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Recent cancer incidence trends in Ukraine and short-term predictions to 2022
Abstract
Background:
Using data from the National Cancer Registry of Ukraine (NCRU), we analyzed recent trends in incidence rates (2003-2012) and used these to predict the future cancer incidence burden up to 2022.
Methods:
All cancer cases (excluding non-melanoma of skin) for the years 2003-2012 were retrieved from the NCRU's database (n = 1,459,851). Age-standardized incidence rates (ASRs) were estimated and the numbers of new cases and incidence rates predicted for 2022 using age-period modeling.
Results:
ASR increased from 2003 to 2012 for most cancers except lip and stomach cancers (in both sexes) and laryngeal and lung cancers (in males). Assuming these trends will continue, lung cancer will remain the most common male cancer in 2022 (ASR 40.5/100,000), followed by prostate cancer (36.8/100,000), colorectal cancer (34.6/100,000), and cancers of the oral cavity and pharynx (18.5/100,000). In females, the order of the four most common cancers will not change in 2022 compared with 2012, with cervical cancer remaining the fourth most common cancer (17.5/100,000). We predict an overall increase of 18 % in the number of cancer cases in Ukraine (relative to 2012) to 179,493 cases in 2022.
Conclusion:
The anticipated increase in the number of cancer patients in Ukraine clearly has knock-on effects on a healthcare system undergoing reforms. Tobacco control appears to be the only functioning aspect of cancer prevention in the country, and there is a need for a broader national cancer control plan. The continued monitoring and evaluation of implemented cancer control measures by the NCRU will help prioritize targets and allocate future resources to cancer services.
... oalam@jamiaham dard.ac.in 18.1 million new cancer cases and 9.6 million cancer deaths were reported in 2018, out of which 23 percent of new cases and 20 percent of deaths happened in Europe. In Ukraine, as assessed by GLOBOCAN, 170 thousand new cancer incidents were reported, out of which ninety-eight thousand deaths from cancer were reported in Ukraine alone, where age standard percentage rates (ASR 258.3 per 1 hundred thousand in males, 203.6 per 1 hundred thousand in females) were the smallest [3,4]. In a nutshell, cancer has become a serious health problem for the community as over 10 million people are diagnosed with the disease every year around the globe. ...
... Wu and colleagues [182] identified the anti-microtubule polymerization activity of compound 21 by synthesizing and testing indole-based [1,2,4] Fig. 22 for SAR). When measured at the protein level, compound 21 caused a cellular cycle pause in the G2/M phase, indicating that it may have the capacity to prevent tumor cell movement and metastasis. ...
... Yang et al. [183] developed compound 22 from 3,6diaryl- [1,2,4] triazolo[4,3-a] pyridine scaffolds to inhibit tubulin polymerization when compared to the reference drug Combretastatin A-4. The effect of these drugs on tubulin polymerization inhibition was shown to be highly associated with their antiproliferative effectiveness, indicating that tubulin would be the most prime suspect of these agents. ...
Cancer is a heterogeneous disease characterized by an abnormal and uncontrolled division of the cells leading to tumors that invade the adjacent normal tissues. After cardiovascular diseases, it is the second most prevalent disease accounting for one in every six deaths worldwide. This alarming rate thus, demands an urgent need to investigate more effective drugs to combat the said disease. Oxygen and nitrogen-based heterocyclic compounds have shown remarkable therapeutic activity towards several diseases, including cancer. In this review, we have attempted to summarize the work done in the last decade (2009-2019), highlighting the anticancer activity of pyrido fused five-membered heterocyclic ring derivatives. Additionally, we have focused on seven heterocyclic pyridine fused rings: Imidazopyridine, Triazolopyridine, Pyrrolopyridine, Pyrazolopyridines, Thienopyridine, and Isoxazolopyridine. A total of forty-nine compounds have been studied based on their in-vitro cytotoxic activity and their structure-activity relationship, underlining the anticancer activity of their various pharmacophores and substituents. This review, therefore, aims to draw the attention of the researchers worldwide towards the enormous scope of development of heterocyclic drug compounds, focussing mainly on pyrido fused five-membered heterocyclic rings as anticancer drugs.
... Cervical cancer mortality in Ukraine is 8.8 per 100,000 women, which is significantly higher than other parts of Eastern Europe (6.1 per 100,000) [3] [12]. The mortality incidence ratio in 2017 was 39.1% [13]. There has also been a trend towards a mild increase in cervical cancer rates in Ukraine [14]. ...
... Registry of Ukraine data and cancer incidence rates from 2003-2012 to estimate age-standardized rates, an overall increase of 18% in the number of cancer cases is predicted [13]. ...
... Cancer is a highly destructive disease that claims more lives each year ranking just below heart diseases in terms of global health burden (Kumari Singh et al. 2024). The worldwide impact of cancer is immense, with new cases around 1.8 million and deaths reaching up to 9.6 million, as reported in 2018, presenting a significant threat to public health (Ryzhov et al. 2020). In 2020, nearly 10 million deaths were reported due to cancer, by World Health Organization (WHO), with projections suggesting that this number could rise to over 12 million by 2030 (Xi and Xu 2021). ...
Globally, colorectal cancer (CRC) continues to rank among the leading causes of cancer-related death. Systemic toxicity, multidrug resistance, and nonspecific targeting often pose challenges to conventional therapy for CRC. Because it is a complex disease with a complex genetic and environmental pathophysiology, advanced therapeutic strategies are needed. Nanotechnology presents a potential solution that may maximize therapeutic efficacy while minimizing negative effects by enabling personalized delivery of anticancer drugs. This review focuses on recent developments in colorectal drug delivery systems based on nanotechnology. Numerous nanomaterials, including liposomes, dendrimers, micelles, exosomes, and gold nanoparticles, are developed and used. Distinctive characteristics of mentioned nanocarriers are discussed along with strategies that can be employed for enhancing the delivery of drugs to colorectal cancer cells. The review also quotes the most relevant preclinical and clinical studies that show how these nanomaterials improve drug solubility, stability, and targeted delivery while overcoming the shortcomings of conventional therapies. Nanotechnology has made CRC treatment very efficient and advanced, which has opened up new possibilities for targeted drug delivery. Preclinical and clinical studies have also proved that the use of nano-formulations in colon-specific delivery systems have significant results, indicating potential for better patient outcomes. Future research can be done in order to overcome the hurdles regarding biocompatibility, expansion, and regulatory challenges. Large-scale clinical trials and nanomaterial formulation optimization should be the main goals of future research to confirm the efficacy and safety of these novel treatments.
Graphical abstract
... Cancer has become one of the biggest threats to human health due to an increase in incidence worldwide; in 2018, there were 9.6 million deaths, and 1.8 million reported new cases [60,61]. As the third most prevalent type of cancer globally, colon cancer is a major cause of death, especially in the United States [62,63]. ...
... Surveillance of the dynamic and structural changes in cancer incidence over the past years with the use of the National Cancer Registry of Ukraine (NCRU) database makes it possible to study the features of cancer burden in Ukraine and evaluate its further progress [1]. Meanwhile, NCRU registered an extraordinary drop in the number of new cancer diagnoses in the Ukrainian population in 2020 [2], which can be due to the quarantine restrictions and other impacts of the pandemic. ...
Background. In 2020, a sharp decrease in the number of new cancer cases was registered in Ukraine in the setting of the quarantine restrictions due to the COVID-19 pandemic, which contrasted with the previous trends. Aim. To study trends of cancer incidence rates in Ukraine in the recent decade and to assess the impact of COVID-19 pandemic on cancer detection in 2020. Materials and Methods. Records on cancer cases diagnosed during 2010—2020 (n = 1,498,911) from the database of the National Cancer Registry of Ukraine were used; the data being submitted early in 2022. Trends of the age-standardized incidence rates in 2010—2019 were estimated by the Joinpoint Regression Program. Results. During 2010—2019, the incidence rates increased (p < 0.05) for colon, prostate, and pharyngeal cancers in males and for colon, thyroid, and pancreas in females with the rates of other prevalent cancers being stable or decreasing (lung and larynx in males, cervix and rectum in females, stomach in both genders); the incidence increased mainly at the expense of the population aged 60—74 years. A significant decrease in cancer incidence was in males aged 40—59 years. In 2020, the serious negative impact of COVID-19 outbreak on the timely detection of cancer occurred in all adult age groups of the Ukrainian population and involved all the most common cancers. The most pronounced diminution of the incidence rate was observed for non-melanoma skin cancers (by 35.9%— 37.9%); the decrements of the rates for other prevalent cancers varied from –23.0% (prostate gland) to –9.7% (pharynx) in males and from –21.2% (kidney) to –9.1% (pancreas) in females, the greatest ones being in the population aged 75+. Conclusions. The sharp drop of the cancer incidence rates registered in Ukraine 2020 is evidently the result of the limited access to healthcare facilities as well as the reduced oncological alertness of the population due to the predominant focus on COVID-19 during the pandemic. However, it is not a manifestation of a decrease in cancer incidence as such. In the following years, this may increase the proportion of advanced-stage diagnoses, the load on the cancer care system, and cancer mortality in the Ukrainian population. An evaluation of the short-termand long-term effects of the COVID-19 pandemic on the cancer burden in Ukraine requires further monitoring.
... A nationwide study conducted in Denmark from 1980 to 2014 found: a significant decrease in LC incidence in men stratified by gender, but there was no significant change in the incidence among women (20). A decrease in male incidence was found in Ukraine (21). Median age at diagnosis was 60 yr. ...
