Trends in mortality from cutaneous malignant melanoma in Spain (1982-2016): sex-specific age-cohort-period effects.

BACKGROUND: Mortality from malignant cutaneous melanoma increased alarmingly during the second half of the 20th century in Spain and other European countries. OBJECTIVE: The aim was to analyse sex- and age-specific trends in melanoma mortality in Spain in the period 1982-2016. METHODS: European age-standardized melanoma mortality rates during the period 1982-2016 were calculated from mortality figures provided by the National Statistics Institute. Joinpoint regressions were used to identify significant points of change in trends and to compute average annual per cent change (AAPC). Age-cohort-period models were fitted to explore the effect of these variables on mortality. RESULTS: During the period 1982-2016, age-standardized melanoma mortality rates increased in Spain from 0.90 to 1.80 deaths per 100 000 people in men and from 0.64 to 1.11 per 100 000 in women, rising noticeably from 1982 to 1995 in both sexes and in all age groups. From the mid-90s different trends were observed depending on sex and age: there was a decrease in mortality in the population younger than 45 years (AAPC -2 in both sexes) and aged 45-64 years (AAPC -1 among men and -0.2 among women), but in the group over 64 years rates continued to increase (AAPC 1.7 and 0.2, respectively, for men and women). The mortality sex ratio decreased in the younger population but increased in older individuals. A cohort effect was observed with lower mortality in the cohorts born after 1943 in men and 1956 in women. There was also a period effect with decreased mortality rates at the beginning of the 1990s. CONCLUSIONS: Melanoma mortality rates in Spain increased during the last decades of the 20th century; however, later they stabilized in women and began to decrease in younger cohorts and middle-aged men. Promotion of primary and secondary prevention measures should continue, with particular emphasis on males over 65 years.

Analyzing the evolution of young people's brain cancer mortality in Spanish provinces.

OBJECTIVES: To analyze the spatio-temporal evolution of brain cancer relative mortality risks in young population (under 20 years of age) in Spanish provinces during the period 1986-2010. METHODS: A new and flexible conditional autoregressive spatio-temporal model with two levels of spatial aggregation was used. RESULTS: Brain cancer relative mortality risks in young population in Spanish provinces decreased during the last years, although a clear increase was observed during the 1990s. The global geographical pattern emphasized a high relative mortality risk in Navarre and a low relative mortality risk in Madrid. Although there is a specific Autonomous Region-time interaction effect on the relative mortality risks this effect is weak in the final estimates when compared to the global spatial and temporal effects. CONCLUSIONS: Differences in mortality between regions and over time may be caused by the increase in survival rates, the differences in treatment or the availability of diagnostic tools. The increase in relative risks observed in the 1990s was probably due to improved diagnostics with computerized axial tomography and magnetic resonance imaging techniques.

Municipal distribution and trends in bladder cancer incidence in health area of León, Spain (1996-2010).

OBJECTIVE: Spain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. MATERIAL AND METHODS: the new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996-2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR greater than one. RESULTS: 1.573 cases were included. Incidence rates standardized to European population increased among men from 20,8/100.000 (1996-98) to 33,1/100.000 (2006-2008) and among women these rates increased from 1,9/100.000 to 5,9/100.000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. CONCLUSIONS: bladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexs, particularly in women are observed.

Cancer mortality trends in Spain: 1980-2007.

INTRODUCTION: Since the 1990s, there has been a downturn in mortality for specific types of tumour in Spain and other European countries. This article reports on the current situation of cancer mortality in Spain, as well as mortality trends over the period 1980-2007, and provides an overview of cancer mortality trends in Europe in recent years. METHODS: Data were sourced from the National Statistics Institute (Instituto Nacional de Estadística - INE) and the World Health Organization mortality database. Mortality trends were studied using change-point Poisson regression models. RESULTS: All-cancer mortality decreased in both sexes from 1980 to 2007, owing to the fact that the tumours responsible for the highest number of deaths registered declining trends from the mid-1990s onwards. In men, mortality due to stomach and prostate cancer fell by >3% per annum in the last 10 years of the study period. In women, the largest contributions to the fall in cancer mortality were due to breast and colorectal cancers. In contrast, female mortality due to smoking-related cancers rose significantly. Within the European context, Spain's estimated 2005 mortality rates were intermediate for men and low for women. CONCLUSION: Cancer control is progressing in the right direction in Spain. Further interventions directed to reduce tobacco-related cancer mortality remain a priority, particularly for women.

