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Abstract: In international comparisons of cancer registry based survival it is common practice to restrict the analysis to first primary tumours and exclude multiple cancers. The probability of correctly detecting subsequent cancers depends on the registry’s running time, which results in different proportions of excluded patients and may lead to biased comparisons. We evaluated the impact on the age-standardised relative survival estimates of also including multiple primary tumours. Data from 2,919,023 malignant cancers from 69 European cancer registries participating in the EUROCARE-4 collaborative study were used. A total of 183,683 multiple primary tumours were found, with an overall proportion of 6.3% over all the considered cancers, ranging from 0.4% (Naples, Italy) to 12.9% (Iceland). The proportion of multiple tumours varied greatly by type of tumour, being higher for those with high incidence and long survival (breast, prostate and colon-rectum). Five-year relative survival was lower when including patients with multiple cancers. For all cancers combined the average difference was –0.4 percentage points in women and –0.7 percentage points in men, and was greater for older registries. Inclusion of multiple tumours led to lower survival in 44 out of 45 cancer sites analysed, with the greatest differences found for larynx (–1.9%), oropharynx (–1.5%), and penis (–1.3%). Including multiple primary tumours in survival estimates for international comparison is advisable because it reduces the bias due to different observation periods, age, registration quality and completeness of registration. The general effect of inclusion is to reduce survival estimates by a variable amount depending on the proportion of multiple primaries and cancer site. [Copyright &y& Elsevier]

Abstract: The present study is aimed to compare survival and prognostic changes over time between elderly (70–84 years) and middle-aged cancer patients (55–69 years). We considered seven cancer sites (stomach, colon, breast, cervix and corpus uteri, ovary and prostate) and all cancers combined (but excluding prostate and non-melanoma skin cancers). Five-year relative survival was estimated for cohorts of patients diagnosed in 1988–1999 in a pool of 51 European populations covered by cancer registries. Furthermore, we applied the period-analysis method to more recent incidence data from 32 cancer registries to provide 1- and 5-year relative survival estimates for the period of follow-up 2000–2002. A significant survival improvement was observed from 1988 to 1999 for all cancers combined and for every cancer site, except cervical cancer. However, survival increased at a slower rate in the elderly, so that the gap between younger and older patients widened, particularly for prostate cancer in men and for all considered cancers except cervical cancer in women. For breast and prostate cancers, the increasing gap was likely attributable to a larger use of, respectively, mammographic screening and PSA test in middle-aged with respect to the elderly. In the period analysis of the most recent data, relative survival was much higher in middle-aged patients than in the elderly. The differences were higher for breast and gynaecological cancers, and for prostate cancer. Most of this age gap was due to a very large difference in survival after the 1st year following the diagnosis. Differences were much smaller for conditional 5-year relative survival among patients who had already survived the first year. The increase of survival in elderly men is encouraging but the lesser improvement in women and, in particular, the widening gap for breast cancer suggest that many barriers still delay access to care and that enhanced prevention and clinical management remain major issues. [Copyright &y& Elsevier]

Cancer survival analyses based on cancer registry data do not provide direct information on the main aim of cancer treatment, the cure of the patient. In fact, classic survival indicators do not distinguish between patients who are cured, and patients who will die of their disease and in whom prolongation of survival is the main objective of treatment. In this study, we applied parametric cure models to the cancer incidence and follow-up data provided by 49 EUROCARE-4 (European Cancer Registry-based study, fourth edition) cancer registries, with the aims of providing additional insights into the survival of European cancer patients diagnosed from 1988 to 1999, and of investigating between-population differences. Between-country estimates the proportion of cured patients varied from about 4-13% for lung cancer, from 9% to 30% for stomach cancer, from 25% to 49% for colon and rectum cancer, and from 55% to 73% for breast cancer. For all cancers combined, estimates varied between 21% and 47% in men, and 38% and 59% in women and were influenced by the distribution of cases by cancer site. Countries with high proportions of cured and long fatal case survival times for all cancers combined were characterised by generally favourable case mix. For the European pool of cases both the proportion of cured and the survival time of fatal cases were associated with age, and increased from the early to the latest diagnosis period. The increases over time in the proportions of Europeans estimated cured of lung, stomach and colon and rectum cancers are noteworthy and suggest genuine progress in cancer control. The proportion of cured of all cancers combined is a useful general indicator of cancer control as it reflects progress in diagnosis and treatment, as well as success in the prevention of rapidly fatal cancers.

Aims and Background: Stomach cancer still remains one of the most frequent tumors in Italy and Europe. The aim of this paper is to present estimates for stomach cancer mortality, incidence and prevalence over the period 1970-2010 for the Italian regions and for Italy as a whole., Methods: Estimated figures for incidence, prevalence and mortality were obtained by using the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates and projections up to the year 2010 by means of a statistical back-calculation approach. Survival at the regional and national levels was modelled on the basis of published survival data from the Italian cancer registries., Results: Incidence and mortality trends for both sexes decrease by about 60% during the estimation period 1970-2010. Both indicators show a 2-fold male/female ratio all over the country, and a similar gender time trend. The incidence and mortality in the North and Center of the country are estimated to be higher and to decrease more steeply than those in the South, both for men and women. A total of around 13,000 incident cases, 57,000 prevalent cases, and 8,000 deaths are estimated to have occurred in Italy in 2005., Conclusions: The incidence and mortality trends are estimated to decline during the entire period 1970-2010, with different slopes between northern-central and southern regions. The incidence and mortality are quite similar among Italian regions, showing that the risk of developing the disease diminishes and is becoming more homogeneous than in the past decades all over the country.

We described the relative survival of thyroid cancer cases diagnosed in Europe during the period 1990-1994 and analysed time trends in relative survival during the period 1983-1994 using the EUROCARE-3 database. Relative survival of thyroid cancers is one of the highest amongst cancer sites, with age-standardised relative survival rates of 74% in men and 82% in women over the period 1990-1994, with marked differences between countries. The higher relative survival rates are observed in Scandinavian countries and the lower rates are observed in the UK and the countries of Eastern Europe. Relative survival is higher in women than in men, and decreases with age whatever the histological group. There are significant differences in relative survival according to histological type. Relative survival has slightly increased over the period 1983-1994 only when all histological types have been considered together. Time trend was, however, non-existent when the different histological groups were taken into account except during the most recent period of observation. One possible explanation for the differences in relative survival between countries and sex may probably be found in the changes in thyroid classification and diagnosis techniques. When these changes are not homogeneous, the distribution of thyroid cancers by histology and by stage at diagnosis may be very different. The only way to understand these differences is to conduct specific studies including a description of stage at diagnosis, diagnosis procedures used for staging and details of treatment.