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PURPOSE: Longer time between breast cancer (BC) diagnosis and treatment initiation is associated with poorer survival, and this may be a factor behind disparities in global survival rates. We assessed time to BC treatment in the Kathmandu Valley, Nepal, including factors associated with longer waiting times and their impact on survival. METHODS: We conducted a retrospective population-based study of BC cases recorded in the Kathmandu Valley Population-Based Cancer Registry between 2018 and 2019. Fieldwork survey through telephone was undertaken to collect additional sociodemographic and clinical information. Logistic regression was performed to identify factors associated with longer time to treatment, and Kaplan-Meier and Cox proportional hazard regression was used to examine survival time and evaluate the association between longer time to treatment and survival. RESULTS: Among the 385 patients with BC, one third waited >4 weeks from diagnosis to initial treatment. Lower education was associated with longer time to treatment (adjusted odds ratio, 1.63 [95% CI, 1.03 to 2.60]). The overall 3-year survival rate was 88.6% and survival was not associated with time to treatment (P = .50). However, advanced stage at diagnosis was associated with poorer survival (adjusted hazard ratio, 4.09 [95% CI, 1.27 to 13.23]). There was some indication that longer time to treatment was associated with poorer survival for advanced-stage patients, but data quality limited that analysis. CONCLUSION: In the Kathmandu Valley, Nepal, women with a lower education tend to wait longer from BC diagnosis to treatment. Patients with advanced-stage BC had poorer survival, and longer waiting time may be associated with poorer survival for women diagnosed with advanced-stage disease.
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Neoplasias de la Mama , Tiempo de Tratamiento , Humanos , Femenino , Nepal/epidemiología , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/terapia , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Tiempo de Tratamiento/estadística & datos numéricos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Anciano , Tasa de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVE: Australia has relatively high multiple myeloma (MM) incidence and mortality rates. Advancements in MM treatment over recent decades have driven improvements in MM survival in high-income countries; however, reporting in Australia is limited. We investigated temporal trends in population-wide MM survival across 3 periods of treatment advancements in New South Wales (NSW), Australia. METHODS: Individuals with an MM diagnosis in the NSW Cancer Registry between 1985 and 2015 with vital follow-up to 2020, were categorized into 3 previously defined treatment eras according to their diagnosis date (1985-1995, chemotherapy only; 1996-2007, autologous stem cell transplantation; and 2008-2015, novel agents including proteasome inhibitors and immunomodulatory drugs). Both relative survival and cause-specific survival according to Fine and Gray's competing risks cumulative incidence function were calculated by treatment era and age at diagnosis. RESULTS: Overall, 11,591 individuals were included in the study, with a median age of 70 years at diagnosis. Five-year relative survival improved over the 36-year (1985-2020) study period (31.0% in 1985-1995; 41.9% in 1996-2007; and 56.1% in 2008-2015). For individuals diagnosed before 70 years of age, the 5-year relative survival nearly doubled, from 36.5% in 1985-1995 to 68.5% in 2008-2015. Improvements for those > 70 years of age were less pronounced between 1985-1995 and 1996-2007; however, significant improvements were observed for those diagnosed in 2008-2015. Similar overall and age-specific patterns were observed for cause-specific survival. After adjustment for gender and age at diagnosis, treatment era was strongly associated with both relative and cause-specific survival (P < 0.0001). CONCLUSIONS: Survival of individuals with MM is improving in Australia with treatment advances. However, older age groups continue to experience poor survival outcomes with only modest improvements over time. Given the increasing prevalence of MM in Australia, the effects of MM treatment on quality of life, particularly in older age, warrant further attention.