Changes in colorectal cancer incidence and mortality trends in Spain.

BACKGROUND: Some years ago, Spain registered a much lower colorectal cancer (CRC) incidence and mortality rate than did other European countries but the rates have since converged. This study sought to compare time trends for CRC incidence and mortality, identify change-points in these trends and thereby update available information in Spain. METHODS: Incidence data were drawn from all population-based cancer registries in Spain which participated in the European Network of Cancer Registries and had been collecting data for at least 10 consecutive years during the period 1975-2004. Colorectal cancer corresponded to codes 153, 154 and 159.0 of the International Classification of Diseases ninth revision (ICD-9) and codes C18-C21 and C26.0 of the ICD-10. In all, the 13 registries included in this study cover approximately 26% of the total Spanish population. We evaluated the time trends in incidence and mortality using transition change-point and age-period-cohort models. RESULTS: Our results revealed an important increase in CRC incidence in Spain, which held constant across the entire study period but became slightly attenuated in both sexes around 1995, when a change-point was detected. The annual increase in incidence, which had been 4.3% per annum in men up to this point, declined to 2.5% thereafter. In women, the increase in incidence, albeit also of considerable magnitude, was more moderate. The incidence trend contrasted sharply with that for mortality, inasmuch as the latter changed in 1997-98, after which point mortality rates in both sexes began to decline. CONCLUSIONS: The divergence between incidence (upward trend) and mortality rates (downward trend from the mid-1990s onwards) would suggest that possible explanations may lie in improved accessibility to endoscopy increased early detection with a corresponding shift to an earlier disease stage and improvements in therapy. This trend is having important consequences insofar as disease prevalence and burden of care are concerned.

Do sex and site matter? Different age distribution in melanoma of the trunk among Swedish men and women.

BACKGROUND: Recent research on cutaneous malignant melanoma (CMM) points to the coexistence of several biological pathways linked to the anatomical site of the lesion, which could lead to this neoplasm. Although the different anatomical distribution of CMM by sex is usually attributed to gender-specific patterns of sun exposure, it has been suggested that an alternative explanation might lie in gender-specific site susceptibility. OBJECTIVES: This paper aimed at analysing the age distribution of CMM by site and sex to gain in-depth knowledge of differences between the sexes. METHODS: Using a large Swedish cohort comprising 2 992 166 workers, Poisson models were fitted to estimate age-specific incidence rates by site and sex, duly adjusted for several factors that might account for changes in environmental exposures (period, birth cohort, socioeconomic level, latitude and rurality). RESULTS: Incidence rates were 17.4 cases per 100 000 person-years in men and 16.5 in women. Sex differences were particularly striking for CMM of the trunk, where both crude and adjusted incidence rates displayed a steady increase with age in men, but reached a plateau in women at around four cases per 100 000 person-years from the 40-45-year age group (perimenopausal period) upwards. There was an almost fivefold increase in the sex ratio for this body site between the younger and older age groups, a difference which could not be attributed to period or cohort effects. CONCLUSIONS: If different aetiological pathways can be assumed to lead to melanoma, then disparities between men and women, particularly in CMM of the trunk, suggest that a possible interaction between site and sex should be borne in mind.

Mesothelioma mortality in men: trends during 1977-2001 and projections for 2002-2016 in Spain.

