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We identify that flexural guided elastic waves in elastic pipes carry a well-defined orbital angular momentum associated with the compressional dilatational potential. This enables the transfer of elastic orbital angular momentum, that we numerically demonstrate, through the coupling of the compressional potential in a pipe to the acoustic pressure field in a surrounding fluid in contact with the pipe., 5 pages, 3 figures plus supplemental material

BACKGROUND Breast carcinoma survival rates were found to be higher in the U.S. than in Europe. METHODS Multiple regression analysis of breast carcinoma survival rates among women diagnosed between 1990 and 1992 was performed using clinical data from population-based case series from the Surveillance, Epidemiogy, and End Results (SEER) program (13,172 women) and the European Concerted Action on survival and Care of Cancer Patients (EUROCARE) project (4478 women). RESULTS Early-stage tumors (T1N0M0) were more frequent in the SEER data (41% of cases) than in the EUROCARE data (29%). In the SEER data, early tumors were more frequent in women age ≥ 65 years (43%) than in younger women (38%), whereas the reverse was true in the European data (25% vs. 31%). In both case series, > 90% of women underwent surgery and 81–82% underwent lymphadenectomy, but the number of axillary lymph nodes evaluated was higher in the SEER data than in the EUROCARE data. The 5-year survival rate was higher in the U.S. case series (89%) than in the European series (79%). This differential was observed for each stage category evaluated: early (T1N0M0), large lymph node-negative (T2–3N0M0), lymph node-positive (T1–3N+M0), locally advanced (T4M0), and metastatic (M1) tumors. The overall relative excess risk (RER) of death was significantly higher (RER, 1.37; 95% confidence interval [95% CI], 1.25–1.50) among European women compared with U.S. women (referent group). Adjustment for stage, age, surgery, and the number of lymph nodes evaluated explained most of the excess risk (RER, 1.07; 95% CI, 0.98–1.17). CONCLUSIONS Transatlantic differences in the 5-year survival rates for women diagnosed with breast carcinoma between 1990 and 1992 were attributable mainly to differences in stage of disease. Resources should be invested to achieve earlier diagnosis of breast carcinoma in Europe, especially for elderly women. Cancer 2004;100:715–22. © 2003 American Cancer Society.

BACKGROUND: EUROCARE-3 collected data from 45 population-based cancer registries in 20 countries on 24 620 European children aged from 0 to 14 years diagnosed with malignancy in the period 1990-1994. METHODS: Five-year survival between countries was compared for all malignancies and for the major diagnostic categories, adjusting for age, and estimated average European survival weighting for differences in childhood populations. RESULTS: For all cancers combined, survival variation was large (45% in Estonia to 90% in Iceland), and was generally low (60-70%) in eastern Europe and high (> or =75%) in Switzerland, Germany and the Nordic countries (except Denmark). The Nordic countries had the highest survival for four of the seven major tumour types: nephroblastoma (92%), acute lymphoid leukaemia (85%), CNS tumours (73%) and acute non-lymphocytic leukaemia (62%). The eastern countries had lowest survival: 89% for Hodgkin's disease, 71% for nephroblastoma, 68% for acute lymphoid leukaemia, 61% for non-Hodgkin's lymphoma, 57% for central nervous system (CNS) tumours and 29% for acute non-lymphocytic leukaemia. CONCLUSIONS: The Nordic countries represent a survival gold standard to which other countries can aspire. Since most childhood cancers respond well to treatment, survival differences are attributable to differences in access (including referral and timely diagnosis) and use of modern treatments; however, the obstacles to access and application of standard treatments probably vary markedly with country.

