RESUMEN
Fruit peels might be a valuable source of active ingredients for cosmetics, leading to more sustainable usage of plant by-products. The aim of the study was to evaluate the phytochemical content and selected biological properties of hydroglycolic extracts from peels and pulps of Annona cherimola, Diospyros kaki, Cydonia oblonga, and Fortunella margarita as potential cosmetic ingredients. Peel and pulp extracts were compared for their antiradical activity (using DPPH and ABTS radical scavenging assays), skin-lightening potential (tyrosinase inhibitory assay), sun protection factor (SPF), and cytotoxicity toward human fibroblast, keratinocyte, and melanoma cell lines. The total content of polyphenols and/or flavonoids was significantly higher in peel than in pulp extracts, and the composition of particular active compounds was also markedly different. The HPLC-MS fingerprinting revealed the presence of catechin, epicatechin and rutoside in the peel of D. kaki, whereas kaempferol glucoside and procyanidin A were present only in the pulp. In A. cherimola, catechin, epicatechin and rutoside were identified only in the peel of the fruit, whereas procyanidins were traced only in the pulp extracts. Quercetin and luteolinidin were found to be characteristic compounds of F. margarita peel extract. Naringenin and hesperidin were found only in the pulp of F. margarita. The most significant compositional variety between the peel and pulp extracts was observed for C. oblonga: Peel extracts contained a higher number of active components (e.g., vicenin-2, kaempferol rutinoside, or kaempferol galactoside) than pulp extract. The radical scavenging potential of peel extracts was higher than of the pulp extracts. D. kaki and F. margarita peel and pulp extracts inhibited mushroom and murine tyrosinases at comparable levels. The C. oblonga pulp extract was a more potent mushroom tyrosinase inhibitor than the peel extract. Peel extract of A. cherimola inhibited mushroom tyrosinase but activated the murine enzyme. F. margarita pulp and peel extracts showed the highest in vitro SPF. A. cherimola, D. kaki, and F. margarita extracts were not cytotoxic for fibroblasts and keratinocytes up to a concentration of 2% (v/v) and the peel extracts were cytotoxic for A375 melanoma cells. To summarize, peel extracts from all analyzed fruit showed comparable or better cosmetic-related properties than pulp extracts and might be considered multifunctional active ingredients of skin lightening, anti-aging, and protective cosmetics.
Asunto(s)
Annona , Catequina , Diospyros , Melanoma , Rosaceae , Rutaceae , Ratones , Animales , Humanos , Catequina/análisis , Antioxidantes/farmacología , Diospyros/química , Quempferoles/análisis , Monofenol Monooxigenasa , Pulgar , Frutas/química , Rosaceae/química , Rutina/análisis , Fitoquímicos/análisis , Extractos Vegetales/químicaRESUMEN
PURPOSE: With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients' age. METHODS: We analysed 101,714 CC women diagnosed in 2000-2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed. RESULTS: EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women. CONCLUSION: Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.