OBJECTIVES: To evaluate mesothelioma death trends in Spain and to predict the number of future cases of mesothelioma. METHODS: After descriptive analysis of mesothelioma mortality data, an age-period-cohort model was applied to estimate future mesothelioma deaths. RESULTS: From 1977 to 2001, 1928 men over 35 years of age died of mesothelioma in Spain. Projections indicate that 1321 men are expected to die from mesothelioma between 2007 and 2016. CONCLUSION: It is expected that mesothelioma deaths will increase at least until 2016. Available data do not allow prediction of the year when mortality will start to decrease.

Acute health problems among subjects involved in the cleanup operation following the Prestige oil spill in Asturias and Cantabria (Spain).

The purpose of this study was to evaluate exposure conditions and acute health effects in subjects participating in the Prestige oil spill cleanup activities and the association between these and the nature of the work and use of protection devices in the regions of Asturias and Cantabria (Spain). The sample comprised 400 subjects in each region, selected from a random sampling of all persons involved in cleanup activities, stratified by type of worker and number of working days. Data were obtained via a structured questionnaire and included information on specific tasks, number of working days, use of protective materials, and acute health effects. These effects were classified into two broad groups: injuries and toxic effects. Data analysis was performed using complex survey methods. Significant differences between groups were evaluated using Pearson's chi(2) test. Unconditional logistic regression was used to compute odds ratios and 95% confidence intervals. Bird cleaners accounted for the highest prevalence of injuries (19% presented with lesions). Working more than 20 days in highly polluted areas was associated with increased risk of injury in all workers. Occurrence of toxic effects was higher among seamen, possibly due to higher exposure to fuel oil and its components. Toxic effects were more frequent among those working longer than 20 days in highly polluted areas, performing three or more different cleaning activities, having skin contact with fuel oil on head/neck or upper limbs, and eating while in contact with fuel or perceiving disturbing odors. No severe disorders were identified among individuals who performed these tasks. However, potential health impact should be considered when organizing cleanup activities in similar environmental disasters.

Municipal pleural cancer mortality in Spain.

BACKGROUND: Pleural cancer is a recognised indicator of exposure to asbestos and mesothelioma mortality. AIMS: To investigate the distribution of municipal mortality due to this tumour, using the autoregressive spatial model proposed by Besag, York, and Mollie. METHODS: It was possible to compile and ascertain the posterior distribution of relative risk on the basis of a single Bayesian spatial model covering all of Spain's 8077 municipal areas. Maps were plotted depicting standardised mortality ratios, smoothed relative risk (RR) estimates, and the distribution of the posterior probability that RR >1. RESULTS: There was a higher risk of death due to pleural cancer in well defined towns and areas, many of which correspond to municipalities where asbestos using industries once existed for many years, the prime example being the municipal pattern registered for Barcelona Province. The quality of mortality data, the suitability of the model used, and the usefulness of municipal atlases for environmental surveillance are discussed.

[State of cancer in Spain: incidence]. / Situación del cáncer en España: incidencia.

It is estimated that at present in Spain around 162,000 cases of cancer are diagnosed each year (without including non-melanoma skin cancer), of which 25,600 correspond to colorectal carcinomas, which is the most frequent of all tumours in absolute terms. The next tumour in terms of frequency is lung cancer with 18,800 new cases, followed by breast cancer in women with 15,979 cases. When the incidence of cancer is compared with that in neighbouring countries, Spain shows adjusted rates in men higher than those of the average for the EU, occupying the 5th place. However, in women, Spain shows the lowest rates together with Greece. Spain occupies the first place for cancer of the bladder in men, with rates that are considerably higher than those of the rest of the countries. It is important to verify the increase underway in the incidence of cancer in Spain and the contrast that this represents facing the evolution of mortality. For many important tumoral localisations (lung, stomach, bladder), the population registers do not cover the provinces where there is a greater mortality.

Cutaneous melanoma: hints from occupational risks by anatomic site in Swedish men.

