F. Bray’s research while affiliated with International Agency for Research on Cancer and other places

Estimates of the worldwide incidence and mortality from 36 cancers and for all cancers combined for the year 2018 are now available in the GLOBOCAN 2018 database, compiled and disseminated by the International Agency for Research on Cancer (IARC). This paper reviews the sources and methods used in compiling the cancer statistics in 185 countries. The validity of the national estimates depends upon the representativeness of the source information, and to take into account possible sources of bias, uncertainty intervals are now provided for the estimated sex‐ and site‐specific all‐ages number of new cancer cases and cancer deaths. We briefly describe the key results globally and by world region. There were an estimated 18.1 million (95% UI: 17.5–18.7 million) new cases of cancer (17 million excluding non‐melanoma skin cancer) and 9.6 million (95% UI: 9.3–9.8 million) deaths from cancer (9.5 million excluding non‐melanoma skin cancer) worldwide in 2018.

Background and context: Cancer control requires knowledge of cancer incidence. Information on anatomic extent of disease (stage) at presentation significantly enhances incidence and mortality data in understanding the cancer burden. The most frequently used staging classification of cancer disease extent is the tumor, node, metastases (TNM). Population-based registries (PBCR) in low- and middle-income countries (LMIC) frequently have insufficient information to derive complete TNM data, either because of inability to perform the necessary evaluations or because of a lack of recorded information. Aim: To develop a simplified system of recording extent of disease to facilitate the collection of stage data by PBCR and enhance the utility of data to facilitate cancer control in LMICs. Strategy/Tactics: A working group with representatives from the UICC (Union for International Cancer Control), the IARC (International Agency for Cancer Research), IACR (International Association of Cancer Registries) and the NCI (National Cancer Institute) was formed and Essential TNM was developed. When the T, N, and M categories have not been recorded in the clinical records or if the complete data to determine the categories is unavailable, the cancer registrar can code extent of disease according to the Essential TNM scheme. Once a cancer registrar had identifies the presence of metastatic disease (M1) this is recorded and additional information is unnecessary to establish that stage of disease. If there is no metastatic disease the extent of nodal disease is recorded. In turn if there is no nodal disease the extent/size of the primary carcinoma is recorded. The extent of disease can be summarized in the following order: M, N and T. Program/Policy process: Diagrams and rules for combining Essential TNM elements into stage groups (I-IV) or to be expressed as “distant”, “regional” or “localized” if only the most limited data were available, were developed for breast, cervix, prostate and colon cancers and will be demonstrated. Once the schema were developed they were verified in Georgia (USA) and field tested in Ecuador, Malawi, Cote d'Ivoire and Zimbabwe. Outcomes: There was good agreement between the stage identified through Essential TNM and that within the Georgia State Registry. The field tests however identified three key issues: the underidentification of distant metastases, inaccurate the collection of lymph node data and improved training needs. In particular there was uncertainty in the identification of when lymph node involvement was considered to be distant metastatic or regional. In view of this, refinements to the schemas have been made to simplify the collection of nodal data. The schema have been updated to ensure compatibility with the 8th edition of TNM. Training programs are being developed and Essential TNM is being expanded. What was learned: Essential TNM can be used by LMIC PBCR to facilitate the collection of stage data. Further refinements and training are needed and are underway.

Introduction: Europe contains 9% of the world population but has a 25% share of the global cancer burden. Up-to-date cancer statistics in Europe are key to cancer planning. Cancer incidence and mortality estimates for 25 major cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for Europe and the European Union (EU-28) for 2018. Methods: Estimates of national incidence and mortality rates for 2018 were based on statistical models applied to the most recently published data, with predictions obtained from recent trends, where possible. The estimated rates in 2018 were applied to the 2018 population estimates to obtain the estimated numbers of new cancer cases and deaths in Europe in 2018. Results: There were an estimated 3.91 million new cases of cancer (excluding non-melanoma skin cancer) and 1.93 million deaths from cancer in Europe in 2018. The most common cancer sites were cancers of the female breast (523,000 cases), followed by colorectal (500,000), lung (470,000) and prostate cancer (450,000). These four cancers represent half of the overall burden of cancer in Europe. The most common causes of death from cancer were cancers of the lung (388,000 deaths), colorectal (243,000), breast (138,000) and pancreatic cancer (128,000). In the EU-28, the estimated number of new cases of cancer was approximately 1.6 million in males and 1.4 million in females, with 790,000 men and 620,000 women dying from the disease in the same year. Conclusion: The present estimates of the cancer burden in Europe alongside a description of the profiles of common cancers at the national and regional level provide a basis for establishing priorities for cancer control actions across Europe. The estimates presented here are based on the recorded data from 145 population-based cancer registries in Europe. Their long established role in planning and evaluating national cancer plans on the continent should not be undervalued.