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Neoplasias del Cuello Uterino/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Unión Europea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias del Cuello Uterino/mortalidadRESUMEN
BACKGROUND: Wealthy countries have observed in recent decades a fast-growing number of prostate patients, who require treatment and long-term cancer care. This trend seems to be connected with some demographic changes such as aging societies, better access to diagnostic methods with high sensitivity as well as large-scale secondary prevention (prostate cancer screening at early stage before clinical manifestation). Secondary prevention is becoming more accessible and widely applied. The expected effect of prevention is to improve overall survival while the mortality trend is decreasing. The prevention success requires highly effective healthcare system that must manage additional burden which is a consequence of the need to provide optimal treatment and healthcare in a big group of cancer patients diagnosed in effective prevention programms. According to the National Cancer Registry (NCR) the number of incidence from year 1980 - 1731 cases rose in year 2013 to 12 162 cases. Apart from incidence and mortality rates, the 5-year survival is a significant factor for the assessment of a population healthcare and healthcare system efficiency. The prognosis related to prostate incidence is 22 344 men in year 2025 in comparison to 12 162 in year 2013 - that would be a double rise in incidence. CONCORD-2 results (years 1995-2009) showed, among the others, that cancer curability for some cancers, including prostate cancer improved. In year 2018 the results of CONCORD-3 were published (years 2000-2014) showing a rising trend in improvement in prostate cancer curability in Poland. OBJECTIVE: The objective was to analyse the 5-year survival in prostate cancer patients in Poland, and in each of 16 voivodships, with the focus on changes in years 2000 - 2014 in comparison to European trends. MATERIAL AND METHODS: The analysis was based on the 5-year net survival (estimated in CONCORD-3) in prostate cancer patients diagnosed in Poland (NCR national data) and in all Polish voivodships. The 5-year survival of prostate cancer patients and its changes in years 2000 - 2014 compared between 16 voivodships, Poland in total and 28 European countries. RESULTS: In Poland in years 2010 - 2014 the 5-year survival in prostate cancer patients was 78.1%, and compared to years 2000 - 2004 rose by 9.3 percentage points. Despite a systematic improvement in survival the differences between individual voivodships in Poland remained. In 6 voivodships the survival was higher than average for Poland and ranged from 80 to 82%. The lowest survival was in Opolskie voivodship - 72.3%. On a European scale, the curability of prostate cancer at that time was over 90% (9 countries), while Poland was among 5 countries whose total survival rate was less than 80% (from 72.3% - Opolskie voivodship to 83.6% -- Pomeranian voivodship). CONCLUSIONS: The 5-year survival in prostate cancer patients in years 2010 - 2014 in Poland was significantly lower in comparison to Western Europe countries, and favourable trends on a regional level in Poland were too slow to overcome high differentiation in Europe. It is expected that changing the structure and organisation of cancer care in Poland into a modern National Oncology Network Comprehensive Cancer Care Network, together with the use of the experiences from European projects, including iPAAC and better financing will contribute to improvement in prostate cancer treatment in Poland.
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Detección Precoz del Cáncer , Neoplasias de la Próstata , Europa (Continente)/epidemiología , Humanos , Incidencia , Masculino , Polonia/epidemiología , Antígeno Prostático Específico , Neoplasias de la Próstata/terapiaRESUMEN
Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009-2013, and 4 STs: surgery; breast-conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (≤6 weeks after diagnosis). Covariate-adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z-test assessed the significance of time-trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = -0.9), but prompt treatment weakly (R = -0.01/-0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non-standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence-based treatments.
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Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/terapia , Comorbilidad , Tiempo de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Neoplasias de la Mama/patología , Terapia Combinada/estadística & datos numéricos , Europa (Continente) , Femenino , Humanos , Mamoplastia/estadística & datos numéricos , Mastectomía Segmentaria/estadística & datos numéricos , Persona de Mediana Edad , Radioterapia Adyuvante , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: The 5-year population-based survival rate, next to cancer incidence and mortality, is a key element for the assessment of effective health care quality provided by OECD in order to establish the condition of health care and set up health care policies. They also apply when assessing breast and cervical cancer prevention in Poland. AIM: The aim of the paper was to analyse the breast and cervical cancer survival in women in Poland in 2010-2014 and its changes in 2000-2014 in comparison to other European countries. RESULTS: The analysis of the 5-year survival rate was performed with the CONCORD-3 programme data. In order to guarantee the comparability of results, the uniform standards for data quality control, all calculations and analyses were performed by a world-leading centre for research, The London School of Hygiene and Tropical Medicine. The absolute value of the survival rate was used to assess survival variations in 2000-2004 and 2010-2014. In 2010-2014 the highest 5-year survival rate in women with breast cancer was in Island (89%), Sweden (89%), Finland (89%) and Norway (88%). Despite its systematic improvement, the 5-year survival rate in Poland was lower than in the majority of European countries, and in the final period amounted to 76,6%. In 2010-2014 the highest survival in women with cervical cancer in Europe was in Island (80%), Norway (73%) and Switzerland (71%). The progress of favourable changes in Poland was not sufficient enough to allow the survival rate (55%) to be significantly closer to the European average. CONCLUSIONS: The 5-year survival rate for breast and cervical cancer in Poland in 2010-2014 was significantly different than in other European countries, and placed Poland among the countries with the lowest survival rate. In 2000-2014 in Poland there was an insignificant progress in survival in women with breast and cervical cancer, which did not contribute to fighting the substantial differences when compared to other European countries.