Laryngeal cancer comprises 30%-40% of head and neck malignancies, and it is the most common malignancy in otolaryngology. The main risk factors for laryngeal cancer are tobacco use, excessive alcohol consumption, gastroesophageal reflex, Plummer-Vinson syndrome, exposure to heat, chemicals, and some viral infections. This literature review summarizes all known data over the past decade with an assessment of the main etiological factors related to cancer incidence, general measurement issues in the cancer epidemiology and the current state of science in relation to laryngeal cancer. The geographical distribution of laryngeal cancer also reveals some important aspects. Europe remains the most prevalent continent for this type of malignancy, whilst the epidemiologic burden in Africa remains low. Overall, there are clear differences in morbidity and mortality from laryngeal cancer between urban and rural areas, with gender inequalities. In some countries, the incidence rates are high in rural areas, and in some, such as in China, the urban population is more affected. High rates of laryngeal cancer are closely associated with both low average income and a high percentage of the population with lower-than-average education countries with higher Socio-demographic Index (SDI) have made greater improvements in the treatment of LC than countries with lower SDI. Epidemiological data on risk factors can provide valuable information for developing cancer prevention strategies.
... Cancer is a devastating disease that continues to claim numerous lives each year [60]. With a global increase in cancer cases, it has become one of the most significant challenges to human health, accounting for 1.8 million reported new cases and 9.6 million deaths in 2018 [61]. Colon cancer, ranking as the third most common cancer worldwide, stands as a leading cause of mortality, particularly in the United States [62,63]. ...
In the realm of cancer diagnostics, imaging and therapeutics, nanocarrier-based drug delivery systems have gained extensive importance owing to their promising attributes and potential to enhance therapeutic effectiveness. The primary area of research revolves around formulating innovative intelligent nanocarriers such as nanoparticles (NPs) which are capable of selectively responding to cancer-specific conditions and efficiently delivering medications to target cells. These nanocarriers, whether operating in a passive or active manner, can transport loaded therapeutic cargos to the tumor site while minimizing drug elimination from the drug delivery systems. This review primarily focuses on presenting recent advancements in the development and utilization of nanoparticles in the treatment of various cancer types, such as pancreatic cancer, prostate cancer, colorectal cancer, cervical cancer, and breast cancer.
... According to the cancer registry da ta in Ukraine for 2020, cancer of the trachea, bronchi, and lungs was identified in 8,222 men and 2,129 women [1]. In 2022, the incidence of malig-nant lung neoplasms in Ukraine was 40.5 per 100,000 population [6]. The World Health Organization (WHO) reports that about 10 million people worldwide die annually from oncological diseases. ...
Lung cancer holds a prominent position in the malignant mortality rates. Despite the rapid advancement of pharmacological approaches to the lung malignancy treatment, surgical interventions remain relevant and pertinent in contemporary practice. The choice of an appropriate therapy for local lung cancer presents a particularly acute dilemma. This issue gives rise to contradictions as it necessitates a tailored approach for each individual case. In such instances, the only radical treatment methods for lung cancer involve surgical interventions, namely pneumonectomy and lobectomy/bilobectomy. The preference leans towards lobectomy, given that this choice mitigates disability, thereby enhancing the patient's quality of life. Organ-preserving surgery holds a distinct significance for patients with compromised functional reserves, where complete lung resection is intolerable. However, at the time of identifying centrally located lung neoplasms, tumors or metastatic lymph nodes often extend to the orifices of the segmental and main bronchi. A lobectomy is feasible only with the resection (wedge-shaped or circumferential one) of the main bronchus and subsequent bronchoplasty. Tumor invasion of the pulmonary artery presents a formidable obstacle to organ-preserving surgery.In cases where pneumonectomy is intolerable, bronchoangioplastic lobectomy/bilobectomy stands as the sole viable radical intervention. Pneumonectomy with wedge-shaped or circumferential resection of the trachea, followed by tracheobronchoplasty, represents one of the most intricate procedures in thoracic surgery. However, when the tumor extends to the tracheal bifurcation, only this operation allows for a radical surgical approach. Notably, in circumstances where the tumor (carcinoid) affects the main bronchus, partial circumferential bronchial resection with subsequent bronchoplasty becomes feasible. Thus, the entire pulmonary ventilation capacity is preserved. Clinical observations of such procedures have been documented in patients with diminished functional reserves.
... As highlighted by the review (Table 1) there is no HPV vaccination campaign: in fact, cervical cancer is the fourth most common among women [26]. ...
Background:
The COVID-19 pandemic has dramatically affected all aspects of the patient's pathway to cancer diagnosis and subsequent treatment. Our main objective was to evaluate the status of cancer trials in Ukraine as of September 2022.
Methods:
Initially, we examined with a narrative review the state of breast, colorectal, and cervical cancer population-based screening. Subsequently, we assessed each trial status for the years 2021 and 2022.
Results:
Estimates of participation in breast and cervical cancer screening are different from region to region. Moreover, regarding cervical cancer screening, extremely different participation estimates were reported: 73% in 2003 vs. <10% 2020. Our data show that from 2014 to 2020, despite the pandemic, cancer trials in Ukraine significantly increased from 27 to 44. In 2021 no trials were completed; in fact, we observed that out of 41 trials, 8 were active not recruiting, 33 were recruiting, and 0 were completed or terminated. In 2022 in Ukraine, for oncological pathologies, only 3 trials were registered, while in 2021, 41 trials were registered. The suspension of trials regarded above all concern hematological tissue (66.7%) and the genitourinary tract (60%).
Conclusions:
Our work has highlighted how the areas most affected by the conflict present criticalities in oncological care.
... In 2018, 170,000 new cases and almost 100,000 cancer-related deaths were reported in Ukraine, with a predicted significant increase in cancer incidence of almost 18% from 2012 to 2022 [3]. Age-standardized incidence rates are one of the lowest as reported for Eastern Europe [3e6]. ...
Background
On 24th of February 2022, Ukrainian cancer patients had to face a new war. Here we describe an experience of the Maria Sklodowska-Curie National Research Institute of Oncology Branch Krakow in providing cancer care for Ukrainian refugees during the initial 6 weeks of war. We present patients’ characteristic, point out the main challenges and share initiatives undertaken.
Materials and methods
For this cross-sectional analysis, we have gathered demographic and clinical data together with date of crossing the Polish-Ukrainian border for 112 Ukrainian refugees with cancer who had their first-time oncology consultation between 24th February and 8th April 2022. We have also implemented national guidelines and created local procedures, interventions and policies to manage this situation.
Results
The peak of patient inflow was the third week of War and refugees accounted for 13% of all first-time patients within that period of time. The majority of refugees were women (86%), treated radically (57%) with breast cancer (43%). Most of the patients required systemic treatment (67%). Amongst the main challenges at the time were differences in the reimbursement system, communication issues, lack of patients’ documentation or tissue samples, prolonged diagnostic or treatment interruptions, increased risk of COVID-19 infections, chemotherapy side effects, and lack of procedures. Legal, procedural and organizational steps implemented at the local and national level were described.
Conclusions
The Russian invasion on Ukraine forced an unexpectedly high number of Ukrainian cancer patients to seek help abroad, leading to the straining of the health care system in Poland.
... According to GLOBOCAN data, there were 162,594 new cases of cancer and 84,194 deaths in Ukraine (population: ≈ 44 million) in the year 2020. In that same year in Poland (population: ≈ 38 million), there were 204,575 newly diagnosed cases of cancer and 119,319 deaths [2,3]. The ratio of new cases to the total number of inhabitants was 0.37 in Ukraine versus 0.54 in Poland, suggesting that the incidence of malignant neoplasms in Poland is higher than in Ukraine. ...
The war in Ukraine has led to a massive influx of refugees into Poland, posing a major challenge for the health care system. The large number of refugees will undoubtedly lead to a substantial increase in the number of patients requiring treatment for a wide range of conditions, including cancer. In the present article, we describe and discuss the many difficulties faced by cancer treatment centres in Poland due to these circumstances. Key issues include the lack of proper diagnostic testing in this population and differences in oncological practices between Poland and Ukraine. Other problems include difficulties in obtaining patients' medical records and communication issues caused by the language barrier. In addition, in the context of the ongoing COVID-19 pandemic, the low vaccination rate among Ukrainian refugees is also a significant risk factor. Addressing these challenges will require a comprehensive approach involving the national health care agency and individual cancer centres. This is especially important in oncology due to the interdisciplinary nature of the field, which requires the contribution of specialists from many different fields as well as appropriate funding.
... The CCI was computed based on ICD-10 codes and was used as a summary measure. 29 CCI scores were classified as low (index score = 0), moderate (index score = 1-2), or high (index score ≥3), based on definitions from previous studies and to increase the statistical power. ...
Background
Conflicting results have been reported regarding the potential preventive effects of statins on the risk of cancer. This study investigated the associations of statin use with the incidence and mortality of kidney cancer in South Korea.
Methods
In this retrospective population-based cohort study using the National Health Insurance claims database, we compared patients aged 45-70 years who had used statins for at least 6 months to non-statin users matched by age and sex from 2005 to June 2013. The main outcomes were kidney cancer incidence and mortality according to statin use. Cox proportional hazard regression was used to calculate the adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs).
Results
In the cohort of 1 008 101 people, the aHRs for the association between statin use and the outcomes were .84 (95% CI: 0.71-.99) for kidney cancer incidence and .65 (95% CI: 0.41-.98) for kidney cancer mortality. In the matched cohort of 337 578, the risk per 1000 people of cancer incidence and mortality was 1.63, 1.07, and .24, .17 in statin users and non-users, respectively. In matched cohort, the risk of kidney cancer incidence and mortality decreased, but it is not statistically significant. Also, there was no linear relationship with increased doses.