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Mieloma Múltiple , Humanos , Mieloma Múltiple/mortalidad , Mieloma Múltiple/terapia , Mieloma Múltiple/tratamiento farmacológico , Femenino , Masculino , Nueva Gales del Sur/epidemiología , Anciano , Persona de Mediana Edad , Sistema de Registros , Anciano de 80 o más Años , Incidencia , Adulto , Trasplante Autólogo , Tasa de Supervivencia , Inhibidores de Proteasoma/uso terapéuticoRESUMEN
OBJECTIVE: Improvement in cancer survival over recent decades has not been accompanied by a narrowing of socioeconomic disparities. This study aimed to quantify the loss of life expectancy (LOLE) resulting from a cancer diagnosis and examine disparities in LOLE based on area-level socioeconomic status (SES). METHODS: Data were collected for all people between 50 and 89 years of age who were diagnosed with cancer, registered in the NSW Cancer Registry between 2001 and 2019, and underwent mortality follow-up evaluations until December 2020. Flexible parametric survival models were fitted to estimate the LOLE by gender and area-level SES for 12 common cancers. RESULTS: Of 422,680 people with cancer, 24% and 18% lived in the most and least disadvantaged areas, respectively. Patients from the most disadvantaged areas had a significantly greater average LOLE than patients from the least disadvantaged areas for cancers with high survival rates, including prostate [2.9 years (95% CI: 2.5-3.2 years) vs. 1.6 years (95% CI: 1.3-1.9 years)] and breast cancer [1.6 years (95% CI: 1.4-1.8 years) vs. 1.2 years (95% CI: 1.0-1.4 years)]. The highest average LOLE occurred in males residing in the most disadvantaged areas with pancreatic [16.5 years (95% CI: 16.1-16.8 years) vs. 16.2 years (95% CI: 15.7-16.7 years)] and liver cancer [15.5 years (95% CI: 15.0-16.0 years) vs. 14.7 years (95% CI: 14.0-15.5 years)]. Females residing in the least disadvantaged areas with thyroid cancer [0.9 years (95% CI: 0.4-1.4 years) vs. 0.6 years (95% CI: 0.2-1.0 years)] or melanoma [0.9 years (95% CI: 0.8-1.1 years) vs. 0.7 years (95% CI: 0.5-0.8 years)] had the lowest average LOLE. CONCLUSIONS: Patients from the most disadvantaged areas had the highest LOLE with SES-based differences greatest for patients diagnosed with cancer at an early stage or cancers with higher survival rates, suggesting the need to prioritise early detection and reduce treatment-related barriers and survivorship challenges to improve life expectancy.
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Esperanza de Vida , Neoplasias , Sistema de Registros , Clase Social , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Neoplasias/mortalidad , Neoplasias/diagnóstico , Anciano de 80 o más Años , Nueva Gales del Sur/epidemiología , Sistema de Registros/estadística & datos numéricos , Factores Socioeconómicos , Tasa de Supervivencia , Disparidades en el Estado de SaludRESUMEN
AIM: Large-scale studies investigating health-related quality of life (HRQL) in cancer survivors are limited. This study aims to investigate HRQL and its relation to optimism and social support among Australian women following a cancer diagnosis. METHODS: Data were from the Australian Longitudinal Study on Women's Health, a large cohort study (n = 14,715; born 1946-51), with 1428 incident cancer cases ascertained 1996-2017 via linkage to the Australian Cancer Database. HRQL was measured using the Short Form-36 (median 1.7 years post-cancer-diagnosis). Multivariable linear regression was performed on each HRQL domain, separately for all cancers combined, major cancer sites, and cancer-free peers. RESULTS: Higher optimism and social support were significantly associated with better HRQL across various domains in women with and without a cancer diagnosis (p < 0.05). Mean HRQL scores across all domains for all cancer sites were significantly higher among optimistic versus not optimistic women with cancer (p < 0.05). Adjusting for sociodemographic and other health conditions, lower optimism was associated with reduced scores across all domains, with greater reductions in mental health (adjusted mean difference (AMD) = -11.54, p < 0.01) followed by general health (AMD = -11.08, p < 0.01). Social support was less consistently related to HRQL scores, and following adjustment was only significantly associated with social functioning (AMD = -7.22, p < 0.01) and mental health (AMD = -6.34, p < 0.01). CONCLUSIONS: Our findings highlight a strong connection between optimism, social support, and HRQL among cancer survivors. Providing psychosocial support and addressing behavioral and socioeconomic factors and other health conditions associated with optimism and social support may improve HRQL.
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PURPOSE: Shorter time from symptoms recognition to diagnosis and timely treatment would be expected to improve the survival of patients with breast cancer (BC). This review identifies and summarizes evidence on time to diagnosis and treatment, and associated factors to inform an improved BC care pathways in Low- and Middle-Income Countries (LMICs). METHODS: A systematic search was conducted in electronic databases including Medline, Embase, PsycINFO and Global Health, covering publications between January 1, 2010, and November 6, 2023. Inclusion criteria encompassed studies published in English from LMICs that reported on time from symptoms recognition to diagnosis and/or from diagnosis to treatment, as well as factors influencing these timelines. Study quality was assessed independently by two reviewers using a standard checklist. Pre-contact, post-contact and treatment intervals and delays in these intervals are presented. Barriers and facilitators for shorter time to diagnosis and treatment found by individual studies after adjusting with covariates are summarized. RESULTS: The review identified 21 studies across 14 countries and found that BC cases took a longer time to diagnosis than to treatment. However, time to treatment also exceeded the World Health Organization (WHO) recommended period for optimal survival. There was inconsistency in terminology and benchmarks for defining delays in time intervals. Low socioeconomic status and place of residence emerged as frequent barriers, while initial contact with a private health facility or specialist was commonly reported as a facilitator for shorter time to diagnosis and treatment. CONCLUSIONS: Guidelines or consensus recommendations are essential for defining the optimal time intervals to BC diagnosis and treatment. Our review supported WHO's Global Breast Cancer Initiative recommendations. Increasing public awareness, strengthening of healthcare professional's capacities, partial decentralization of diagnostic services and implementation of effective referral mechanisms are recommended to achieve a shorter time to diagnosis and treatment of BC in LMICs.