Summary Background Leukaemia is a heterogeneous group of haemopoietic cancers that comprises a number of diverse and biologically distinct subgroups. We examine the leukaemia burden worldwide and highlight the distinct incidence patterns in order to elucidate explanatory factors that may support preventive measures and health resource planning. We aimed to estimate the global burden of leukaemia incidence according to the four major subtypes stratified by age and sex. Methods In this population-based study, we assessed leukaemia incidence for the major subtypes using the Cancer Incidence in Five Continents Volume X (CI5-X), which includes data from 290 cancer registries in 68 countries covering the diagnostic period 2003–07, for all ages and both sexes. We then extracted counts and incidence rates in 184 countries for the year 2012 from IARC’s GLOBOCAN database of national estimates. We calculated age-specific incidence rates per 100 000 person-years and age-standardised rates (ASRs) using the world standard population by country, sex, age group, and where applicable, by major subtypes. We excluded from all analyses registries for which the total number of leukaemia cases was less than 100 or the proportion of microscopically verified (MV%) cases was less than 80% (2572 cases). Findings 717 863 cases between 2003–07 were included in this analysis. More than 350 000 new leukaemia cases were estimated in 2012. We observed substantial variation in incidence between and within world regions. The highest leukaemia incidence rates for both sexes were estimated in Australia and New Zealand (ASR per 100000 11·3 in males and 7·2 in females), Northern America (10·5 in males and 7·2 in females), and western Europe (9·6 in males and 6·0 in females), and the lowest was in in western Africa (1·4 in males and 1·2 in females). Rates were generally higher in males than females with an overall male to female ratio of 1·4. In children, acute lymphoblastic leukaemia was the main subtype in all studied countries in both sexes, and characterised by a bimodal age-specific pattern. The subtype distribution was more diverse in adults, with a relatively higher proportion of chronic lymphocytic leukaemia in most European and North American countries, whereas rates of acute lymphoblastic leukaemia remained relatively high among adults in selected South American, Caribbean, Asian, and African populations.

Introduction Colorectal cancer (CRC) is one of most common cause of cancer death worldwide. Mortality rate from CRC has been decreasing in many high-income countries yet in many low and middle-income countries its rate continues to rise. The lack of resources and basic health infrastructure may face many developing countries with important challenges to decrease the CRC mortality rates. Past trends and future predictions of CRC mortality can inform health planners and raise awareness of the need for cancer control action. Methods Numbers of deaths from malignant neoplasms of the colon (ICD-10 C18) and the rectum (C19–21) were obtained from the World Health Organization (WHO) mortality database for the period 1988–2012, by year, sex and age for 49 countries, where high quality data were available for the period of interest. To predict numbers of deaths and mortality rates of colon and rectal cancer up to 2035, we fitted a log-linear age–period–cohort model. We reported both numbers of expected deaths and age-standardized mortality rates per 100,000 person-years for the total population studied as well as country and subsite. Results Mortality rates for colon and rectal cancer are predicted to continue decreasing in most populations studied (32 out of 49 countries), except for most countries in Latin America and the Caribbean. Where rates have decreased in the past, colon cancer mortality rates for these countries combined was 7.2 in 2012 and is expected to be 6.6 per 100,000 person-years in 2035. In countries where rates have increased, the rate was 6.7 in 2012 and will be 7.4 by 2035. In most countries where colon cancer rates have decreased, we also predicted a decline in future rectal cancer mortality (ASR: 3.5 in 2012 and 3.2 in 2035), except, in Ireland, United Kingdom, Australia, Canada and United States, where age-standardized rates are predicted to increase by 2035 (ASR 4.1 vs. 2.9 in 2012). Despite contrasting trends in rates, number of deaths is expected to rise for both colon and rectal cancer in all countries (colon cancer: from 203,690, to 304,440 between 2012 and 2035 (+49.4%), respectively, and rectal cancer: 85,547, and 136,948 in 2012, and 2035, (+60.0%) respectively). Conclusions We highlight further decline in colon and rectal cancer mortality rates in most of countries studied, which however will not compensate the expected rise in number of deaths from this cancer, mainly due to population ageing and growth. Projected reductions of colon and rectal cancer mortality rates in Europe, North America and Oceania are partly related to earlier detection and improved cancer management. The predicted increases in rectal cancer mortality rates in some developed countries are worrisome and warrant further investigations.

