels of circulating sex hormones, resulting in reduced stimulation of tumour cell growth. Early diagnosis may also be important in the peri-menopausal period due to increased diagnostic attention. Low survival in the United Kingdom may be due to inadequate adherence to consensus treatment guidelines and greater variation in treatment.
International Journal of Cancer 09/1998; 77(5):679-83. · 5.44 Impact Factor
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K Filali,
G Hédelin,
P Schaffer, J Estève,
P Arveux,
C Bouchardy,
C Exbrayat,
J Faivre,
F Lévi,
J Macé-Lesech,
D Pottier,
J Torhorst
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ABSTRACT: The use of different registration rules from one registry to another, both generally and also for paired organs, leads to variations in the proportion of multiple primary cancers: in men, from 0.4 to 4.9% for the colon, 0.1 to 2.7% for the lung, and 4.1 to 8.6% for the mouth and pharynx. Subjective factors, often impossible to verify, contribute to these variations. The impact on the estimation of incidence rates and trends is not negligible for cancers of the mouth and the pharynx and for all the cancers taken together. The trend towards an increase of cancers of the mouth and pharynx in the Bas-Rhin disappeared when the incidence was expressed taking only the first cancer (incidence by individual) into consideration, and the differences in incidence between the Calvados and the Bas-Rhin registries for the same site also disappeared. In the absence of harmonisation of the rules and methods followed for registration, incidence by individual is the only approach which makes it possible to compare incidence rates and trends between registries.
European Journal of Cancer 05/1996; 32A(4):683-90. · 5.54 Impact Factor
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J Estève,
E Riboli,
G Péquignot,
B Terracini,
F Merletti,
P Crosignani,
N Ascunce,
L Zubiri,
F Blanchet,
L Raymond,
F Repetto,
A J Tuyns
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ABSTRACT: The main causes of cancer of the larynx and hypopharynx are smoking cigarettes and drinking alcohol. However, for these as well as for other cancers of the upper aerodigestive tract, some dietary components, mainly low consumption of fruit and vegetables, have been observed to be associated with increased cancer risk. We report results from a multicenter case-control study carried out in six regions of Europe located in northern Spain, northern Italy, Switzerland, and France. A total of 1,147 males with cancer (cases) and 3,057 population controls were interviewed on usual diet, lifelong drinking and smoking habits, and occupational history. Cancer cases had histologically verified epidermoid carcinomas. The cancers were classified in two anatomic sub-entities: the epilarynx (hypopharynx and upper part of the larynx), which enters into contact with the bolus and the air; and the endolarynx, through which air and tobacco smoke pass, but not the bolus. A previous report from this study found that alcohol drinking presents a greater risk factor for cancer of the epilarynx than for cancer of the endolarynx. The main results regarding diet indicate that high intake of fruit, vegetables, vegetable oil, fish, and low intake of butter and preserved meats were associated with reduced risk of both epilaryngeal and endolaryngeal cancers, after adjustment for alcohol, tobacco, socioeconomic status, and non-alcohol energy intake. Among nutrients, a reduced risk was found for high intake of vitamins C and E and for a high polyunsaturated/saturated fatty acids (P/S) ratio. While these variables are relevant in scoring nutritional behaviour, it remains unresolved whether the biologic properties of these nutrients play a role in the apparent protective effect.
Cancer Causes and Control 04/1996; 7(2):240-52. · 2.88 Impact Factor