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Neoplasias de la Mama , Países en Desarrollo , Tiempo de Tratamiento , Humanos , Neoplasias de la Mama/terapia , Neoplasias de la Mama/diagnóstico , Femenino , Tiempo de Tratamiento/estadística & datos numéricos , Diagnóstico Tardío/estadística & datos numéricos , Persona de Mediana Edad , Adulto , Factores SocioeconómicosRESUMEN
Cancer screening has the potential to decrease mortality from several common cancer types. The first cancer screening programme in China was initiated in 1958 and the Cancer High Incidence Fields established in the 1970s have provided an extensive source of information for national cancer screening programmes. From 2012 onwards, four ongoing national cancer screening programmes have targeted eight cancer types: cervical, breast, colorectal, lung, oesophageal, stomach, liver, and nasopharyngeal cancers. By synthesising evidence from pilot screening programmes and population-based studies for various screening tests, China has developed a series of cancer screening guidelines. Nevertheless, challenges remain for the implementation of a fully successful population-based programme. The aim of this Review is to highlight the key milestones and the current status of cancer screening in China, describe what has been achieved to date, and identify the barriers in transitioning from evidence to implementation. We also make a set of implementation recommendations on the basis of the Chinese experience, which might be useful in the establishment of cancer screening programmes in other countries.
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Detección Precoz del Cáncer , Neoplasias , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiología , Neoplasias/prevención & control , Tamizaje Masivo , China/epidemiología , IncidenciaRESUMEN
Background: Racial/ethnic disparities in prostate cancer are reported in the United States (US). However, long-term trends and contributors of racial/ethnic disparities in all-cause and cause-specific death among patients with prostate cancer remain unclear. We analysed the trends and contributors of racial/ethnic disparities in prostate cancer survivors according to the cause of death in the US over 25 years. Methods: In this retrospective, population-based longitudinal cohort study, we identified patients diagnosed with first primary prostate cancer between 1995 and 2019, with follow-up until Dec 31, 2019, using population-based cancer registries' data from the Surveillance, Epidemiology, and End Results (SEER) Program. We calculated the cumulative incidence of death for each racial/ethnic group (Black, white, Hispanic, Asian or Pacific Islander [API], and American Indian or Alaska Native [AI/AN] people), by diagnostic period and cause of death. We quantified absolute disparities using rate changes for the 5-year cumulative incidence of death between racial/ethnic groups and diagnostic periods. We estimated relative (Hazard ratios [HR]) racial/ethnic disparities and the percentage of potential factors contributed to racial/ethnic disparities using Cox regression models. Findings: Despite a decreasing trend in the cumulative risk of death across five racial/ethnic groups, AI/AN and Black patients consistently had the highest rate of death between 1995 and 2019 with an adjusted HR of 1.48 (1.40-1.58) and 1.40 (1.38-1.42) respectively. The disparities in all-cause mortality between AI/AN and white patients increased over time, with adjusted HR 1.32 (1.17-1.49) in 1995-1999 and 1.95 (1.53-2.49) in 2015-2019. Adjustment of stage at diagnosis, initial treatment, tumor grade, and household income explained 33% and 24% of the AI/AN-white and Black-white disparities in all-cause death among patients with prostate cancer. Interpretation: The enduring racial/ethnic disparities in patients with prostate cancer, call for new interventions to eliminate health disparities. Our study provides important evidence and ways to address racial/ethnic inequality. Funding: National Key R&D Program of China, National Natural Science Foundation of China, Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support, the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Key Projects of Philosophy and Social Sciences Research, Ministry of Education of China.