Asunto(s)
Neoplasias de la Mama/mortalidad , Sistema de Registros , Neoplasias del Cuello Uterino/mortalidad , Europa (Continente)/epidemiología , Femenino , Humanos , Polonia/epidemiología , Tasa de SupervivenciaRESUMEN
BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. FUNDING: Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).
Asunto(s)
Neoplasias/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Salud Global , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Sistema de Registros , Distribución por Sexo , Análisis de Supervivencia , Adulto JovenRESUMEN
Background: The transformation period in Poland is associated with a set of factors seen as 'socio-economic stress', which unfavourably influenced cancer treatment and slowed down the progress of the Polish cancer care in the 90's. These outcomes in many aspects of cancer care may be experienced till today. The results of the international EUROCARE and CONCORD studies based on European data prove evidence that there is a substantial potential for improvement of low 5-year survival rates in Poland. Since high survivals are related to notably efficient health care system, therefore, to improve organization and treatment methods seems to be one of the most important directions of change in the Polish health care system. Till today, cancer care in Poland is based on a network outlined by Professor Koszarowski in the middle of the last century, and is a solid foundation for the contemporary project of the Comprehensive Cancer Care Network (CCCN) proposed in the frame of CanCon Project. Objective: Analysis of the structure of health care system and the changes introduced within the network of oncology in Poland since the beginning of the post-commuinist socio-economic transformation in 1989. Materials and Methods: This study was conducted based on the CanCon methods aimed at reviewing specialist literature and collecting meaningful experiences of European countries in cancer care, including the main legal regulations. Results: The analysis provided evidence that the political situation and the economic crisis of the Transformation period disintegrated the cancer care and resulted in low 5-year survival rates. A step forward in increasing efficiency of the cancer treatment care was a proposal of the 'Quick Oncological Therapy' together with one more attempt to organize a CCCN. With this paper the Authors contribute to the CanCon Project by exploration, analysis and discussion of the cancer network in Poland as an example of existing net-like structures in Europe as well as by preparation of guidelines for constructing a contemporary CCCN. Conclusions: (1) 'Socio-economic' stress adversely affected the efficiency of oncological treatment, both by reducing safety and slowing down the development of modern oncology. (2) Changing the current system into the contemporary form - CCCN could be an important step forward to optimise the oncological health care in Poland. (3) Introduction of the mandatory monitoring of organizational changes with the use of health standardized indicators could allow for the assessment of the effectiveness of implemented solutions and their impact on better prognosis for cancer patients. (4) Optimising the organization of the health care system is possible only by implementing necessary legislative corrections.