EUROCARE-3 analysed the survival of 1815584 adult cancer patients diagnosed from 1990 to 1994 in 22 European countries. The results are reported in tables, one per cancer site, coded according to the International Classification of Diseases (ICD)-9 classification. The main findings of the tables are summarised and commented on in this article. For most solid cancers, wide differences in survival between different European populations were found, as also reported by EUROCARE-1 and EUROCARE-2, despite a remarkable (10%) overall increase in cancer survival from 1985 to 1994. Survival was highest in northern Europe (Sweden, Norway, Finland and Iceland), and fairly good in central-southern Europe (France, Switzerland, Austria and Spain). Survival was particularly low in eastern Europe, low in Denmark and the UK, and fairly low in Portugal and Malta. The mix of tumour stage at diagnosis explains much of the survival differences for cancers of the digestive tract, female reproductive system, breast, thyroid, and also skin melanoma. For tumours of the urinary tract and prostate, the differences were explained mainly by differences in diagnostic criteria and procedures. The case mix by anatomic subsite largely explains differences in survival for head and neck cancers. For oesophagus, pancreas, liver and brain cancer, with poor prognoses, survival differences were limited. Tumours, for which highly effective treatments are available, such as testicular cancer, Hodgkin's lymphoma and some haematological malignancies, had fairly uniform survival across Europe. Survival for all tumours combined (an indicator of the overall cancer care performance of a nation's health system) was better in young than old patients, and better in women than men. The affluence of countries influenced overall cancer survival through the availability of adequate diagnostic and treatment procedures, and screening programmes.

Summary International differences and trends in cancer survival withinEurope are larger than can reasonably be accounted for by arte-fact, bias or chance. The geographical patterns and trends in sur-vival are often broadly consistent with geographical differences ortrends in the type of cancer, diagnostic investigations or overallinvestment in health care, and for several major cancers, support-ing evidence is available from population-based studies of clinicalinformation. Incomplete ascertainment of cancer cases, particu-larly of long-term survivors, may contribute to some regional andinternational differences in survival, however, and more system-atic information on completeness is required. We may concludethat large international differences in survival do exist for manycancers, but we should be cautious in drawing quantitative orcausal conclusions from observational survival data.We do not yet have a fully satisfactory interpretation of thesedifferences, but we have few alternatives to this type of study if weare to understand the determinants of improved outcome for allcancer patients, and to enable better planning of their health care.The EUROCARE Working Group has developed several strategiesto disentangle the various possible explanations [73]. These includefurther development of high-resolution studies to examine theimpact on survival differences of disease stage, staging techniquesand treatment; and further development of mathematical modelsof cure. Extension of systematic international survival compari-sons to other regions of the world, such as Australia, Canada, Japanand the USA, is also in progress (the CONCORD study) [22].Oncologists and epidemiologists may provide insight into thegeographic differences and trends in survival reported by thisstudy, and may suggest further lines of enquiry. Do we need morerefined studies of survival to monitor progress against cancer andto plan future cancer care? Will such analyses help us quantify theeffect of new treatments arising from recent progress in the basicsciences and genomics on population cancer survival rates? Sub-stantial human and financial resources are required to improve theoutcome of cancer treatment. Will future investments in cancerservices include matching investment to monitor their impact onsurvival and mortality?Earlier diagnosis and prompt, universal access to optimal treat-ment would be expected to reduce international differences incancer survival in Europe. To achieve this, oncologists and healthcare planners will need better information on the comparativeperformance of their health systems. Population-based cancer reg-istries provide some of the information for such comparisons, buttheir traditional output may no longer be sufficient to evaluate theeffectiveness of health systems, and especially to explain geo-graphical differences in survival. In some countries, their role isalso under threat. Confidentiality constraints recently inhibitedthe collection of cancer registration data in the UK [90], and thelinkage of cancer registrations and deaths is currently illegal inEstonia [91]. Both activities are essential for internationally com-parable survival rates. Legal protection for cancer registrationacross Europe will be required.The mission of cancer registries should be reconsidered, and thepriority shifted from classical descriptive epidemiology and geo-graphical pathology toward more analytical monitoring ofprogress against cancer, including the probability of survival andcure, the burden of cancer prevalence, and the late effects oftherapy. Several European studies of this type have been reportedrecently [3, 36, 9294] and others are in progress. Many cancer–registries are developing closer relationships with cancer clini-cians and general practitioners, and some now systematicallycollect detailed clinical information that was collected eitherirregularly or not at all in the past. These developments willimprove the power of population-based cancer data to explain dif-ferences in cancer survival, and should enhance their relevance toclinical practice.European average survival rates are useful for comparativepurposes, but they should not become the goal for cancer controlprogrammes: the benchmark should always be the highest achiev-able survival rates.The aim of exploring geographic differences in cancer survivalis not to establish international league tables or to excite nationalrivalries, but to estimate the range of survival rates, and to identifyregions or countries in which survival could be improved.