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PURPOSE: To compare the incidence profile of four major cancers in Australia by place of birth. METHODS: In this retrospective population-based cohort study, the analysis included 548,851 residents diagnosed with primary colorectum, lung, female breast, or prostate cancer during 2005-2014. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were calculated for migrant groups relative to Australian-born. RESULTS: Compared with Australian-born residents, most migrant groups had significantly lower incidence rates for cancers of the colorectum, breast and prostate. The lowest rates of colorectal cancer were among males born in Central America (IRR = 0.46, 95% CI 0.29-0.74) and females born in Central Asia (IRR = 0.38, 95% CI 0.23-0.64). Males born in North-East Asia had the lowest rates of prostate cancer (IRR = 0.40, 95% CI 0.38-0.43) and females born in Central Asia had the lowest rates of breast cancer (IRR = 0.55, 95% CI 0.43-0.70). For lung cancer, several migrant groups had higher rates than Australian-born residents, with the highest rates among those from Melanesia (males IRR = 1.39, 95% CI 1.10-1.76; females IRR = 1.40, 95% CI 1.10-1.78). CONCLUSIONS: This study describes cancer patterns among Australian migrants, which are potentially helpful in understanding the etiology of these cancers and guiding the implementation of culturally sensitive and safe prevention measures. The lower incidence rates observed for most migrant groups may be maintained with continued emphasis on supporting communities to minimize modifiable risk factors such as smoking and alcohol consumption and participation in organized cancer screening programmes. Additionally, culturally sensitive tobacco control measures should be targeted to migrant communities with high lung cancer incidence rates.
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Neoplasias Pulmonares , Neoplasias de la Próstata , Migrantes , Masculino , Humanos , Australia/epidemiología , Incidencia , Estudios de Cohortes , Estudios RetrospectivosRESUMEN
There is growing, but inconsistent evidence suggesting oestrogen may play a key role in lung cancer development, especially among never-smoking women for whom lung cancer risk factors remain largely elusive. Using the China Kadoorie Biobank, a large-scale prospective cohort with 302 510 women aged 30 to 79 years recruited from 10 regions in China during 2004 to 2008, we assessed the risk of lung cancer death among self-reported never-smoking women who were cancer-free at baseline, in relation to age at menarche, age at menopause, time since menopause, prior use of oral contraceptives (OCP), number of livebirths, breastfeeding and age at first livebirth. Women were followed up to December 31, 2016 with linkage to mortality data. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression, adjusting for key confounders including several socio-demographic, environmental and lifestyle factors. Among 287 408 never-smoking women, 814 died from lung cancer with a median follow-up of 10.3 years. Women who had used OCP within 15 years prior to baseline had a significantly higher hazard of lung cancer death compared with never-users: HR = 1.85 (95% CI: 1.14-3.00) and risk increased by 6% with each additional year of use: HR = 1.06 (1.01-1.10). Among parous women, the hazard of lung cancer death increased by 13% with each single livebirth: HR = 1.13 (1.05-1.23); and among post-menopausal women, the risk increased by 2% with each year since menopause: HR = 1.02 (1.01-1.04). These results suggest that reproductive factors which were proxies for lower endogenous oestrogen level, for example, longer duration of OCP use, could play a role in lung cancer development.
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Pueblos del Este de Asia , Neoplasias Pulmonares , Femenino , Humanos , Anticonceptivos Orales , Estrógenos , Neoplasias Pulmonares/mortalidad , Menarquia , Menopausia , Estudios Prospectivos , Factores de Riesgo , No FumadoresRESUMEN
BACKGROUND: Cancer literacy is associated with several health-related behaviors and outcomes. However, there is still a lack of nationwide surveys for cancer literacy in China. OBJECTIVE: This study aims to evaluate cancer literacy in China, explore disparities, and provide scientific evidence for policy makers. METHODS: A cross-sectional survey was conducted in mainland China in 2021 using the multistage probability proportional to the size sampling method. Both the reliability and validity of the questionnaire were evaluated. The awareness levels were adjusted by sampling weights and nonrepresentativeness weights to match the actual population distributions. The Rao-Scott adjusted chi-square test was applied to test geographic, demographic, and socioeconomic disparities. A generalized linear model was used to explore potential factors. RESULTS: A total of 80,281 participants aged 15-74 years were finally enrolled from 21 provinces, with an overall response rate of 89.32%. The national rate of cancer literacy was 70.05% (95% CI 69.52%-70.58%). The rates were highest regarding knowledge of cancer management (74.96%, 95% CI 74.36%-75.56%) but were lowest regarding basic knowledge of cancer (66.77%, 95% CI 66.22%-67.33%). Cancer literacy was highest in East China (72.65%, 95% CI 71.82%-73.49%), Central China (71.73%, 95% CI 70.65%-72.81%), and North China (70.73%, 95% CI 68.68%-72.78%), followed by Northeast (65.38%, 95% CI 64.54%-66.22%) and South China (63.21%, 95% CI 61.84%-64.58%), whereas Southwest (59.00%, 95% CI 58.11%-59.89%) and Northwest China (57.09%, 95% CI 55.79%-58.38%) showed a need for improvement. Demographic and socioeconomic disparities were also observed. Urban dwellers, the Han ethnic group, and population with higher education level or household income were associated with prior knowledge. The questionnaire showed generally good internal and external reliability and validity. CONCLUSIONS: It remains important for China to regularly monitor levels of cancer literacy, narrow disparities, and strengthen health education for dimensions with poor performance and for individuals with limited knowledge to move closer to the goal of Healthy China 2030.