Asunto(s)
Atención a la Salud/tendencias , Neoplasias/terapia , Tasa de Supervivencia/tendencias , Predicción , Humanos , PoloniaRESUMEN
BACKGROUND: Cancer survival is a key measure of the effectiveness of health-care systems. EUROCARE-the largest cooperative study of population-based cancer survival in Europe-has shown persistent differences between countries for cancer survival, although in general, cancer survival is improving. Major changes in cancer diagnosis, treatment, and rehabilitation occurred in the early 2000s. EUROCARE-5 assesses their effect on cancer survival in 29 European countries. METHODS: In this retrospective observational study, we analysed data from 107 cancer registries for more than 10 million patients with cancer diagnosed up to 2007 and followed up to 2008. Uniform quality control procedures were applied to all datasets. For patients diagnosed 2000-07, we calculated 5-year relative survival for 46 cancers weighted by age and country. We also calculated country-specific and age-specific survival for ten common cancers, together with survival differences between time periods (for 1999-2001, 2002-04, and 2005-07). FINDINGS: 5-year relative survival generally increased steadily over time for all European regions. The largest increases from 1999-2001 to 2005-07 were for prostate cancer (73.4% [95% CI 72.9-73.9] vs 81.7% [81.3-82.1]), non-Hodgkin lymphoma (53.8% [53.3-54.4] vs 60.4% [60.0-60.9]), and rectal cancer (52.1% [51.6-52.6] vs 57.6% [57.1-58.1]). Survival in eastern Europe was generally low and below the European mean, particularly for cancers with good or intermediate prognosis. Survival was highest for northern, central, and southern Europe. Survival in the UK and Ireland was intermediate for rectal cancer, breast cancer, prostate cancer, skin melanoma, and non-Hodgkin lymphoma, but low for kidney, stomach, ovarian, colon, and lung cancers. Survival for lung cancer in the UK and Ireland was much lower than for other regions for all periods, although results for lung cancer in some regions (central and eastern Europe) might be affected by overestimation. Survival usually decreased with age, although to different degrees depending on region and cancer type. INTERPRETATION: The major advances in cancer management that occurred up to 2007 seem to have resulted in improved survival in Europe. Likely explanations of differences in survival between countries include: differences in stage at diagnosis and accessibility to good care, different diagnostic intensity and screening approaches, and differences in cancer biology. Variations in socioeconomic, lifestyle, and general health between populations might also have a role. Further studies are needed to fully interpret these findings and how to remedy disparities. FUNDING: Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation, Cariplo Foundation.
Asunto(s)
Neoplasias/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. METHODS: We analysed survival data for 157,499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers. FINDINGS: We analysed 59,579 cases. For all cancers combined for children diagnosed in 2000-07, 1-year survival was 90.6% (95% CI 90.2-90.9), 3-year survival was 81.0 % (95% CI 80.5-81.4), and 5-year survival was 77.9% (95% CI 77.4-78.3). For all cancers combined, 5-year survival rose from 76.1% (74.4-77.7) for 1999-2001, to 79.1% (77.3-80.7) for 2005-07 (hazard ratio 0.973, 95% CI 0.965-0.982, p<0.0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65.2% (95% CI 63.1-67.3) in 1999-2001, to 70.2% (67.9-72.3) in 2005-07. Europe-wide average yearly change in mortality (hazard ratio) was 0.939 (95% CI 0.919-0.960) for acute lymphoid leukaemia, 0.959 (0.933-0.986) for acute myeloid leukaemia, and 0.940 (0.897-0.984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005-07). INTERPRETATION: Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe. FUNDING: Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
Asunto(s)
Neoplasias/mortalidad , Adolescente , Niño , Preescolar , Europa (Continente) , Humanos , Lactante , Recién Nacido , Factores de TiempoRESUMEN
BACKGROUND: We used the comprehensive definition of AYA (age 15 to 39 years) to update 5-year relative survival (RS) estimates for AYAs in Europe and across countries and to evaluate improvements in survival over time. METHODS: We used data from EUROCARE-6. We analysed 700,000 AYAs with cancer diagnosed in 2000-2013 (follow-up to 2014). We focused the analyses on the 12 most common cancers in AYA. We used period analysis to estimate 5-year RS in Europe and 5-year RS differences in 29 countries (2010-2014 period estimate) and over time (2004-06 vs. 2010-14 period estimates). FINDINGS: 5-year RS for all AYA tumours was 84%, ranging from 70% to 90% for most of the 12 tumours analysed. The exceptions were acute lymphoblastic leukaemia, acute myeloid leukaemia, and central nervous system tumours, presenting survival of 59%, 61%, and 62%, respectively. Differences in survival were observed among European countries for all cancers, except thyroid cancers and ovarian germ-cell tumours. Survival improved over time for most cancers in the 15- to 39-year-old age group, but for fewer cancers in adolescents and 20- to 29-year-olds. INTERPRETATION: This is the most comprehensive study to report the survival of 12 cancers in AYAs in 29 European countries. We showed variability in survival among countries most likely due to differences in stage at diagnosis, access to treatment, and lack of referral to expert centres. Survival has improved especially for haematological cancers. Further efforts are needed to improve survival for other cancers as well, especially in adolescents.