Conclusion
Statin use might be associated with a decreased risk of kidney cancer incidence and mortality, but it showed no statistical significance. This study was a large-scale analysis, however, further studies that are larger and multinational in scope are needed to confirm the beneficial effects of statins on survival.
... 5 The most common cancers in males are lung, prostate, colorectal, and oropharyngeal; the most common cancers in females are breast, colorectal, uterine, and cervical cancer. 6 Since the first days of invasion, patients with cancer in Ukraine experienced disruption in their cancer treatment and survivorship care. ...
... Ukraine has a population of 44 million, with cancer epidemiology rates that are similar to other European countries. 2 Many refugees have moved on from those countries to other European countries. Some of these refugees have medical conditions, including cancer, that require treatment. ...
To describe the current situation and management of Ukrainian patients at two European cancer care centers in Poland and Italy. Both centers admit refugees from the war in Ukraine.
... bidity index[CCI], cardiovascular disease, hypertension, diabetes mellitus, hyperlipidemia, rheumatoid arthritis, osteoarthritis and hypothyroidism), the number of physician visits during the baseline period, the number of hospitalizations during the baseline period and the use of angiotensin-converting enzyme inhibitors and aspirin during the baseline period. The CCI has been validated for use with hospital discharge data with diagnoses based on the ICD-10 and was used as a summary measure.36 CCI scores were classified as low (index score = 0), moderate (index score = 1-2), or high (index score > 2), based on definitions from previous studies and to increase statistical power. ...
Previous studies have reported inconsistent findings concerning the impact of statin use on cancer prevention. Our study examined the association between statin use and cancer incidence and mortality related to breast and gynecologic cancers in South Korea. A population‐based cohort study was conducted using the National Health Insurance claims database. Women aged 45 to 70 years old who had taken statins for at least 6 months were compared to statin non‐users of the same age from January 2005 to June 2013. The primary outcomes were cancer incidence and mortality related to breast cancer, total gynecologic cancers, cervix uteri cancer and ovarian cancer. Cox proportional hazards regression was conducted to calculate the adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). Out of 587 705 women, there were 3591 cases of breast cancer, 2239 cases of gynecologic cancers and 565 breast and total gynecologic cancer deaths during 7.6 person‐years. The aHRs for the association between the risk of each cancer and statin use were 0.88 (95% CI 0.79‐0.97) for breast cancer and 0.83 (95% CI 0.67‐0.99) for cervix uteri cancer. Statin use was associated with decreased breast cancer mortality (HR = 0.65, 95% CI 0.43‐0.99) and total gynecologic cancer mortality (HR = 0.70, 95% CI 0.50‐0.98). A dose‐response relationship was only found for all‐cancer mortality. Statin use for at least 6 months was significantly associated with a lower risk of breast and cervix uteri cancer incidence, and with lower mortality of breast and gynecologic cancers. Further research on these associations will be needed.
... [4] In addition, the global burden of cancer is growing yearly, with 18100000 new cases totalizing 9,60,0000 deaths from cancer in 2018. [5] Essential oils are known for their antimicrobial, antioxidant, antifungal, and anticancer properties. Their bioactivities can be attributed to their phenolic compounds, such as monoterpenes, which can be exploited for the development of new drugs [6] Carvacrol (5-isopropyl-2-methylphenol) is a monoterpene, found in essential oils of the family Lamiaceae, which has proven to be promising for pharmaceutical and biomedical applications in disease treatments. ...
Phenolic compounds are prone to degradation from external deleterious conditions. Thus, a carrier for its delivery can be useful in protecting them and ensuring their optimal release profile. The objective of this study was to produce starch nanofibers as delivery carriers for carvacrol and to evaluate its in-vitro digestion simulation and anti-glioma activity. Nanofibers were produced by electrospinning of starch solution where carvacrol was incorporated in various concentrations (20, 30, and 40% v/w; dry basis). The nanofibers were evaluated by in-vitro digestion simulation and anti-tumoral activity in C6 rat glioma cells and cytotoxicity in astrocytes. By measuring the residual amount of carvacrol after digestion, the starch nanofibers showed to be a promising vehicle for the delivery of carvacrol by resisting in-vitro digestion. The carvacrol-loaded starch nanofibers resulted in up to 50% reduction in tumoral cells (C6 rat glioma cells). Free carvacrol elicited cytotoxicity in astrocytes after 72 h of treatment; interestingly the carvacrol-loaded starch nanofibers were not toxic to this cell. In view of the demand for natural drugs in pharmaceutical applications, the nanofibers may be promising for cancer complementary treatment.
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... The relatively high breast cancer death rates observed in Russia and Ukraine reflected a combination of factors that are somewhat difficult to identify, including later stage at diagnosis (few organized screening programs are available) and inadequate access to high-quality treatment services (Ryzhov et al., 2020). However, in these countries we predicted further appreciable declines in breast cancer mortality to 2020. ...
Objectives:
Predicted cancer mortality figures are useful for public health planning. We predicted cancer mortality rates in Israel, Hong Kong, Japan, the Philippines, Korea, Australia, Russia and Ukraine for the year 2020 using the most recent available data. We focused on breast cancer.
Methods:
We obtained cancer death certification and population data from the WHO and the United Nations Population Division databases. We derived figures for 10 major cancer sites and total cancers over 1970-2017. We predicted numbers of deaths and age-standardized mortality rates for 2020 through joinpoint regression models. We calculated the number of avoided deaths from 1994-2020.
Results:
Overall, total cancer mortality is predicted to decline. Russia had the highest all cancers rates in 2020, 151.9/100 000 men and 79.6 women; the Philippines had the lowest rate in men, 78.0/100 000, Korea in women, 47.5. Stomach cancer rates declined over the whole period in all countries considered, colorectal cancer since the late 1990s. Trends for pancreas were inconsistent. Predicted rates for lung and breast cancer were favourable; women from Hong Kong, Korea and Australia had lung cancer death rates higher than breast ones. Predicted rates for uterine, ovarian, prostate and bladder cancers and leukaemias were downward for most countries. Between 1994 and 2020, over 3.3 million cancer deaths were avoided in the considered countries, except for the Philippines where no reduction was observed.
Conclusion:
Predicted cancer rates were lower than in the European Union and the USA, even though falls started later and were less marked.
PURPOSE
This study aims to identify the factors influencing colorectal cancer (CRC) screening practices, along with the barriers and facilitators from the perspective of primary care physicians (PCPs) in Ukraine. Considering health care system challenges, including those posed by the ongoing war, this research seeks to inform improvements in CRC screening and outcomes in Ukraine and other low- and middle-income countries (LMICs).
METHODS
A survey was designed and distributed electronically to Ukrainian PCPs, focusing on CRC screening practices, beliefs, and barriers. The survey incorporated questions adapted from established cancer screening surveys and frameworks. Complete responses were collected from 740 PCPs. Sample statistics were computed, and population-level perceptions and associations with CRC screening practices were estimated by standardizing responses to national PCP demographics.
RESULTS
The majority of respondents were women (91%) and specialized in family medicine (84%). Respondents believed in the effectiveness of colonoscopy for reducing CRC mortality (80%), with 75% of PCPs referring patients for this screening modality. Major barriers identified include inadequate training of PCPs in screening and lack of resources. Respondents reported high utilization of fecal occult blood test and colonoscopy for screening when these tests were said to be available in their practices. Self-reported familiarity with CRC screening guidelines and participation in educational workshops were positively associated with screening referrals.
CONCLUSION
The study highlights the role of access to CRC screening tests and awareness of screening guidelines in enhancing CRC screening practices among Ukrainian PCPs. Addressing training and resource barriers, alongside public health interventions targeting patient-related barriers, is essential. These findings offer valuable insights for LMICs facing similar challenges, emphasizing the need for tailored strategies to improve cancer screening in these health care settings.
Background
Bloodstream infections (BSIs) are one of the leading causes of death in cancer patients. Nevertheless, the risk factors of BSIs in solid tumors have rarely been ascertained adequately.
Methods
We conducted a single-center case-controlled retrospective study from 2017 to 2021 among adults with solid tumors in a tertiary-level hospital. The BSIs and control group were matched by the propensity score matching method. We found independent risk factors of occurrence and death of BSIs using univariate and multivariate regression analysis. Additionally, a nomogram was constructed to predict the risk of mortality in BSIs.
Results
Of 602 patients with solid tumors in the study period, 186 had BSIs and 416 had non-BSIs. The incidence of BSIs was 2.0/1,000 admissions (206/102,704), and the 30-day mortality rate was 18.8% (35/186). Compared to the control group, the BSIs had longer hospital stays (24.5 days vs. 20.0 days), and higher frequency complicating with organ failure (10.5% vs. 2.4%), nephropathy (19.6% vs. 3.8%), comorbidities≥3 (35.5% vs. 20.0%), and liver-biliary-pancreatic infections (15.6% vs. 5.3%) (all P<0.001). Among the 186 patients with BSIs, 35 died within 30 days after BSIs. Gram-negative bacteria were the most frequent microorganisms (124/192, 64.6%). Liver cancer, organ failure, a high level of lactate dehydrogenase and septic shock were the independent hazardous factors for death of BSIs. What’s more, a nomogram was constructed to predict the 30-day survival rate of BSIs, which was proved to have good accuracy (AUC: 0.854; 95% confidence interval: 0.785~0923) and consistency.
Conclusion
Being aware of the risk factors of BSIs redounds to take preventive measures to reduce the incidence and death of BSIs.
This cohort study evaluates cancer care provided to Ukrainian war refugees in Poland.