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Alfabetización en Salud , Neoplasias , Humanos , Estudios Transversales , Disparidades Socioeconómicas en Salud , Reproducibilidad de los Resultados , China/epidemiología , Neoplasias/epidemiologíaRESUMEN
BACKGROUND: Racial disparities in endometrial cancer have been reported in the United States, but trends and the underlying causes are not well understood. We aimed to examine the trends and contributing factors in racial disparities for causes of death among endometrial cancer patients. METHOD: In this population-based cohort study, we identified 139â473 women diagnosed with first, primary endometrial cancer between 1992 to 2018 from the Surveillance, Epidemiology, and End Results Program. We used the "Fine and Gray" method to calculate the cumulative incidence of all-cause and specific-cause death. We used proportional subdistribution hazard (PSH) and cause-specific hazard (CSH) models to quantify the relative risk of Black-White disparities. We performed a mediation analysis to assess the contribution of potential factors to disparities. RESULTS: The cumulative incidence of all-cause death decreased in endometrial cancer patients, with estimates at 5 years of 26.72% in 1992-1996 and 22.59% in 2007-2011. Compared with White patients, Black patients persistently had an increased risk of death due to endometrial cancer (PSH hazard ratio [HR] = 2.05, 95% confidence interval [CI] = 1.90 to 2.22; CSH HR = 2.19, 95% CI = 2.00 to 2.40) and causes other than endometrial cancer (PSH HR = 1.23, 95% CI = 1.10 to 1.37; CSH HR = 1.46, 95% CI = 1.31 to 1.63). Grade, histological subtype, surgery utilization, and stage at diagnosis explained 24.4%, 20.1%, 18.4%, and 16.6% of the Black-White disparity in all-cause death, respectively. CONCLUSIONS: Although the cumulative incidence of all-cause death decreased, the Black-White gaps persisted in patients with endometrial cancer. Grade and histological subtype had the greatest influence. More efforts are needed to address the disparities.
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Neoplasias Endometriales , Población Blanca , Humanos , Femenino , Estados Unidos/epidemiología , Estudios de Cohortes , Causas de Muerte , Neoplasias Endometriales/epidemiología , Población NegraRESUMEN
While the life expectancy of cancer survivors has substantially improved over time in the United States, the extent to which cancer patients are cured is not known. Population-level cure patterns are important indicators to quantify cancer survivorships. This population-based cohort study included 8978,721 cancer patients registered in the Surveillance, Epidemiology and End Results (SEER) databases between 1975 and 2018. The primary outcome was cure fractions. Five-year cure probability, time to cure and median survival time of uncured cases were also assessed. All four measures were calculated using flexible parametric models, according to 46 cancer sites, three summary stages, individual age and calendar year at diagnosis. In 2018, cure fractions ranged from 2.7% for distant liver cancer to 100.0% for localized/regional prostate cancer. Localized cancer had the highest cure fraction, followed by regional cancer and distant cancer. Except for localized breast cancer, older patients generally had lower cure fractions. There were 38 cancer site and stage combinations (31.2%) that achieved 95% of cure within 5 years. Median survival time of the uncured cases ranged from 0.3 years for distant liver cancer to 10.9 years for localized urinary bladder cancer. A total of 117 cancer site and stage combinations (93.6%) had increased cure fraction over time. A considerable proportion of cancer patients were cured at the population-level, and the cure patterns varied substantially across cancer site, stage and age at diagnosis. Increases in cure fractions over time likely reflected advances in cancer treatment and early detection.