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Neoplasias del Sistema Nervioso Central , Neoplasias Hematológicas , Neoplasias , Neoplasias de la Tiroides , Femenino , Humanos , Adolescente , Adulto Joven , Adulto , Sistema de Registros , Neoplasias/diagnóstico , Neoplasias/epidemiología , Neoplasias/terapia , Europa (Continente)/epidemiologíaRESUMEN
Breast cancer survival is reportedly higher in the US than in Europe. The first worldwide study (CONCORD) found wide international differences in age-standardized survival. The aim of this study is to explain these survival differences. Population-based data on stage at diagnosis, diagnostic procedures, treatment and follow-up were collected for about 20,000 women diagnosed with breast cancer aged 15-99 years during 1996-98 in 7 US states and 12 European countries. Age-standardized net survival and the excess hazard of death up to 5 years after diagnosis were estimated by jurisdiction (registry, country, European region), age and stage with flexible parametric models. Breast cancers were generally less advanced in the US than in Europe. Stage also varied less between US states than between European jurisdictions. Early, node-negative tumors were more frequent in the US (39%) than in Europe (32%), while locally advanced tumors were twice as frequent in Europe (8%), and metastatic tumors of similar frequency (5-6%). Net survival in Northern, Western and Southern Europe (81-84%) was similar to that in the US (84%), but lower in Eastern Europe (69%). For the first 3 years after diagnosis the mean excess hazard was higher in Eastern Europe than elsewhere: the difference was most marked for women aged 70-99 years, and mainly confined to women with locally advanced or metastatic tumors. Differences in breast cancer survival between Europe and the US in the late 1990s were mainly explained by lower survival in Eastern Europe, where low healthcare expenditure may have constrained the quality of treatment.
Asunto(s)
Neoplasias de la Mama/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Sistema de Registros , Estados Unidos/epidemiología , Adulto JovenRESUMEN
THE PURPOSE OF THE STUDY: The purpose of the study was to analyze the level and the trends of premature mortality caused by selected cancers in Swietokrzyskie Province in years 1999-2010. MATERIAL AND METHODS: The material for the study was the data published in the Swietokrzyskie Cancer Registry on the number of deaths caused by cancers as well as the information from the Central Statistical Office on the number of deaths due to general death causes in Swietokrzyskie Province in years 1999-2010. The premature mortality analysis was conducted with the use of PYLL indicator (PYLL - potential years of life lost). PYLL rate was calculated according to the method proposed by J. Romeder, according to which the premature mortality was defined as death before the age of 70. Time trends of PYLL rate and the average annual percent change (APC - annual percent change) were assessed usingjointpoint models as well as the Jointpoint Regression Program (Version 4.0.1 - January 2013). RESULTS: In year 2010 cancers were responsible for 18.3% of PYLL in men and 48.1% in women. In years 1999-2010 PYLL rate in men decreased due to lung cancer (APC=0.75%) and stomach cancer (APC=1.2%). The increase in rate of PYLL was noted for colorectal cancer (APC=3.3%, p<0.05) and prostate cancer (APC=1.6%). In women, rate of PYLL increased due to lung cancer (APC=6.2%, p<0.05), colorectal cancer (APC=2.9%), breast cancer (APC=1.8%) and ovarian cancer (APC=0.15%). Rate of PYLL decreased due to cervical cancer (APC=4.3%, p<0.05) and stomach cancer (APC=1.5%). SUMMARY AND CONCLUSIONS: During the analysed period the highest increase of premature mortality was observed in colorectal cancer in both sexes and lung cancer in women, a slightly smaller increase was noted for breast cancer and prostate cancer. What is particularly important is the trend and a slight decrease of premature mortality rate caused by lung cancer in men and its significant decrease for cervical cancer as well as stomach cancer in both sexes.