The radiation-related risk of breast cancer among women following the Chornobyl accident remains uncertain. During pregnancy, there is rapid cell proliferation in the breast while radioactive iodine from fallout exposure can concentrate in lactating breast tissues. We conducted a standardized incidence ratio (SIR) analysis of breast cancer in a cohort of 2,631 women who were lactating and/or pregnant at any time during the 2-month period of radioiodine fallout (April 26, 1986–June 30, 1986). There were 37,151 person-years of follow-up, and 26 incident breast cancers were identified through linkage with the National Cancer Registry of Ukraine. Breast cancer rates among pregnant or lactating women were compared to the general population rates, and SIRs were adjusted for oblast, urban/rural, age, and calendar year. The SIR was not significant for women pregnant at the time of the accident (SIR = 0.75; 95% CI 0.44, 1.18) or for women lactating anytime within 2 months of the accident (SIR = 0.96; 95% CI 0.48, 1.68). However, there was a non-significantly elevated risk for women lactating at the time of accident (SIR = 1.30, 95% CI 0.40, 3.01). The increased SIR for breast cancer among lactating women is consistent with the results of a similar study in Belarus and indicates the need to quantify the radiation risk of breast cancer in a larger study of women lactating during the period of fallout exposure.
The paper analyzes the morbidity and mortality of patients with malignant neoplasms of the lip and oral cavity in Ukraine from 2010 to 2019. It compares it with global trends to justify decisions on the necessary preventive measures to reduce the burden of these diseases in the population of Ukraine. Data on morbidity and mortality in 2010–2019 were obtained from the issues of the Bulletin of the National Cancer Registry of Ukraine. The study used updated information published by the NCRU on the number of cases of MN of the lip (ICD code–10 C00) and oral cavity (C01–C08, C46.2) and deaths from these diseases in the population of Ukraine, as well as the corresponding age-standardized indices calculated for the standard world population. The calculation of indices absent in the publications was performed according to the data of the National Cancer Registry of Ukraine. The quality and completeness of the data of the National Cancer Registry of Ukraine are high and meet internationally accepted requirements. Cancer epidemiology indices of other countries were obtained from the Global Cancer Observatory project's web platform. According to the results of the study, there is a need to improve the system of care for cancer patients, review the existing and create a new regulatory framework in Ukraine, provide institutions with a sufficient number of specialists in maxillofacial oncology, increase the number of scientific studies in oncology, the need for annual preventive examinations, etc.
In connection with our efforts in the development of new anticancer agents, herein we report the design and synthesis of new small pyrimidine-5-carbonitrile based derivatives. The target pyrimidines were evaluated in vitro for their anticancer activity against three cancer cell lines: hepatocellular carcinoma (HepG2), non-small cell lung cancer (A549) and breast cancer (MCF-7) cell lines. Compounds 10a, 10b, 13a, 13b, 15a, 15e and 15j exhibited the highest activities towards the three cell lines. In particular, compound 10b exhibited excellent activities against HepG2, A549 and MCF-7 cell lines with IC50 values of 3.56, 5.85 and 7.68 μM, respectively, compared to erlotinib as a reference drug with IC50 values of 0.87, 1.12 and 5.27 μM, respectively. Additionally, the effect of the most cytotoxic derivatives on EGFR inhibition was assessed. Compound 10b emerged as the most potent EGFR inhibitor with an IC50 value of 8.29 ± 0.04 nM, in comparison with that of erlotinib (IC50 = 2.83 ± 0.05 nM). Moreover, compound 10b arrested the cell growth in HepG2 cells at the G2/M phase and induced a significant increase in apoptotic cells. Finally, the binding patterns of the target derivatives were investigated by a docking study against the proposed molecular target (EGFR, PDB ID: 1M17).
Background. Esophageal cancer remains a major medical challenge since it belongs to the most aggressive malignant neoplasms, usually diagnosed at a late stage of the disease.
Purpose – Studying the general patterns of time course of esophageal cancer epidemiological status in terms of morbidity and mortality among the adult population of Ukraine within the period from 2014 to 2019.
Materials and Methods. General and standardized morbidity and mortality rates resulting from esophageal cancer from 2014 to 2019 throughout Ukraine and in terms of administrative territories per 100 thousand adult population have been researched along with calculating the growth rate. The study was carried out based on the data of National Cancer Registry of Ukraine.
Statistical processing of the obtained data was performed by means of generally accepted statistical methods.
Results and discussion. The all-Ukrainian incidence of esophageal cancer averaged 4.5 per 100 thousand population. Zhytomyr, Sumy and Chernihiv regions can be considered as the regions with the highest incidence of esophageal cancer. The lowest number of esophageal cancer cases was found in Chernivtsi and Odesa regions of Ukraine.
Esophageal cancer mortality rates ranged slightly from 3.3 to 3.6 per 100 thousand population, but it reduced by 8.3% within six years. Monitoring changes of esophageal cancer mortality rate over time, in 2014 and 2019 in Ivano-Frankivsk, Mykolaiv and Rivne regions and in Kyiv it increased by more than 20%. A 30% reduction in mortality was observed in Kirovohrad, Odesa, Kharkiv and Zhytomyr regions. In 2019, Odessa and Kirovograd could be considered the regions with a low mortality rate showing 2.1 per 100 thousand population. In 2018, 88% of esophageal cancer cases were diagnosed in men and only 12% in women. The vast majority of cancer patients were aged 50 to 80 years. Mortality from esophageal cancer was significantly higher in men (91.2%) compared to women.
Conclusions. The consistency of morbidity and mortality levels of esophageal cancer among the population of Ukraine during 2014-2019 has been established with insignificant regional disparities.
The colorectal cancer is the main causative factor for the morbidity and mortality in most of the developed countries. There are two main risk factors mainly associated with the colon cancer, first is dietary conditions and the second one is genetic factors. After surgical treatment of colon cancer, the overall survival rate is fifty percentages (50%) and half of the surgery experience has recurrence to patients. The present study has provided a collective systematic review from the previous literatures and the data retrieved from different sources (PubMed, Sci-finder, and Scopus). Diverse research findings from the different organizations were retrieved, collected, compiled, and written in a systematic manner. The review comprehensively covers different approaches of drug delivery that are burgeoning in colorectal cancer treatment. These various approaches of drug delivery based on different anti-cancer drugs formulation (5- fluorouracil, cucumin, doxorubicin, paclitaxel and their combinations) have been proven to be a successful chemotherapeutic approach. Despite of the advancements in surgery as well as in adjuvant therapies, there is no tremendous reduction in colorectal cancer allied mortality. The overall observations and outcomes of this review conclude use of varied novel drug delivery systems viz. nanocarriers-based approaches, nanotheranostics, gene therapy, radiotherapy and other new-fangled drug delivery systems for the treatment of colorectal cancer owing to their effectiveness and safety. The present review suggests that burden of colon cancer is enormously large enough and it should be dealt with apt advanced and promising treatment strategies.
Background. Radiation therapy is an essential in the complex of modern cancer care methods, since it is needed by more than half of cancer patients worldwide. However, each year more than 2 million people from low-income countries are unable to access modern radiotherapy technologies [1]. Thus, the urgent task in the field of radiation oncology is to increase the availability, quality and efficiency of radiotherapy, monitoring the level of technical, methodological and human resourcing of radiation therapy in Ukraine in accordance with trends in Europe and the world. The actual task of the study is to review and analyze the existing level, availability and effectiveness of applying the modern technologies of radiation therapy in the regions of Ukraine.
Purpose – analyzing the current state and level of availability of radiotherapy in Ukraine, seeking for opportunities to expand applying it.
Materials and methods. Analyzing and comparing statistical data of the National Cancer Registry of Ukraine and the information of IARC GLOBOCAN, IAEA DIRAC Database, summarizing the results.
Results. The level of technical and technological equipment as well as staffing of oncology centers of Ukraine has been analyzed, along with assessing quantitative and qualitative components of radiotherapy care in comparison with the average European indicators. The assessment of the state of radiotherapy care in Ukraine was carried out with due regard for the increasing number of patients.
Conclusions. According to the WHO, the structure of cancer incidence in Ukraine is similar to the European one, however higher specific mortality rate indicates, first of all, the insufficient level of covering the population of Ukraine by specialized diagnosis and oncological care, its low efficiency and engineering backwardness. It has been determined that radiation therapy in Ukraine is needed annually by at least 90 thousand cancer patients. In fact, only about 44 thousand of them are provided with tele-radiation therapy. First of all, this is due to extremely insufficient radiotherapy equipment available in Ukraine and using outdated radiation treatment technologies in gamma-ray teletherapy that result in its low quality and aggravating the clinical consequences. Given the growing number of cancer patients in 2022, Ukraine will need about 160 machines for tele-radiotherapy. The rise and adjusting the clinical and technical capabilities of regional oncology centers in terms of quality and efficiency of radiation therapy is possible under the conditions of their rapid technical.
Background: Ukraine, one of the largest states formed on the rubble of the Soviet Union, is widely perceived as a country that has lost its opportunities. Being devastated by corruption, it shows incapable to modernize and enter the economic path of sustainable growth. Similarly in the health care system no deeper reform efforts have been
taken in the entire post-soviet period, leaving the system in bonds of ineffective solutions taken out of the Soviet era.
Main body: The recent geopolitical and economic crisis seem to favor the introduction of radical solutions that might lead to a rapid change in the organizational paradigm of the economic system, as well as in health care in Ukraine. In this paper we aim to highlight the key features of the ongoing health reform in Ukraine, identify basic challenges for it, and assess rationality and feasibility of the reform. We found that the projected scope and schedule of changes in the
Ukrainian health system give promising prognosis regarding its final effect.