Introduction In 2012, about half of all new cancer diagnoses and deaths were estimated to occur among people age 65 years and older; these will be around two third by 2035. Assessing trends in cancer incidence and mortality in this growing population is of great importance to understand the impact of cancer on this vulnerable population and to design cancer control and management plans. We therefore described temporal trends in incidence and mortality for the most common cancers–i.e. breast, prostate, colorectal and lung cancers–in adults aged 65 years or older in 17 countries with long history of population-based cancer registration. Methods Data on incidence for cancers of the colorectum, breast, prostate and lung from 1983 to 2012 were obtained from the Cancer Incidence in Five Continents in17 countries in Asia, northern America, central and south America, northern Europe, western and southern Europe and Oceania. Cancer mortality data were obtained from the World Health Organization mortality database. Country- and sex-specific truncated age-standardized rates (65 + ) and average annual percentage changes were calculated. Results Between 1983 and 2012, incidence rates of colorectal cancer have increased between +0.4–22% on average annually in older males and between +0.0–15.7% in older females in most countries under study, while incidence rate has significantly decreased in USA (−8.3% in females and −10.6% in males). In contrast, mortality from colorectal cancer has decreased in all countries from −10.5% in Switzerland to −0.8% in Singapore but it has significantly increased in Costa Rica (+5.5% in males and 2.8% in females) and Spain (8.7% in males and +1.6% in females). The incidence of prostate and breast cancers has increased in almost all countries between 2.6% in Canada and +38.8% in Japan for prostate cancer and between +1.1% in USA and 19.4% in Japan for breast cancer. However, prostate and breast cancer mortality rates have decreased in most countries, except in Costa Rica (+4.5% and +3.3% for prostate and breast cancers respectively), Japan (+8.6% and +13.4%) and Singapore (+9.4% and +6.1%). In almost all countries, incidence and mortality rates for lung cancer have greatly increased in females over the 30-year period following the smoking epidemic pattern (from 5.2% and 0.7% respectively in Japan to 35.8% and 26.0%, respectively in Netherlands), while lung cancer in males are largely decreasing, notably in UK, Netherlands and Finland (> −10% per year on average for incidence and mortality rates). Conclusion Decreasing deaths from cancer in older adults might probably be related to earlier cancer detection and better management. Yet, the rising incidence of the most common cancer sites will increase strain in national health care resources and therefore prevention programs needs to be strengthen. The expected rise in the number of new older cancer patients must encourage the development of geriatric oncology worldwide.

Background Ovarian cancer is the seventh most common cancer worldwide. Historically, the incidence of ovarian cancer in Europe and North America had been higher compared to other regions of the world. Among European countries, the incidence of ovarian cancer has steadily declined over the years, nevertheless, countries in Europe continues to have the highest incidence of ovarian cancer. The aim of the study is to provide an overview of ovarian cancer incidence trends for high-income countries that are currently part of the Cancer Survival in High-Income Countries (SURVMARK-2) project. These countries include Norway, Denmark, Ireland, the United Kingdom, Canada, Australia and New Zealand. In addition, an age-period-cohort (APC) analysis was also conducted utilizing data from population-based cancer registries from these seven countries. Methods Ovarian cancer incidence rates were calculated using data from three sources, namely, SURVMARK-2, the Cancer Incidence in Five Continents database (CI5plus), and the European cancer registries (EUREG) database. The study contains all available years included in the databases until 2014, with Norway and Denmark having the longest study periods (1953–2014). The overall age-standardized incidence rates for ovarian cancer in women aged 20 and above were computed per year. SURVMARK-2 was utilized to calculate the incidence rates from 1995 to 2014. Incidence rates prior to 1995 were then derived from the CI5plus and the EUREG databases. Additionally, the estimated annual percent change (EAPC) between 1999 and 2013 was calculated for all women age 20 and above, women age 25–49 years and 50–74 years. Lastly, the data was grouped into 5-year age groups starting with 20–24 through 70–74 years, and APC analysis was performed to examine the effects of birth cohort and period. In addition, the goodness-of-fit of the models were assessed and the likelihood ratio test was used for APC model comparison. Results In general, Norway, Denmark, Ireland and the United Kingdom, consistently had higher incidence of ovarian cancer compared to non-European countries. Nevertheless, the incidence trends revealed decreasing incidence trends of ovarian cancer in all countries evaluated. Additionally, in the last 15-year period of the study, the overall incidence rate of ovarian cancer has generally been stable. Between 1999 and 2013 the highest decline of ovarian incidence rate was observed in Norway (EAPC: −1.9, 95% CI: −4.0, 0.4). Incidences of ovarian cancer in 25–49 years and 50–74 years age groups have also declined for most countries. Notably, among the age group 25–49 years, a statistically significant decline of ovarian cancer incidence rate was observed in Norway (EAPC: −4.2, 95% CI: −7.7, −0.6). In contrast, a modest increase of incidence rate in Canada (EAPC: 1.8, 95% CI: −2.2, 5.9) was observed in this age group. Moreover, the United Kingdom (EAPC: −1.8, 95% CI: −3.3, −0.3) had statistically significant decline of incidence rates among women 50–74 years. In addition, the APC analysis yielded the full APC model as the best fitting model for all countries. After adjusting for the period effect, a statistically significant cohort effect (P < 0.001) was observed in all countries included in the study. Furthermore, the United Kingdom (P < 0.001), Norway (P = 0.019) and Canada (P = 0.019) also exhibited a significant period effect after adjusting for the cohort effect. Conclusion In summary, a gradual decline of ovarian cancer was observed for all countries in the study. The birth cohort effect observed in the study may be linked to the changes in the prevalence of ovarian cancer risk factors, such as the use of oral contraceptive pill. In the other hand, the period effect observed may be explained partly by changes in disease classifications and cancer registry practices.