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Neoplasias de la Mama , Neoplasias Hepáticas , Masculino , Humanos , Estados Unidos/epidemiología , Estudios de CohortesRESUMEN
Background: Overweight and obesity is a growing public health issue as it contributes to the future burden of obesity-related diseases, including cancer, especially in high-income countries. In Australia, 4.3% of all cancers diagnosed in 2013 were attributable to overweight and obesity. Our aim was to examine Australian age-specific incidence trends over the last 35 years for obesity-related cancers based on expert review (colorectal, liver, gallbladder, pancreas, breast in postmenopausal women, uterine, ovary, kidney, thyroid, and multiple myeloma) individually and pooled. Methods: Australian incidence data for 10 obesity-related cancers among people aged 25-84 years, diagnosed from 1983 to 2017, were obtained from the Australian Cancer Database. We used age-period-cohort modelling and joinpoint analysis to assess trends, estimating incidence rate ratios (IRR) by birth-cohort for each individual cancer and pooled, and the annual percentage change. The analyses were also conducted for non-obesity-related cancers over the same period. Findings: The total number of cancers where some proportion is obesity-related, diagnosed from 1983-2017, was 1,005,933. This grouping was 34.7% of cancers diagnosed. The IRR of obesity-related cancers increased from 0.77 (95% CI 0.73, 0.81) for the 1903 birth-cohort to 2.95 (95% CI 2.58, 3.38) for the recent 1988 cohort relative to the 1943 cohort. The IRRs of non-obesity related cancers were stable with non-significant decreases in younger cohorts. These trends were broadly similar across sex and age groups. Interpretation: The incidence of obesity-related cancers in Australia has increased by birth-cohort across all age-groups, which should be monitored. Obesity, a public health epidemic, needs to be addressed through increased awareness, policy support and evidence-based interventions. Funding: This research received no specific funding.
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BACKGROUND: Long-term projections of cancer incidence and mortality estimate the future burden of cancer in a population, and can be of great use in informing the planning of health services and the management of resources. We aimed to estimate incidence and mortality rates and numbers of new cases and deaths up until 2044 for all cancers combined and for 21 individual cancer types in Australia. We also illustrate the potential effect of treatment delays due to the COVID-19 pandemic on future colorectal cancer mortality rates. METHODS: In this statistical modelling study, cancer incidence and mortality rates in Australia from 2020 to 2044 were projected based on data up to 2017 and 2019, respectively. Cigarette smoking exposure (1945-2019), participation rates in the breast cancer screening programme (1996-2019), and prostate-specific antigen testing rates (1994-2020) were included where relevant. The baseline projection model using an age-period-cohort model or generalised linear model for each cancer type was selected based on model fit statistics and validation with pre-COVID-19 observed data. To assess the impact of treatment delays during the COVID-19 pandemic on colorectal cancer mortality, we obtained data on incidence, survival, prevalence, and cancer treatment for colorectal cancer from different authorities. The relative risks of death due to system-caused treatment delays were derived from a published systematic review. Numbers of excess colorectal cancer deaths were estimated using the relative risk of death per week of treatment delay and different durations of delay under a number of hypothetical scenarios. FINDINGS: Projections indicate that in the absence of the COVID-19 pandemic effects, the age-standardised incidence rate for all cancers combined for males would decline over 2020-44, and for females the incidence rate would be relatively stable in Australia. The mortality rates for all cancers combined for both males and females are expected to continuously decline during 2020-44. The total number of new cases are projected to increase by 47·4% (95% uncertainty interval [UI] 35·2-61·3) for males, from 380â306 in 2015-19 to 560â744 (95% UI 514â244-613â356) in 2040-44, and by 54·4% (95% UI 40·2-70·5) for females, from 313â263 in 2015-19 to 483â527 (95% UI 439â069-534â090) in 2040-44. The number of cancer deaths are projected to increase by 36·4% (95% UI 15·3-63·9) for males, from 132â440 in 2015-19 to 180â663 (95% UI 152â719-217â126) in 2040-44, and by 36·6% (95% UI 15·8-64·1) for females, from 102â103 in 2015-19 to 139â482 (95% UI 118â186-167â527) in 2040-44, due to population ageing and growth. The example COVID-19 pandemic scenario of a 6-month health-care system disruption with 16-week treatment delays for colorectal cancer patients could result in 460 (95% UI 338-595) additional deaths and 437 (95% UI 314-570) deaths occurring earlier than expected in 2020-44. INTERPRETATION: These projections can inform health service planning for cancer care and treatment in Australia. Despite the continuous decline in cancer mortality rates, and the decline or plateau in incidence rates, our projections suggest an overall 51% increase in the number of new cancer cases and a 36% increase in the number of cancer deaths over the 25-year projection period. This means that continued efforts to increase screening uptake and to control risk factors, including smoking exposure, obesity, physical inactivity, alcohol use, and infections, must remain public health priorities. FUNDING: Partly funded by Cancer Council Australia.