Conclusions: The final success of health reform in Ukraine is dependent on a number of factors, including the financial foundation arising of economic stability of the country, balance assurance between public and private spending for health and ability to eliminate the long-lasting practices, particularly when they are connected
with activities of lobbying groups occupying particular positions in the health system. A consequence of actions taken by the political decision-makers in the longer perspective are also to highly determine the reform’s chances for success.
Purpose:
The incidence of colorectal cancer (CRC) is increasing worldwide, and the greatest increase is in low- to middle-income countries, such as Ukraine. Better knowledge of epidemiology of CRC in Ukraine is needed to understand how best to decrease the burden of disease.
Methods:
The National Cancer Registry of Ukraine (NCRU) was queried for CRC incidence, mortality, stage, and treatment in Ukraine and assessed for regional variation from 1999 to 2015. Joinpoint analysis was used to analyze the trends.
Results:
The incidence of colon cancer increased from 10.6 to 13.3 occurrences per 100,000, which provided an average annual percent change (AAPC) of 1.48 (95% CI, 1.3 to 1.7; P < .05). The incidence of rectal and anal cancers also increased from 9.9 to 11.5 occurrences per 100,000, which provided an AAPC of 1.0 (95% CI, 0.8 to 1.3; P < .05). Mortality remained the same (AAPC, 0.1; 95% CI, -0.3 to 0.2; P = .4). The proportion of patients who received cancer-specific treatment increased from 54.6% to 68.5% for colon cancer and from 61% to 74.4% for rectal and anal cancers. Overall, 34.5% of patients with colon cancer and 27.5% of patients with rectal cancer died within a year of diagnosis in 2015. Great regional variations in 1-year mortality and treatment received were identified.
Conclusion:
The incidence of CRC in Ukraine is increasing. Despite stable mortality rates, many do not receive cancer-specific treatment, and a large proportion of patients die within a year of diagnosis. These findings illustrate the need to promote establishment of a screening program and to improve access to cancer-specific therapy in Ukraine.
Thyroid cancer incidence varies greatly between and within high‐income countries (HICs), and overdiagnosis likely plays a major role in these differences. Yet, little is known about the situation in low‐ and middle‐income countries (LMICs). We compare up‐to‐date thyroid cancer incidence and mortality at national and subnational levels. 599,851 thyroid cancer cases in subjects aged 20–74 reported in Cancer Incidence in Five Continents volume XI from 55 countries with at least 0.5 million population, aged 20–74 years, covered by population‐based cancer registration, and 22,179 deaths from the WHO Mortality Database for 36 of the selected countries, over 2008–2012, were included. Age‐standardized rates were computed. National incidence rates varied 50‐fold. Rates were 4 times higher among women than men, with similar patterns between countries. The highest rates (>25 cases per 100,000 women) were observed in the Republic of Korea, Israel, Canada, the United States, Italy, France, and LMICs such as Turkey, Costa Rica, Brazil, and Ecuador. Incidence rates were low (<8) in a few HICs (the Netherlands, the United Kingdom, and Denmark) and lowest (3–4) in some LMICs (such as Uganda and India). Within‐country incidence rates varied up to 45‐fold, with the largest differences recorded between rural and urban areas in Canada (HIC) and Brazil, India, and China (LMICs). National mortality rates were very low (<2) in all countries and in both sexes, and highest in LMICs. The very high thyroid cancer incidence and low mortality rates in some LMICs also strongly suggest a major role of overdiagnosis in these countries.
The Ukrainian–American (UkrAm) thyroid study is a cohort study of thyroid cancer and other thyroid pathologies in Ukrainian individuals exposed as children or adolescents to radioactive fallout from the Chernobyl accident. The 13,243 cohort members with direct thyroid radioactivity measurements taken in May–June 1986 were first screened in 1998–2000. During the period 2001–07, three additional biennial cycles of thyroid screening examinations were carried out. A fifth screening was conducted between 2012 and 2015, with 76.4% of the original cohort coming for examinations. As a result of this latest screening, 47 new pathologically confirmed thyroid cancers were diagnosed by the end of 2015. Preliminary analyses of the fifth cycle data show a statistically significant excess of radiation-related thyroid cancer 26–30 years after I-131 exposure. Further follow-up of the UkrAm cohort would help clarify the dose dependence and long-term temporal pattern of risk. In addition, pooling of data from the UkrAm and parallel Belarusian cohort (BelAm) could improve the precision of risk assessment of thyroid disease after exposure at young ages to I-131 in Chernobyl fallout.
PurposeTo describe epidemiologic patterns of childhood (0–14 years) lymphomas in the Southern and Eastern European (SEE) region in comparison with the Surveillance, Epidemiology and End Results (SEER), USA, and explore tentative discrepancies. Methods
Childhood lymphomas were retrieved from 14 SEE registries (n = 4,702) and SEER (n = 4,416), diagnosed during 1990–2014; incidence rates were estimated and time trends were evaluated. ResultsOverall age-adjusted incidence rate was higher in SEE (16.9/106) compared to SEER (13.6/106), because of a higher incidence of Hodgkin (HL, 7.5/106 vs. 5.1/106) and Burkitt lymphoma (BL, 3.1 vs. 2.3/106), whereas the incidence of non-Hodgkin lymphoma (NHL) was overall identical (5.9/106 vs. 5.8/106), albeit variable among SEE. Incidence increased with age, except for BL which peaked at 4 years; HL in SEE also showed an early male-specific peak at 4 years. The male preponderance was more pronounced for BL and attenuated with increasing age for HL. Increasing trends were noted in SEER for total lymphomas and NHL, and was marginal for HL, as contrasted to the decreasing HL and NHL trends generally observed in SEE registries, with the exception of increasing HL incidence in Portugal; of note, BL incidence trend followed a male-specific increasing trend in SEE. Conclusions
Registry-based data reveal variable patterns and time trends of childhood lymphomas in SEE and SEER during the last decades, possibly reflecting diverse levels of socioeconomic development of the populations in the respective areas; optimization of registration process may allow further exploration of molecular characteristics of disease subtypes.
Socioeconomic factors are associated with cancer incidence through complex and variable pathways. We assessed cancer incidence for all cancers combined and 27 major types according to national human development levels. Using GLOBOCAN data for 184 countries, age-standardized incidence rates (ASRs) were assessed by four levels (low, medium, high, very high) of the Human Development Index (HDI), a composite index of life expectancy, education, and gross national income. A strong positive relationship between overall cancer incidence and HDI level was observed. When comparing the ASR in very high HDI regions to that in low HDI regions, we observed a positive association ranging from 2-14 and 2-11 times higher in males and females, respectively, depending on the cancer type. Positive dose-response relationships between the ASR and HDI level were observed in both sexes for the following cancer types: lung, pancreas, leukemia, gallbladder, colorectum, brain/nervous system, kidney, multiple myeloma, and thyroid. Positive associations were also observed for testicular, bladder, lip/oral cavity, and other pharyngeal cancers, Hodgkin lymphoma, and melanoma in males, and corpus uteri, breast, and ovarian cancers and non-Hodgkin lymphoma in females. A negative dose-response relationship was observed for cervical and other pharyngeal cancers and Kaposi sarcoma in females. Although the relationship between incidence and the HDI remained when assessed at the country-specific level, variations in risk within HDI levels were also observed. We highlight positive and negative associations between incidence and human development for most cancers, which will aid the planning of cancer control priorities among countries undergoing human development transitions. This article is protected by copyright. All rights reserved.
This analysis of the Ukrainian health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance. Since the country gainedindependence from the Soviet Union in 1991, successive governments havesought to overcome funding shortfalls and modernize the health care systemto meet the needs of the population’s health. However, no fundamental reformof the system has yet been implemented and consequently it has preserved themain features characteristic of the Semashko model; there is a particularly highproportion of total health expenditure paid out of pocket (42.3% in 2012), andincentives within the system do not focus on quality or outcomes.The most recent health reform programme began in 2010 and sought tostrengthen primary and emergency care, rationalize hospitals and changethe model of health care financing from one based on inputs to one basedon outputs. Fundamental issues that hampered reform efforts in the pastre-emerged, but conflict and political instability have proved the greatestbarriers to reform implementation and the programme was abandoned in 2014.More recently, the focus has been on more pressing humanitarian concernsarising from the conflict in the east of Ukraine. It is hoped that greater political,social and economic stability in the future will provide a better environmentfor the introduction of deep reforms to address shortcomings in the Ukrainian health system.
Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer-related death among women worldwide. Herein, we examine global trends in female breast cancer rates using the most up-to-date data available.
Methods: Breast cancer incidence and mortality estimates were obtained from GLOBOCAN 2012 (globocan.iarc.fr). We analyzed trends from 1993 onward using incidence data from 39 countries from the International Agency for Research on Cancer and mortality data from 57 countries from the World Health Organization.
Results: Of 32 countries with incidence and mortality data, rates in the recent period diverged—with incidence increasing and mortality decreasing—in nine countries mainly in Northern/Western Europe. Both incidence and mortality decreased in France, Israel, Italy, Norway, and Spain. In contrast, incidence and death rates both increased in Colombia, Ecuador, and Japan. Death rates also increased in Brazil, Egypt, Guatemala, Kuwait, Mauritius, Mexico, and Moldova.
Conclusions: Breast cancer mortality rates are decreasing in most high-income countries, despite increasing or stable incidence rates. In contrast and of concern are the increasing incidence and mortality rates in a number of countries, particularly those undergoing rapid changes in human development. Wide variations in breast cancer rates and trends reflect differences in patterns of risk factors and access to and availability of early detection and timely treatment.