Asunto(s)
Causas de Muerte/tendencias , Mortalidad Prematura/tendencias , Neoplasias/mortalidad , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Polonia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Premature mortality in younger age groups influences the society as far as social and economic aspects are concerned. Therefore, it is important to come up with a tool which will allow to assess them, and will enable to implement only these health care measures that bring tangible benefits. That is the reason for introducing PYLL rate (PYLL - potential years of life lost), which is an addition to the analysis of premature mortality as it includes the number of deaths due to a particular cause and the age at death. OBJECTIVE: The purpose of this study was to analyse the level and trends of PYLL rate according to death causes in years 2002 -2010 in Swietokrzyskie Province. MATERIAL AND METHODS: The material for the analysis was the information from the Central Statistical Office on the number of deaths due to all causes registered among the inhabitants of Swiytokrzyskie Province in years 2002-2010. Causes of death were coded according to the 10th revision of the International Classification of Diseases. The analysis of premature mortality was carried out with the use of PYLL rate. PYLL rate was calculated according to the method proposed by Romeder, according to which the premature mortality was defined as death before the age of 70. The analysis of time trends of PYLL rate and the APC (annual percent change) of the PYLL rate were calculated using jointpoint model as well as the Jointpoint Regression Program (Version 4.0.1 - January 2013). RESULTS: In men, in years 2002 - 2007 PYLL rate increased by 1.5% per year (p<0.05). From year 2007 the trend went downward and PYLL rate decreased on average by 3.1% per year till year 2010. External causes of death, cardiovascular diseases and cancers in years 2002 - 2010 were the reason for almost 74.0% PYLL in men. In year 2010 PYLL rate due to all death causes amounted to 8913.8/105 and was three times higher than in women (2975.5/10(5)). In women, however, during the analysed period PYLL rate did not change significantly, and was dominated by cancers, cardiovascular diseases and external death causes. Similarly to men, those three groups of death causes were responsible for an average 76.0% PYLL. CONCLUSIONS: The analysis of the causes of premature mortality in Swietokrzyskie Province shows that in the majority of cases it is due to preventable deaths, which calls for the necessity of more intensive measures in primary and secondary prevention as well as the improvement in treatment standards, mainly of cardiovascular diseases, cancers, injuries and accidents.