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COVID-19 , Neoplasias Colorrectales , COVID-19/epidemiología , Neoplasias Colorrectales/epidemiología , Femenino , Humanos , Incidencia , Masculino , Pandemias/prevención & control , Tiempo de TratamientoRESUMEN
BACKGROUND: While many high-income countries including Australia have successfully implemented a range of tobacco control policies, smoking remains the leading preventable cause of cancer death in Australia. We have projected Australian mortality rates for cancer types, which have been shown to have an established relationship with cigarette smoking and estimated numbers of cancer deaths attributable to smoking to 2044. METHODS: Cancer types were grouped according to the proportion of cases currently caused by smoking: 8%-30% and >30%. For each group, an age-period- cohort model or generalised linear model with cigarette smoking exposure as a covariate was selected based on the model fit statistics and validation using observed data. The smoking-attributable fraction (SAF) was calculated for each smoking-related cancer using Australian smoking prevalence data and published relative risks. RESULTS: Despite the decreasing mortality rates projected for the period 2015-2019 to 2040-2044 for both men and women, the overall number of smoking-related cancer deaths is estimated to increase by 28.7% for men and 35.8% for women: from 138 707 (77 839 men and 60 868 women) in 2015-2019 to 182 819 (100 153 men and 82 666 women) in 2040-2044. Over the period 2020-2044, there will be 254 583 cancer deaths (173 943 men and 80 640 women) directly attributable to smoking, with lung, larynx, oesophagus and oral (comprising lip, oral cavity and pharynx) cancers having the largest SAFs. INTERPRETATION: Cigarette smoking will cause over 250 000 cancer deaths in Australia from 2020 to 2044. Continued efforts in tobacco control remain a public health priority, even in countries where smoking prevalence has substantially declined.
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PURPOSE: Lung cancer (LC) in never-smoking individuals would rank as Australia's eighth most deadly cancer, yet risk factors remain uncertain. We investigated demographic, lifestyle and health-related exposures for LC among never-smoking Australians. METHODS: Using the prospective 45 and Up Study with 267,153 New South Wales (NSW) residents aged ≥ 45 years at recruitment (2006-2009), we quantified the relationship of 20 potential exposures with LC among cancer-free participants at baseline who self-reported never smoking. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident LC were estimated using Cox regression. The NSW Cancer, Lifestyle and Evaluation of Risk (CLEAR) Study, a case-control study including 10,781 NSW residents aged ≥ 18 years (2006-2014), was used to examine 16 potential LC exposures among cancer-free never-smoking participants. Adjusted odds ratios (OR) and 95% CI of LC were estimated using logistic regression. RESULTS: There were 226 LC cases among 132,354 cancer-free 45 and Up Study participants who reported never smoking, with a median follow-up of 5.41 years. The CLEAR Study had 58 LC cases and 1316 cancer-free controls who had never smoked. Analyses of both datasets showed that Asian-born participants had a higher risk of LC than those born elsewhere: cohort, adjusted HR = 2.83 (95% CI 1.64-4.89) and case-control, adjusted OR = 3.78 (1.19-12.05). No significant association with LC was found for other exposures. CONCLUSION: Our findings support the growing evidence that never-smoking, Asian-born individuals are at higher risk of developing LC than those born elsewhere. Ethnicity could be considered when assessing potential LC risk among never-smoking individuals.
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Neoplasias Pulmonares , Fumar , Australia/epidemiología , Estudios de Casos y Controles , Humanos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etiología , Estudios Prospectivos , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiologíaRESUMEN
Rationale: Household air pollution and secondhand tobacco smoke are known carcinogens for lung cancer, but large-scale estimates of the relationship with lung cancer mortality are lacking. Objectives: Using the large-scale cohort China Kadoorie Biobank, we prospectively investigated associations between these two risk factors and lung cancer death among never-smokers. Methods: The Biobank recruited 512,715 adults aged 30-79 years from 10 regions in China during 2004-2008. Self-reported never-smoking participants were followed up to December 31, 2016, with linkage to mortality data. Total duration of exposure to household air pollution was calculated from self-reported domestic solid fuel use. Exposure to secondhand tobacco smoke was ascertained using exposure at home and/or other places. Hazard ratios and 95% confidence intervals for associations between these two exposures and lung cancer death were estimated using Cox regression, adjusting for key confounders. Measurements and Main Results: There were 979 lung cancer deaths among 323,794 never-smoking participants without a previous cancer diagnosis during 10.2 years of follow-up. There was a log-linear positive association between exposure to household air pollution and lung cancer death, with a 4% increased risk per 5-year increment of exposure (hazard ratio = 1.04; 95% confidence interval = 1.01-1.06; P trend = 0.0034), and participants with 40.1-50.0 years of exposure had the highest risk compared with the never-exposed (hazard ratio = 1.53; 95% confidence interval = 1.13-2.07). The association was largely consistent across various subgroups. No significant association was found between secondhand smoke and lung cancer death. Conclusions: This cohort study provides new prospective evidence suggesting that domestic solid fuel use is associated with lung cancer death among never-smokers.