International audience; We explored the influence of morphology on geographic differences in 5-year survival for non-Hodgkin lymphoma (NHL) diagnosed in 1990-1994 and followed for 5years: 16,955 cases from 27 EUROCARE-3 cancer registries, and 22,713 cases from 9 US SEER registries. Overall 5-year relative survival was 56.1% in EUROCARE west, 47.1% in EUROCARE east and 56.3% in SEER. Relative excess risk (RER) of death was 1.05 (95% confidence interval (CI) 1.01-1.10) in EUROCARE west, 1.52 (95% CI 1.44-1.60) in EUROCARE east (SEER reference). Excess risk of death was significantly above reference (diffuse B lymphoma) for Burkitt's and NOS lymphoma; not different for lymphoblastic and other T-cell; significantly below reference (in the order of decreasing relative excess risk) for NHL NOS, mantle cell/centrocytic, lymphoplasmacytic, follicular, small lymphocytic/chronic lymphocytic leukaemia, other specified NHL and cutaneous morphologies. Interpretation of marked variation in survival with morphology is complicated by classification inconsistencies. The completeness and standardisation of cancer registry morphology data needs to be improved.

International audience; OBJECTIVE: To evaluate trends in survival from cervical cancer in Europe and in European countries participating in the EUROCARE study as a function of age, morphology and stage at diagnosis. METHODS: Relative survival and relative excess risk of death within 5 years of diagnosis, as a function of age, morphology and stage, among 73,022 women aged 15-99 years diagnosed during 1983-1994 and followed up to 1999 in each of 18 European countries participating in the EUROCARE study, using data from 34 population-based cancer registries. RESULTS: Overall five-year relative survival was 62%, rising by 2% during the period 1983-1994. The highest survival occurred in Northern and Western Europe and the lowest in Central Europe. Survival falls with age at diagnosis, but mainly for localised disease. Survival is higher for adenocarcinoma in younger women, but higher for squamous cell carcinoma in older women. The proportions of younger women, localised cancer and adenocarcinoma all increased. The main improvements in survival were for women under 65, and for metastatic disease. CONCLUSIONS: Survival in Europe has improved slowly but steadily, but the trend is not geographically uniform. Central European countries and the UK saw little or no improvement, and survival in those countries remains the lowest among participating countries in Europe. Further reduction of cervical cancer mortality in Europe may be expected from expansion of screening, and improvement in the treatment of older women, and of metastatic disease.

International audience; BACKGROUND: Rare cancers are a challenge to clinical practice, and treatment experience, even in major cancer centres to which rare cancers are usually referred, is often limited. We aimed to study the epidemiology of rare cancers in a large population of several countries. METHODS: We analysed survival by age, sex, subsite, and morphology in 57,144 adults with 14 selected rare cancers diagnosed 1983-94. Variations in survival over time and between European regions were also assessed for variations in quality of care. We also estimated the adjusted relative excess risk of death for every rare cancer. FINDINGS: Overall 5-year relative survival was good (ie, >65%) for placental choriocarcinoma (85.4% [95% CI 81.4-89.5]), thyroid medullary carcinoma (72.4% [69.2-75.5]), ovarian germ-cell cancer (73.0% [70.0-76.0]), lung carcinoid (70.1% [67.3-72.9]), and cervical adenocarcinoma (65.5% [64.3-66.6]); intermediate (ie, 35-65%) for testicular cancer at age 65 years or older (64.0% [59.3-68.7]), sarcoma of extremities (60.0% [58.9-61.2]), digestive-system endocrine cancers (55.6% [54.9-56.3]), anal squamous-cell carcinoma (53.1% [51.5-54.8]), and uterine sarcoma (43.5% [42.0-44.9]); low for carcinoma of adrenal-gland cortex (32.7% [28.3-37.2]) and bladder squamous-cell carcinoma (20.4% [18.8-22.0]); and poor for angiosarcoma of liver (6.4% [1.8-11.0]) and mesothelioma (4.7% [4.3-5.2]). Survival was usually better for women than men and poor in those aged 75 years or older. Survival significantly improved over time for ovarian germ-cell cancer, sarcomas of extremities, digestive-system endocrine tumours, anal squamous-cell carcinoma, and angiosarcoma of liver. Survival in northern Europe was higher than in the other geographic groupings for most cancers. INTERPRETATION: Because effective treatments are available for several of the rare cancers we assessed, further research is needed to ascertain why survival is lower in some European countries than in others, particularly in older patients. Audit of best practice for rare cancers with treatment protocols would be useful.