Impact: Increased awareness about breast cancer and the benefits of early detection and improved access to treatment must be prioritized to successfully implement breast cancer control programs, particularly in transitioning countries.
In November 2014, experts from 16 countries met at the International Agency for Research on Cancer (IARC) to assess the cancer-preventive and adverse effects of different methods of screening for breast cancer. (The members of the working group for volume 15 of the IARC Handbook are listed at the end of the article; affiliations are provided in the Supplementary Appendix, available with the full text of this article at NEJM.org.) This update of the 2002 IARC handbook on breast-cancer screening(1) is timely for several reasons. Recent improvements in treatment outcomes for late-stage breast cancer and concerns regarding overdiagnosis call for reconsideration. . . .
Euromelanoma is a dermatologist-led skin cancer prevention programme conducting an annual screening and public education campaign in over 20 European countries. Within its 10-year history, Euromelanoma has screened over 260,000 individuals across Europe, detecting a significant number of cutaneous melanomas and nonmelanoma skin cancers, identifying high-risk individuals for further surveillance and promoting awareness on the suspicious features of melanoma and the hazardous effects of ultraviolet exposure. In this review article, we summarize the history of the Euromelanoma campaign, present its organizational structure and discuss the results of the campaign in individual countries and on a European scale. Euromelanoma has had a significant impact on melanoma prevention and early diagnosis in participating countries and, despite many challenges, has positively influenced public health attitudes towards regular mole examination and the implementation of preventive measures against skin cancer.
full article: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2012.11092.x/pdf
As a result of the accident at the Chernobyl Nuclear Power Plant, millions of residents of Belarus, Russia, and Ukraine were exposed to large doses of radioactive iodine isotopes, mainly I-131. The purpose of the Ukraine-American (UkrAm) and Belarus-American (BelAm) projects are to quantify the risks of thyroid cancer in the framework of a classical cohort study, comprising subjects who were aged under 18 years at the time of the accident, had direct measurements of thyroid I-131 radioactivity taken within two months after the accident, and were residents of three heavily contaminated northern regions of Ukraine (Zhitomir, Kiev, and Chernigov regions). Four two-year screening examination cycles were implemented from 1998 until 2007 to study the risks associated with thyroid cancer due to the iodine exposure caused during the Chernobyl accident. A standardised procedure of clinical examinations included: thyroid palpation, ultrasound examination, blood collection followed by a determination of thyroid hormone levels, urinary iodine content test, and fine-needle aspiration if required. Among the 110 cases of thyroid cancer diagnosed in UkrAm as the result of four screening examinations, 104 cases (94.5%) of papillary carcinomas, five cases (4.6%) of follicular carcinomas, and one case (0.9%) of medullary carcinoma were diagnosed.
For the first time, a comparative analysis of thyroid cancer incidence in Ukraine after the Chernobyl accident was done in a cohort that is almost as large as the general population. On the basis of thyroid doses from radioactive iodine in individuals aged 1-18 years at the time of accident, geographic regions of Ukraine with low and high average accumulated thyroid doses were established and designated "low-exposure" and "high-exposure" territories, respectively. A significant difference of thyroid cancer incidence rates as a function of time between the two territories was found. That is, the increase in the incidence was higher in high-exposure regions than in low-exposure regions. The incidence rates varied substantially among the different attained age-groups, especially in the youngest one (up to 19 years old). The analysis that was adjusted for screening and technological effects also indicated that in the high-exposure regions, thyroid cancer incidence rates at the age of diagnosis of 5-9, 10-14 and 15-19 years were significantly higher in those born in 1982-1986 compared to those born in 1987-1991, while in the low-exposure regions, no significant difference was observed. The observed probable excess of radiation-induced thyroid cancer cases in adults exposed to radioactive iodine from the Chernobyl accident, especially in females, may be due to the high power of the present study. However, it should be noted that our investigation was not essentially free from ecological biases.
This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high‐quality cancer registry data, the basis for planning and implementing evidence‐based cancer control programs, are not available in most low‐ and middle‐income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1‐31. © 2018 American Cancer Society
Background:
Cancer notification has been mandatory in Ukraine since 1953, with the National Cancer Registry of Ukraine (NCRU) established in 1996. The aim of this study was to provide a comprehensive evaluation of the data quality at the NCRU.
Methods:
Qualitative and semi-quantitative methods were used to assess the comparability, completeness, validity and timeliness of cancer incidence data from the NCRU for the period 2002-2012.
Results:
Cancer registration procedures at the NCRU are in accordance with international standards and recommendations. Semi-quantitative methods suggested the NCRU's data was reasonably complete, although decreases in age-specific incidence and mortality rates in the elderly indicated some missing cases at older ages. The proportion of microscopically-verified cases increased from 73.6% in 2002 to 82.3% in 2012, with death-certificate-only (DCO) proportions stable at around 0.1% and unknown stage recorded in 9.6% of male and 7.5% of female solid tumours. Timeliness was considered acceptable, with reporting >99% complete within a turn-around time of 15 months.
Conclusion:
While timely reporting of national data reflects the advantages of a mandatory data collection system, a low DCO% and observed age-specific declines suggest possible underreporting of incidence and mortality data, particularly at older ages. Overall, the evaluation indicates that the data are reasonably comparable and thus may be used to describe the magnitude of the cancer burden in Ukraine. Given its central role in monitoring and evaluation of cancer control activities, ensuring the sustainability of NCRU operations throughout the process of healthcare system reform is of utmost importance.
Background:
We analysed trends in incidence for in situ and invasive melanoma in some European countries during the period 1995-2012, stratifying for lesion thickness.
Material and methods:
Individual anonymised data from population-based European cancer registries (CRs) were collected and combined in a common database, including information on age, sex, year of diagnosis, histological type, tumour location, behaviour (invasive, in situ) and lesion thickness. Mortality data were retrieved from the publicly available World Health Organization database.
Results:
Our database covered a population of over 117 million inhabitants and included about 415,000 skin lesions, recorded by 18 European CRs (7 of them with national coverage). During the 1995-2012 period, we observed a statistically significant increase in incidence for both invasive (average annual percent change (AAPC) 4.0% men; 3.0% women) and in situ (AAPC 7.7% men; 6.2% women) cases.
Discussion:
The increase in invasive lesions seemed mainly driven by thin melanomas (AAPC 10% men; 8.3% women). The incidence of thick melanomas also increased, although more slowly in recent years. Correction for lesions of unknown thickness enhanced the differences between thin and thick cases and flattened the trends. Incidence trends varied considerably across registries, but only Netherlands presented a marked increase above the boundaries of a funnel plot that weighted estimates by their precision. Mortality from invasive melanoma has continued to increase in Norway, Iceland (but only for elder people), the Netherlands and Slovenia.
Aim:
To present incidence of central nervous system (CNS) tumours among adolescents and young adults (AYAs; 15-39 years) derived from registries of Southern and Eastern Europe (SEE) in comparison to the Surveillance, Epidemiology and End Results (SEER), US and explore changes due to etiological parameters or registration improvement via evaluating time trends.
Methods:
Diagnoses of 11,438 incident malignant CNS tumours in AYAs (1990-2014) were retrieved from 14 collaborating SEE cancer registries and 13,573 from the publicly available SEER database (1990-2012). Age-adjusted incidence rates (AIRs) were calculated; Poisson and joinpoint regression analyses were performed for temporal trends.
Results:
The overall AIR of malignant CNS tumours among AYAs was higher in SEE (28.1/million) compared to SEER (24.7/million). Astrocytomas comprised almost half of the cases in both regions, albeit the higher proportion of unspecified cases in SEE registries (30% versus 2.5% in SEER). Similar were the age and gender distributions across SEE and SEER with a male-to-female ratio of 1.3 and an overall increase of incidence by age. Increasing temporal trends in incidence were documented in four SEE registries (Greater Poland, Portugal North, Turkey-Izmir and Ukraine) versus an annual decrease in Croatia (-2.5%) and a rather stable rate in SEER (-0.3%).
Conclusion:
This first report on descriptive epidemiology of AYAs malignant CNS tumours in the SEE area shows higher incidence rates as compared to the United States of America and variable temporal trends that may be linked to registration improvements. Hence, it emphasises the need for optimisation of cancer registration processes, as to enable the in-depth evaluation of the observed patterns by disease subtype.
Background
Marked variations exist in the incidence and mortality trends of major cancers in South-Eastern European (SEE) countries which have now been detailed by age for breast cancer (BC) to seek clues for improvement.
Methods
We brought together and analysed data from 14 cancer registries (CRs), situated in SEE countries or directly adjacent. Age-standardised rate at world standard (ASRw) and truncated incidence and mortality rates during 2000–2010 by year, and for four age groups, were calculated. Average annual percentage change of rates was estimated using Joinpoint regression.
Results
Annual incidence rates increased significantly in countries and age groups, by 2–4% (15–39 years), 2–5% (40–49), 1–4% (50–69) and 1–6% (at 70+). Mortality rates decreased significantly in all age-groups in most countries, but increased up to 5% annually above age 55 in Ukraine, Serbia, Moldova and Cyprus. The BC data quality was evaluated by internationally agreed indicators which appeared suboptimal for Moldova, Bosnia and Herzegovina and Romania.
Conclusion
The observed variations of incidence trends reflect the influence of risk factors, as well as levels of early detection activities (screening). While mortality rates were mostly decreasing, probably due to improved cancer care and introduction of more effective systemic treatment regimens, the worrying increasing mortality trends in the 55-plus age groups in some countries have to be addressed by health professionals and policymakers. In order to assess and monitor the effects of cancer control activities in the region, the CRs need substantial investments.