Asunto(s)
Neoplasias Pulmonares , Contaminación por Humo de Tabaco , Adulto , Humanos , Contaminación por Humo de Tabaco/efectos adversos , Estudios de Cohortes , Fumadores , Estudios Prospectivos , Factores de Riesgo , ChinaRESUMEN
BACKGROUND: Prostate cancer (PC) aetiology is unclear. PC risk was examined in relation to several factors in a large population-based prospective study. METHODS: Male participants were from Sax Institute's 45 and Up Study (Australia) recruited between 2006 and 2009. Questionnaire and linked administrative health data from the Centre for Health Record Linkage and Services Australia were used to identify incident PC, healthcare utilisations, Prostate Specific Antigen (PSA) testing reimbursements and dispensing of metformin and benign prostatic hyperplasia (BPH) prescriptions. Multivariable Cox and Joint Cox regression analyses were used to examine associations by cancer spread, adjusting for various confounders. RESULTS: Of 107,706 eligible men, 4257 developed incident PC up to end 2013. Risk of PC diagnosis increased with: PC family history (versus no family history of cancer; HRadjusted = 1.36; 95% CI:1.21-1.52); father and brother(s) diagnosed with PC (versus cancer-free family history; HRadjusted = 2.20; 95% CI:1.61-2.99); severe lower-urinary-tract symptoms (versus mild; HRadjusted = 1.77; 95% CI:1.53-2.04) and vasectomy (versus none; HRadjusted = 1.08; 95% CI:1.00-1.16). PC risk decreased with dispensed prescriptions (versus none) for BPH (HRadjusted = 0.76; 95% CI:0.69-0.85) and metformin (HRadjusted = 0.57; 95% CI:0.48-0.68). Advanced PC risk increased with vasectomy (HRadjusted = 1.28; 95% CI:1.06-1.55) and being obese (versus normal weight; HRadjusted = 1.31; 95% CI:1.01-1.69). CONCLUSION: Vasectomy and obesity are associated with an increased risk of advanced PC. The reduced risk of localised and advanced PC associated with BPH, and diabetes prescriptions warrants investigation.
Asunto(s)
Diabetes Mellitus , Metformina , Hiperplasia Prostática , Neoplasias de la Próstata , Humanos , Masculino , Metformina/uso terapéutico , Obesidad/complicaciones , Estudios Prospectivos , Hiperplasia Prostática/tratamiento farmacológico , Hiperplasia Prostática/epidemiología , Neoplasias de la Próstata/complicaciones , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: To examine changes in prostate cancer incidence and mortality rates, and 5-year relative survival, in relation to changes in the rate of prostate specific antigen (PSA) screening tests and the use of radical prostatectomy (RP) in the Australian population. METHODS: Prostate cancer stage-specific incidence rates, 5-year relative survival and mortality rates were estimated using New South Wales Cancer Registry data. PSA screening test rates and RP/Incidence ratios were estimated from Medicare Benefits Schedule claims data. We used multiple imputation to impute stage for cases with "unknown" stage at diagnosis. Annual percentage changes (APC) in rates were estimated using Joinpoint regression. RESULTS: Trends in the age-standardized incidence rates for localized disease largely mirrored the trends in PSA screening test rates, with a substantial 'spike' in the rates occurring in 1994, followed by a second 'spike' in 2008, and then a significant decrease from 2008 to 2015 (APC -6.7, 95% CI -8.2, -5.1). Increasing trends in incidence rates were observed for regional stage from the early 2000s, while decreasing or stable trends were observed for distant stage since 1993. The overall RP/Incidence ratio increased from 1998 to 2003 (APC 9.6, 95% CI 3.8, 15.6), then remained relatively stable to 2015. The overall 5-year relative survival for prostate cancer increased from 58.4% (95% CI: 55.0-61.7%) in 1981-1985 to 91.3% (95% CI: 90.5-92.1%) in 2011-2015. Prostate cancer mortality rates decreased from 1990 onwards (1990-2006: APC -1.7, 95% CI -2.1, -1.2; 2006-2017: APC -3.8, 95% CI -4.4, -3.1). CONCLUSIONS: Overall, there was a decrease in the incidence rate of localized prostate cancer after 2008, an increase in survival over time and a decrease in the mortality rate since the 1990s. This seems to indicate that the more conservative use of PSA screening tests in clinical practice since 2008 has not had a negative impact on population-wide prostate cancer outcomes.