AIMS: To improve knowledge of the epidemiology of melanoma by comparing occupational risks of cutaneous melanoma (CM) by anatomic site in Swedish workers. METHODS: Male workers employed in 1970 and living in the country in 1960 were followed up from 1971 to 1989 using the Swedish Registers of Death and Cancer. A more specifically exposed subcohort included men reporting the same occupation in 1960 and 1970. For each location, occupational risk ratios (RRs) were extracted from Poisson regression models adjusted by age, period, town size, and geographical area. To diminish the influence of socioeconomic factors, intrasector analyses, comparing only jobs belonging to the same occupational sector, were performed. Risk patterns for different locations were compared. RESULTS: High RRs for different sites were found among workers exposed to UV sources (dentists, physiotherapists, and lithographers), and sun exposed workers (harbour masters, and lighthouse/related work). Risk excesses were seen in fur tailors, tanners/fur dressers, patternmakers/cutters, electrical fitters/wiremen, telephone/telegraph installers/repairmen, and some glass/pottery/tile workers. Results for lower and upper limbs were significantly correlated but somewhat independent of those found in thorax, the most frequent location. Correlation between head/neck and thorax was moderate. Specific risk excesses were found for rolling mill workers in head/neck, for chimney sweeps in upper limbs, and for aircraft pilots/navigators/flight engineers in lower limbs. CONCLUSIONS: High RRs in the trunk among occupations with UV exposure from artificial sources suggest an effect not restricted to exposed sites. An unusual distribution of cases and RRs in chimney sweeps, rolling-mill, or glass/pottery/tile workers suggests local effects of exposures. The not previously reported risk excess in this job and in fur related processes, and the RR in electrical fitters and telephone/telegraph installers deserve further investigation. Disparities between locations, as RRs in thorax and limbs, may reflect differences in aetiological mechanisms.

Geographical pattern of brain cancer incidence in the Navarre and Basque Country regions of Spain.

BACKGROUND: The study of the distribution of brain cancer mortality in Spain shows a grouping of highest risk provinces corresponding to the autonomous regions of Navarre and the Basque Country. AIM: To explore the possible existence of geographical patterns in these areas. METHODS: Municipal maps of brain cancer incidence were drawn up and the influence of land use related variables on the distribution of the disease duly analysed. Autoregressive conditional models were used to plot smoothed municipal maps. The influence of explanatory land use variables, ascertained by remote sensing, was assessed. RESULTS: The maps revealed that certain towns situated in the "Media" and "Cantábrica-Baja Montaña" districts of Navarre were areas of highest risk. Among the towns in question, those in the "Media" district lie very close to the city of Pamplona. However, the pattern of brain cancer incidence in Navarre and the Basque Country could not be conclusively said to be determined by any specific type of land cover and/or crop. CONCLUSIONS: Results suggest a possible increase of risk linked to areas devoted to a high percentage of non-irrigated arable land.

The contribution of cigarette smoking to bladder cancer in women (pooled European data).

BACKGROUND: Using a combined analysis of 11 case-control studies from Europe, we have investigated the relationship between cigarette smoking and bladder cancer in women. METHODS: Available smoking information on 685 female bladder cancer cases and 2416 female controls included duration of smoking habit, number of cigarettes smoked per day, and time since cessation of smoking habit for ex-smokers. RESULTS: There was an increasing risk of bladder cancer with increasing duration of smoking, ranging from approximately a two-fold increased risk for a duration of less than 10 years (odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.1-3.1) to over a four-fold increased risk for a duration of greater than 40 years (OR = 4.1, 95% CI 3.0-5.5). A dose-response relationship was observed between number of cigarettes smoked per day and bladder cancer up to a threshold limit of 15-20 cigarettes per day, OR = 3.8 (95% CI 2.7-5.4), after which no increased risk was observed. An immediate decrease in risk of bladder cancer was observed for those who gave up smoking. This decrease was over 30% in the immediate 1-4 years after cessation, OR = 0.68 (95% CI 0.38-1.2). However, even after 25 years the decrease in risk did not reach the level of the never-smokers, OR = 0.27 (95% CI 0.21-0.35). CONCLUSION: The proportion of bladder cancer cases among women attributable to ever smoking was 0.30, (0.25-0.35) and to current smoking was 0.18 (0.14-0.22). These attributable proportions are less than those observed among men, although they are likely to increase in the future as the smoking-related disease epidemic among women matures.