The increasing rates of kidney cancer incidence, reported in many populations globally, have been attributed both to increasing exposures to environmental risk factors, as well as increasing levels of incidental diagnosis due to widespread use of imaging. To better understand these trends, we examine long-term cancer registry data worldwide, focusing on the roles of birth cohort and calendar period, proxies for changes in risk factor prevalence and detection practice respectively. We used an augmented version of the Cancer Incidence in Five Continents series to analyse kidney cancer incidence rates 1978-2007 in 16 geographically representative populations worldwide by sex for ages 30-74, using age-period-cohort (APC) analysis. The full APC model provided the best fit to the data in most studied populations. While kidney cancer incidence appears to have been increasing in successive generations born from the early 20(th) century to mid-1970s in most countries, period-specific rates were increasing since late 1970-s, followed by a stabilization from the mid-1990s in certain European countries (Czech Republic, Lithuania, Finland, Spain) as well as Japan, and from the mid-2000s, in Colombia, Costa Rica and Australia. Our results indicate that the effects of both birth cohort and calendar period contribute to the international kidney cancer incidence trends. While cohort-specific increases may partly reflect the rising trends in obesity prevalence and the need for more effective primary prevention policies, the attenuations in period-specific increases (observed in 8 of the 16 populations) highlight a possible change in imaging practices that could lead to mitigation of overdiagnosis and overtreatment. This article is protected by copyright. All rights reserved.
By using data from the International Agency for Research on Cancer publication Cancer Incidence in 5 Continents and GLOBOCAN, this report provides the first consolidated global estimation of the subsite distribution of new cases of lip, oral cavity, and pharyngeal cancers by country, sex, and age for the year 2012. Major geographically based, sex-based, and age-based variations in the incidence of lip, oral cavity, and pharyngeal cancers by subsite were observed. Lip cancers were highly frequent in Australia (associated with solar radiation) and in central and eastern Europe (associated with tobacco smoking). Cancers of the oral cavity and hypopharynx were highly common in south-central Asia, especially in India (associated with smokeless tobacco, bidi, and betel-quid use). Rates of oropharyngeal cancers were elevated in northern America and Europe, notably in Hungary, Slovakia, Germany, and France and were associated with alcohol use, tobacco smoking, and human papillomavirus infection. Nasopharyngeal cancers were most common in northern Africa and eastern/southeast Asia, indicative of genetic susceptibility combined with Epstein-Barr virus infection and early life carcinogenic exposures (nitrosamines and salted foods). The global incidence of lip, oral cavity, and pharyngeal cancers of 529,500, corresponding to 3.8% of all cancer cases, is predicted to rise by 62% to 856,000 cases by 2035 because of changes in demographics. Given the rising incidence of lip, oral cavity, and pharyngeal cancers and the variations in incidence by subsites across world regions and countries, there is a need for local, tailored approaches to prevention, screening, and treatment interventions that will optimally reduce the lip, oral cavity, and pharyngeal cancer burden in future decades. CA Cancer J Clin 2016.
Background:
Cervical cancer incidence remains high in several Baltic, central, and eastern European (BCEE) countries, mainly as a result of a historical absence of effective screening programmes. As a catalyst for action, we aimed to estimate the number of women who could be spared from cervical cancer across six countries in the region during the next 25 years, if effective screening interventions were introduced.
Methods:
In this population-based study, we applied age-period-cohort models with spline functions within a Bayesian framework to incidence data from six BCEE countries (Estonia, Latvia, Lithuania, Belarus, Bulgaria, and Russia) to develop projections of the future number of new cases of cervical cancer from 2017 to 2040 based on two future scenarios: continued absence of screening (scenario A) versus the introduction of effective screening from 2017 onwards (scenario B). The timespan of available data varied from 16 years in Bulgaria to 40 years in Estonia. Projected rates up to 2040 were obtained in scenario A by extrapolating cohort-specific trends, a marker of changing risk of human papillomavirus (HPV) infection, assuming a continued absence of effective screening in future years. Scenario B added the effect of gradual introduction of screening in each country, under the assumption period effects would be equivalent to the decreasing trend by calendar year seen in Denmark (our comparator country) since the progressive regional introduction of screening from the late 1960s.
Findings:
According to scenario A, projected incidence rates will continue to increase substantially in many BCEE countries. Very high age-standardised rates of cervical cancer are predicted in Lithuania, Latvia, Belarus, and Estonia (up to 88 cases per 100 000). According to scenario B, the beneficial effects of effective screening will increase progressively over time, leading to a 50-60% reduction of the projected incidence rates by around 2040, resulting in the prevention of cervical cancer in 1500 women in Estonia and more than 150 000 women in Russia. The immediate launch of effective screening programmes could prevent almost 180 000 new cervical cancer diagnoses in a 25-year period in the six BCEE countries studied.
Interpretation:
Based on our findings, there is a clear need to begin cervical screening in these six countries as soon as possible to reduce the high and increasing incidence of cervical cancer over the next decades.
Funding:
None.
Dramatic increases have been seen over recent decades in the reported incidence of thyroid cancer, but owing to new modes of screening, hundreds of thousands of cases may be overdiagnoses - diagnosis of tumors that would not, if left alone, result in symptoms or death.
Context:
Bladder cancer has become a common cancer globally, with an estimated 430 000 new cases diagnosed in 2012.
Objective:
We examine the most recent global bladder cancer incidence and mortality patterns and trends, the current understanding of the aetiology of the disease, and specific issues that may influence the registration and reporting of bladder cancer.
Evidence acquisition:
Global bladder cancer incidence and mortality statistics are based on data from the International Agency for Research on Cancer and the World Health Organisation (Cancer Incidence in Five Continents, GLOBOCAN, and the World Health Organisation Mortality).
Evidence synthesis:
Bladder cancer ranks as the ninth most frequently-diagnosed cancer worldwide, with the highest incidence rates observed in men in Southern and Western Europe, North America, as well in certain countries in Northern Africa or Western Asia. Incidence rates are consistently lower in women than men, although sex differences varied greatly between countries. Diverging incidence trends were also observed by sex in many countries, with stabilising or declining rates in men but some increasing trends seen for women. Bladder cancer ranks 13th in terms of deaths ranks, with mortality rates decreasing particularly in the most developed countries; the exceptions are countries undergoing rapid economic transition, including in Central and South America, some central, southern, and eastern European countries, and the Baltic countries.
Conclusions:
The observed patterns and trends of bladder cancer incidence worldwide appear to reflect the prevalence of tobacco smoking, although infection with Schistosoma haematobium and other risk factors are major causes in selected populations. Differences in coding and registration practices need to be considered when comparing bladder cancer statistics geographically or over time.
Patient summary:
The main risk factor for bladder cancer is tobacco smoking. The observed patterns and trends of bladder cancer incidence worldwide appear to reflect the prevalence of tobacco smoking.
Abstract
Aim
Following completion of the first 5-year nationwide childhood (0–14 years) registration in Greece, central nervous system (CNS) tumour incidence rates are compared with those of 12 registries operating in 10 Southern–Eastern European countries.
Methods
All CNS tumours, as defined by the International Classification of Childhood Cancer (ICCC-3) and registered in any period between 1983 and 2014 were collected from the collaborating cancer registries. Data were evaluated using standard International Agency for Research on Cancer (IARC) criteria. Crude and age-adjusted incidence rates (AIR) by age/gender/diagnostic subgroup were calculated, whereas time trends were assessed through Poisson and Joinpoint regression models.
Results
6062 CNS tumours were retrieved with non-malignant CNS tumours recorded in eight registries; therefore, the analyses were performed on 5191 malignant tumours. Proportion of death certificate only cases was low and morphologic verification overall high; yet five registries presented >10% unspecified neoplasms. The male/female ratio was 1.3 and incidence decreased gradually with age, apart from Turkey and Ukraine. Overall AIR for malignant tumours was 23/106 children, with the highest rates noted in Croatia and Serbia. A statistically significant AIR increase was noted in Bulgaria, whereas significant decreases were noted in Belarus, Croatia, Cyprus and Serbia. Although astrocytomas were overall the most common subgroup (30%) followed by embryonal tumours (26%), the latter was the predominant subgroup in six registries.
Conclusion
Childhood cancer registration is expanding in Southern–Eastern Europe. The heterogeneity in registration practices and incidence patterns of CNS tumours necessitates further investigation aiming to provide clues in aetiology and direct investments into surveillance and early tumour detection.
Renal cell carcinoma (RCC) incidence rates are higher in developed countries, where up to half of the cases are discovered incidentally. Declining mortality trends have been reported in highly developed countries since the 1990s.
To compare and interpret geographic variations and trends in the incidence and mortality of RCC worldwide in the context of controlling the future disease burden.
We used data from GLOBOCAN, the Cancer Incidence in Five Continents series, and the World Health Organisation mortality database to compare incidence and mortality rates in more than 40 countries worldwide. We analysed incidence and mortality trends in the last 10 yr using joinpoint analyses of the age-standardised rates (ASRs).
RCC incidence in men varied in ASRs (World standard population) from approximately 1/100 000 in African countries to >15/100 000 in several Northern and Eastern European countries and among US blacks. Similar patterns were observed for women, although incidence rates were commonly half of those for men. Incidence rates are increasing in most countries, most prominently in Latin America. Although recent mortality trends are stable in many countries, significant declines were observed in Western and Northern Europe, the USA, and Australia. Southern European men appear to have the least favourable RCC mortality trends.