The EUROCARE database contains data on 6.5 million cancer patients diagnosed from 1978 to 1994 in populations covered by 67 cancer registries in 22 European countries. The quality-checked entries specify age, sex, diagnosis date, cancer site, morphology, microscopic confirmation and vital status, as well as containing broad indicators of stage. For EUROCARE-3, which refers to diagnoses from 1990 to 1994, 3389 cases with major data problems and 142,525 second or subsequent cancers were removed, leaving more than 2 million cases for analysis. From these data, observed and relative survival for each cancer site and country were calculated at 1, 3 and 5 years from diagnosis. Overall European survival for each cancer site and for all cancers combined were calculated combining country-specific survival figures. Overall, 1.1% of cases were lost to follow-up, 4.2% were known from death certificates only and 1.2% were known at autopsy only. The percentage of microscopically confirmed cases varied with cancer site and country, and was always higher in northern European countries. Comparison of quality indicators for the EUROCARE-3 database with earlier EUROCARE databases indicates that data quality and standardisation have improved.

We used multiple regression models to assess the influence of disease stage at diagnosis on the 5-year relative survival of 4,478 patients diagnosed with breast cancer in 1990-1992. The cases were representative samples from 17 population-based cancer registries in 6 European countries (Estonia, France, Italy, Netherlands, Spain and UK) that were combined into 9 regional groups based on similar survival. Five-year relative survival was 79% overall, varying from 98% for early, node-negative (T1N0M0) tumours; 87% for large, node-negative (T2-3N0M0) tumours; 76% for node-positive (T1-3N+M0) tumours and 55% for locally advanced (T4NxM0) tumours to 18% for metastatic (M1) tumours and 69% for tumours of unspecified stage. There was considerable variation across Europe in relative survival within each disease stage, but this was least marked for early node-negative tumours. Overall 5-year relative survival was highest in the French group of Bas-Rhin, Cote d'Or, Herault and Isere (86%), and lowest in Estonia (66%). These geographic groups were characterised by the highest and lowest percentages of women with early stage disease (T1N0M0: 39% and 9%, respectively). The French, Dutch and Italian groups had the highest percentage of operated cases. The number of axillary nodes examined, a factor influencing nodal status, was highest in Italy and Spain. After adjusting for TNM stage and the number of nodes examined, survival differences were greatly reduced, indicating that for these women, diagnosed with breast cancer in Europe during 1990-1992, the survival differences were mainly due to differences in stage at diagnosis. However, in 3 regional groups, the relative risks of death remained high even after these adjustments, suggesting less than optimal treatment. Screening for breast cancer did not seem to affect the survival patterns once stage had been taken into account.

Using the 2,208 non metastatic breast cancer diagnosed women who underwent breast surgery from the 2,432 first breast cancers recorded by the French département of Côte-d'Or cancer registry from 1982 to 1992, we described in this well-defined population, the trend in breast-cancer adjuvant treatment, and related practices with recommendations according to risk groups. Adjuvant treatment was received by 44.1% of the 2,208 women. Inflammatory tumors were systematically treated with chemotherapy. For the non-inflammatory M0 breast-cancer (2,167 women), the adjuvant treatment probability was mainly determined by the nodal involvement. After adjustment on the tumor- and host-characteristics, time period was associated with increased probability of adjuvant treatment in the whole group of patients and within each pN subgroup. In the group without nodal involvement, this increase was also associated with the SBR histologic grade. There was strong evidence of large changes in breast-cancer adjuvant treatment. Clinical practices in the Côte-d'Or region have paralleled the NIH recommendations. For node-negative breast cancers, these trends appeared despite persistent uncertainty in the definition of subgroups to treat. Over time, the SBR histologic grade became an apparent factor of treatment. This use as a treatment indicator was done without validation in any adjuvant treatment trial. The simultaneous recommendation to treat with the absence of guidelines could lead to the treating of an increasingly large group by extending the "high-risk" definition. This could be a non-optimal management of risk while putting strain on health care resources.