Solid-tumor mortality in the vicinity of uranium cycle facilities and nuclear power plants in Spain.

To ascertain solid tumor mortality in towns near Spain's four nuclear power plants and four nuclear fuel facilities from 1975 to 1993, we conducted a mortality study based on 12,245 cancer deaths in 283 towns situated within a 30-km radius of the above installations. As nonexposed areas, we used 275 towns lying within a 50- to 100-km radius of each installation, matched by population size and sociodemographic characteristics (income level, proportion of active population engaged in farming, proportion of unemployed, percentage of illiteracy, and province). Using log-linear models, we examined relative risk for each area and trends in risk with increasing proximity to an installation. The results reveal a pattern of solid-tumor mortality in the vicinity of uranium cycle facilities, basically characterized by excess lung [relative risk (RR) 1.12, 95% confidence interval (CI), 1.02-1.25] and renal cancer mortality (RR 1.37, 95% CI, 1.07-1.76). Besides the effects of natural radiation, these results could well be evincing the influence on public health exerted by the environmental impact of mining. No such well-defined pattern appeared in the vicinity of nuclear power plants. Monitoring of cancer incidence and mortality is recommended in areas surrounding nuclear fuel facilities and nuclear power plants, and more specific studies are called for in areas adjacent to installations that have been fully operational for longer periods. In this regard, it is important to use dosimetric information in all future studies.

Cigar, pipe, and cigarette smoking and bladder cancer risk in European men.

OBJECTIVE: Estimating the risk of bladder cancer from cigar and pipe smoking is complicated by a small number of non-cigarette smokers included in most relevant studies. METHODS: We undertook a pooled analysis of the data on men from six published case-control studies from Denmark, France, Germany, and Spain, to assess the association between pipe and cigar smoking and bladder cancer, and to compare it with the risk from cigarette smoking. Complete history of tobacco smoking was ascertained separately for cigarettes, cigars, and pipe. Odds ratios (ORs) were estimated after adjusting for age, study, and employment in high-risk occupations. RESULTS: The pooled data set comprised 2279 cases and 5268 controls, of whom 88 cases and 253 controls smoked only cigars or pipe. The OR for pure cigarette smoking was 3.5 (95% confidence interval [CI] 2.9-4.2), that for pure pipe smoking was 1.9 (95% CI 1.2-3.1) and that for pure cigar smoking was 2.3 (95% CI 1.6-3.5). The increase in the OR of bladder cancer that was observed with duration of smoking was non-significantly lower for cigars than for cigarettes. CONCLUSION: Our results suggest that smoking of cigars and pipe is carcinogenic to the urinary bladder, although the potency might be lower than for cigarettes.

Consumption of wine stored in leather wine bottles and incidence of gastric cancer.

The authors conducted a survey among participants of a large-scale case-control study to evaluate a possible association between consumption of wine in leather bottles and incidence of gastric cancer. There were 59 cases and 53 controls in the study. The results suggest that some of the components of the complex mixture (i.e., tar) used in the proofing of leather wine bottles might dissolve in the wine and participate in the etiology of gastric cancer. Nevertheless, the results should be confirmed in an independent study.

[Time trends in ovarian cancer incidence in Navarra (1973-1995): effect of age, birth cohort and period of diagnosis]. / Tendencia temporal de la incidencia de cáncer de ovario en Navarra (1973-1995): efecto de la edad, cohorte de nacimiento y período de diagnóstico.