Although RCC incidence is still increasing in most countries, stabilisation of mortality trends has been achieved in many highly developed countries. There are marked absolute differences and opposing RCC mortality trends in countries categorised as areas of higher versus lower human development, and these gaps appear to be widening.
Renal cell cancer is becoming more commonly diagnosed worldwide in both men and women. Mortality is decreasing in the most developed settings, but not in low- and middle-income countries, where access to and the availability of optimal therapies are likely to be limited.
Copyright © 2014. Published by Elsevier B.V.
Human papillomavirus (HPV) has been identified as the cause of the increasing oropharyngeal cancer (OPC) incidence in some countries. To investigate whether this represents a global phenomenon, we evaluated incidence trends for OPCs and oral cavity cancers (OCCs) in 23 countries across four continents.
We used data from the Cancer Incidence in Five Continents database Volumes VI to IX (years 1983 to 2002). Using age-period-cohort modeling, incidence trends for OPCs were compared with those of OCCs and lung cancers to delineate the potential role of HPV vis-à-vis smoking on incidence trends. Analyses were country specific and sex specific.
OPC incidence significantly increased during 1983 to 2002 predominantly in economically developed countries. Among men, OPC incidence significantly increased in the United States, Australia, Canada, Japan, and Slovakia, despite nonsignificant or significantly decreasing incidence of OCCs. In contrast, among women, in all countries with increasing OPC incidence (Denmark, Estonia, France, the Netherlands, Poland, Slovakia, Switzerland, and United Kingdom), there was a concomitant increase in incidence of OCCs. Although increasing OPC incidence among men was accompanied by decreasing lung cancer incidence, increasing incidence among women was generally accompanied by increasing lung cancer incidence. The magnitude of increase in OPC incidence among men was significantly higher at younger ages (< 60 years) than older ages in the United States, Australia, Canada, Slovakia, Denmark, and United Kingdom.
OPC incidence significantly increased during 1983 to 2002 predominantly in developed countries and at younger ages. These results underscore a potential role for HPV infection on increasing OPC incidence, particularly among men.
Individual country- and cancer site-specific studies suggest that the age-adjusted incidence of many common cancers has increased in European populations over the past two decades. To quantify the extent of these trends and the recent burden of cancer, here we present a comprehensive overview of trends in population-based incidence of the five common cancers across Europe derived from a new web-based portal of the European cancer registries.
Data on incidence for cancers of the colon and rectum, prostate, breast, corpus uteri and stomach diagnosed from 1988 to 2008 were obtained from the European Cancer Registry (EUREG) database for cancer registries from 26 countries. Annual age-standardised incidence rates and average annual percentage changes were calculated.
Incidence of four common cancers in eastern and central European countries (prostate, postmenopausal breast, corpus uteri and colorectum) started to approach levels in northern and western Europe, where rates were already high in the past but levelled off in some countries in recent years. Decreases in stomach cancer incidence were seen in all countries.
Increasing trends in incidence of the most common cancers, except stomach cancer, are bad news to public health but can largely be explained by well-known changes in society in the past decades. Thus, current and future efforts in primary cancer prevention should not only remain focussed on the further reduction of smoking but engage in the long-term efforts to retain healthy lifestyles, especially avoiding excess weight through balanced diets and regular physical exercise.
Across Europe, there are over 300,000 new cases of colorectal cancer annually. Major risk factors include excess body weight (usually expressed by a high body mass index, BMI) and physical inactivity (PA). In this study we modelled the potential long-term effects on colon cancer incidence of changes in prevalence of excess body weight and physical inactivity in seven European countries across Europe with adequate data.
We addressed the impact of interventions aimed at preventing weight gain and increasing physical activity on colon cancer incidence using the Prevent model as refined in the FP-6 Eurocadet project. Relative risk (RR) estimates were derived from meta-analyses; sex- and country-specific prevalences of BMI and PA were determined from survey data. Models were made for Czech Republic, Denmark, France, Latvia, the Netherlands, Spain and the United Kingdom.
In a hypothetical scenario in which a whole population had obtained an ideal weight distribution in the year 2009, up to 11 new cases per 100,000 person-years would be avoided by 2040. The population attributable fractions (PAF) for excess weight were much higher for males (between 13.5% and 18.2%) than for females (2.3-4.6%). In contrast, using the optimum scenario where everybody in Europe would adhere to the recommended guideline of at least 30 min of moderate PA 5d per week, the PAFs for PA in various countries were substantially greater in women (4.4-21.2%) than in men (3.2-11.6%). Sensitivity analyses were performed assuming underreporting of BMI by using self-reports (difference of 5 and 0.8 percent-points in males and females, respectively), using different risk estimates (between 5.8 and 11.5 percent-points difference for BMI for men and women, respectively, and up to 11.6 percent-points difference for PA for women).
Changes in lifestyle can indeed result in large health benefits, including for colon cancer. Two interesting patterns emerged: for colon cancer, achieving optimum BMI levels in the population appears to offer the greatest health benefits in population attributable fractions in males, while increased physical activity might offer the greatest fraction of avoidable cancers in females. These observations suggest a sex-specific strategy to colon cancer prevention.
The completeness of cancer registry data -- the extent to which all of the incident cancers occurring in the population are included in the registry database -- is an extremely important attribute of a cancer registry. Only a high degree of completeness in case-finding procedures will ensure cancer incidence rates and survival proportions are close to their true value. This second instalment of a two-part review of data quality methods at the cancer registry, focuses on the principles and techniques available for estimating completeness, separating methods into those that are semi-quantitative -- in that they give an indication of the degree of completeness relative to other registries or over time, and more quantitative techniques -- those that provide a numerical evaluation of the extent to which all eligible cases have been registered.
The value of the modern cancer registry and its ability to carry out cancer control activities rely heavily on the underlying quality of its data and the quality control procedures in place. This two-part review provides an update of the practical aspects and techniques for addressing data quality at the cancer registry. This first installment of the review examines the factors influencing three of the four key aspects, namely, the comparability, validity and timeliness of cancer registry data. Comparability of cancer data may be established through a comprehensive review of the registration routines in place. Validity is examined via numerical indices of that permit comparisons with other registries, or, within a registry, over time, or with respect to specified subsets of cases. There are no international guidelines for timeliness at present, although specific standards for the abstraction and reporting of registry have been set out by certain organisations.
Lip cancer (140 ICD-9) is a form of oral cancer that has a distinctive global epidemiology. This review summarises global incidence rates for male and female lip cancer with the aid of cancer atlases. High male lip cancer rates are reported for regions of North America (12.7 per 100 000 per annum), Europe (12.0 per 100 000 per annum) and Oceania (13.5 per 100 000 per annum), while it is virtually unknown in parts of Asia. Factors commonly cited as important in the aetiology of lip cancer include solar radiation, tobacco smoking and viruses. An attempt is made to summarise the evidence for factors that may be important in lip carcinogenesis. While incidence rates are generally stable or falling among males worldwide, they are rising in many female populations. The aetiology of the disease is far from established and much information regarding its pathogenesis is based on anecdotal rather than case-controlled epidemiological evidence. The epidemiology of lip cancer supports the proposal that the lip should be considered as a distinct cancer site, rather than being included with other forms of intraoral cancer.
The paper compares three different methods for performing disease incidence prediction based on simple interpolation techniques. The first method assumes that the age-period specific numbers of observed cases follow a Poisson distribution and the other two methods assume a normal distribution for the incidence rates. The main emphasis of the paper is on assessing the reliability of the three methods. For this purpose, ex post predictions produced by each method are checked for different cancer sites using data from the Cancer Control Region of Turku in Finland. In addition, the behaviour of the estimators of predicted expected values and prediction intervals, crucial for investigation of the reliability of prediction, are assessed using a simulation study. The prediction method making use of the Poisson assumption appeared to be the most reliable of the three approaches. The simulation study found that the estimator of the length of the prediction interval produced by this method has the smallest coverage error and is the most precise.
To assess the evolution and patterns of obesity in countries of the WHO European Region with a particular focus on the Eastern European countries, and to discuss the health and economic implications of obesity for those countries.
The available data on overweight and obesity in children and adults for the countries of the WHO European countries were collated from the International Obesity TaskForce database and considered in the light of estimates for the costs of obesity-related ill health.
Overweight and obesity in most countries of Europe show rising secular trends, and are predicted to continue rising if not addressed. Estimates of the costs to the health services and to economic productivity indicate that some countries may find it hard to cope with the burden of obesity: up to 6% of total health care costs and as much in indirect costs of lost productivity could be attributed to obesity and its associated illnesses.
Transition, despite the many benefits it has undoubtedly conferred to the population living in the Region, has also entailed the collateral damage of a fast growing obesity challenge. Policy-makers in the new and candidate EU countries as well as other countries of the European Region can learn from the negative Western European and global experience, act now to stem the obesity epidemic from further developing and in so doing, reduce the substantial economic losses associated with obesity. Local, national and international strategies will be needed to combat the problem.
We examine the theoretical basis of screening, followed by an evaluation of screening initiatives from a population health perspective and a discussion of the organisation of mass screening programmes. Evidence for the effectiveness of screening by primary site from both randomised trials and evaluation of service screening is summarised and the existing cancer screening programmes in the European Union are described. Sufficient evidence from several randomised trials to demonstrate mortality reduction exists for breast cancer and colorectal cancer screening. At least one trial has shown efficacy with a mortality end-point in screening for hepatocellular carcinoma and oral cancer. Randomised trials have demonstrated a lack of mortality effect in lung cancer screening based on chest X-ray and sputum cytology. Despite the lack of randomised trials, population screening for cervical cancer with cytological smears has been convincingly shown to reduce cervical cancer incidence and mortality.
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