BACKGROUND: Ovarian cancer is the sixth most common malignancy and the first killer among gynaecologic cancers in women of the European Union. Five years after diagnosis relative survival rates were less than 35%. The aims of the present study are to describe the time trends in ovarian cancer incidence in Navarra over the period 1973-1995, and to identify the age, period-of-diagnosis and birth-cohort components underlying the trend's evolution. METHODS: Standard summary indexes of incidence were calculated. Log-linear Poisson models to quantify risks of ovarian cancer and the relative annual trend were used. Age-period-cohort models were adjusted in order to ascertain the effects on time trend exerted by the respective age, period-of-diagnosis and birth-cohort components. RESULTS: Ovarian cancer incidence has showed annual rises of 2.1% over the period 1973-1995, with stabilisation over the period 1988-1995. A 54% increase in the risk of ovarian cancer was shown for the period 1993-1995 vs.1973-1977. The more recent generations of women born in Navarra do not show significant changes in the risk of ovarian cancer. CONCLUSIONS: A considerable rise in ovarian cancer incidence in Navarra over the period 1973-1995 was found, less pronounced in the last decade. The risk of ovarian cancer shown in the more recent generations of women born in Navarra is stable.

Risk factors for Echinococcus granulosus infection: a case-control study.

Despite the importance of cystic hydatid disease worldwide, no case-control study evaluating the risk factors for Echinococcus granulosus infection has been published to date. Thus, we carried out a hospital study to quantify different risk factors associated with the disease in a province marked by a high incidence of hydatidosis (Soria, Spain). The study population was composed of 127 cases and 127 controls matched by sex, age, and residence. Odds ratios (ORs) for hydatidosis decreased inversely with size of place of birth and residence, and increased with the number of dogs and years of coexistence with them. The variable involving the possibility of dogs ingesting uncooked viscera or carrion proved to be of greater importance (OR = 3.99, 95% confidence interval = 1.94-8.20). Risk factors for hydatidosis traceable to the family environment are of greater relative importance than those attributable to working directly with livestock. No association could be found between ingestion of raw green vegetables and hydatidosis.

Time trends in ovarian cancer mortality in Europe (1955-1993): effect of age, birth cohort and period of death.

The time trend in ovarian cancer mortality in the European Union over the period 1955-1993, and the age, period-of-death and birth cohort components underlying the trend's evolution were analysed using log-linear Poisson models to quantify risk of dying from ovarian cancer in the different countries and regions of Europe, and ascertain the relative annual trend for each country. Furthermore, age-period-cohort models were fitted for each country in order to ascertain the effect on time trend exerted by the respective age, period-of-death and birth cohort components. Ovarian cancer mortality proved 2.77-fold (95% confidence interval (CI) 2.60-2.95) higher in northern versus southern Europe over the period 1955-1993. Denmark registered the highest adjusted rates, namely, 14.3 per 100000 person-years for the 1989-1993 5-year period, the last studied, with Portugal (4.5 per 100000) and Greece (4.5 per 100000) being the countries with the lowest rates. Spain and Greece, with annual rises of 5.8% (95% CI 5.3-6.3) and 5.1% (95% CI 4.2-6.0) respectively, were the countries that displayed the greatest increase in ovarian cancer mortality. Risk of death associated with the birth cohort effect declined in all northern countries from 1920 to 1930. In the south, Italy and France recorded a decline in risk from 1930. Women in Spain and Greece registered an increase in birth cohort-associated mortality, which became less pronounced after 1930. Ovarian cancer mortality in Europe evinces a south-north distribution pattern. The mortality risk for women cohorts born in northern Europe witnessed a gradual decline from 1920 to 1930. In the southern region: (1) Italy and France display a cohort effect of decreased risk from 1930; and (2) Greece and Spain show a cohort effect of increased risk among the different generations of women, though this became less pronounced from 1930 onwards.