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Causas de Muerte/tendencias , Mortalidad Prematura/tendencias , Accidentes/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Enfermedades Cardiovasculares/mortalidad , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Esperanza de Vida , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Polonia/epidemiología , Distribución por Sexo , Tasa de Supervivencia , Heridas y Lesiones/mortalidad , Adulto JovenRESUMEN
BACKGROUND: Survival for ovarian cancer is the poorest of all gynaecological cancer sites. Our aim was to present the most up-to-date survival estimate for ovarian cancer by age and morphology and to answer the question whether survival for ovarian cancer improved in Europe during the 1990s. MATERIAL AND METHODS: This analysis was performed with data from the EUROCARE database. We considered all adult women diagnosed with ovarian cancer between 1995 and 2002 and life status followed up until the end of 2003. A total of 97 691 cases were contributed by 72 European cancer registries in 24 countries. We estimated the most up-to-date relative survival for a mean of 23 661 patients followed up in 2000-2003 using the period hybrid approach and described the relative survival trends from the beginning of 1990s. RESULTS AND CONCLUSION: Overall, the European age-standardised one-year, five-year and five-year conditional on surviving one-year relative survival were 67.2% (95% CI 66.6-67.8), 36.1% (95% CI 35.4-36.8) and 53.7% (95% CI 52.8-54.7), respectively. Five-year relative survival was 58.6% (95% CI 57.4-59.8), 37.1% (95% CI 36.1-38.1) and 20.5% (95% CI 19.1-21.9) in women aged 15-54, 55-74 and 75-99 years, respectively. The age-standardised five-year relative survival was 38.1% (95% CI 36.9-39.3) for serous tumours and 51.9% (95% CI 49.0-54.9) for mucinous cancers and the crude five-year relative survival was 85.6% (95% CI 81.2-90.0) for germ cell cancers. Overall, the age-standardised five-year relative survival increased from 32.4% (95% CI 31.7-33.2) in 1991-1993 to 36.3% (95% CI 35.5-37.0) in 2000-2003. There is a need to better understand the reasons for the wide variation in survival of ovarian cancer in Europe. Actions aiming to harmonise the protocols for therapy should contribute to narrowing the wide gap in survival and research on screening and early detection of ovarian cancer should be enforced.
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Adenocarcinoma de Células Claras/mortalidad , Adenocarcinoma Mucinoso/mortalidad , Cistadenocarcinoma Seroso/mortalidad , Neoplasias Ováricas/mortalidad , Sistema de Registros/estadística & datos numéricos , Adenocarcinoma de Células Claras/epidemiología , Adenocarcinoma Mucinoso/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Cistadenocarcinoma Seroso/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/epidemiología , Tasa de Supervivencia , Factores de Tiempo , Adulto JovenRESUMEN
Governments and other authorities (including MPs) should be well informed on issues of science and technology. This is particularly important in the era of evidence-based practice. This implies the need to get expert advice. The process by which scientific knowledge is transmitted, along with proposals how to solve the problem, is called science advice. The main aim of the article is to discuss the issue of science advice--definitions, interaction between science and policymaking, and its position in contemporary policies. The second aim is to present European Science Advisory Network for Health (EuSANH), EuSANH-ISA project, and framework for science advice for health which was developed by participants. Furthermore, the role of civil society in decision-making process and science advice is also discussed. Interaction between scientists and policy-makers are described in terms of science-push approach (technocratic model), policy-pull (decisionistic) and simultaneous push-pull approach (pragmatic). The position of science advice is described in historical perspective from the 50s, especially in the last two decades. Description relies to USA, Canada and UK. Principles of scientific advice to government (Government Office for Science, UK) are quoted. Some important documents related to science advice in EU and UN are mentioned. EuSANH network is described as well as EuSANH-ISA project, with its objectives and outcomes. According to findings of this project, the process of science advice for health should follow some steps: framing the issue to be covered; planning entire process leading to the conclusion; drafting the report; reviewing the report and revision; publishing report and assessing the impact on policy.
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Comités Consultivos , Agencias Gubernamentales , Política de Salud , Formulación de Políticas , Política Pública , Sociedades Científicas , Canadá , Comunicación , Conducta Cooperativa , Toma de Decisiones , Europa (Continente) , Humanos , Conocimiento , Reino Unido , Estados UnidosRESUMEN
OBJECTIVE: To identify disparities in the management of colon and rectal cancer across Europe by assessing population-based information from 12 European cancer registries (CR) participating in EUROCARE, together with additional information obtained from individual clinical records. METHODS AND PATIENTS: We considered five indicators: (a) resection with curative intent; (b) post-operative mortality; (c) proportion of stage II/III colon cancer cases given adjuvant chemotherapy; (d) proportion of rectal cancer cases receiving radiotherapy; and (e) proportion of curative intent resections with 12 or more lymph nodes examined. RESULTS: A total of 6 871 colorectal cancer patients, diagnosed between 1996-1998, were examined. Overall 71% of patients received resection with curative intent, range 44-86% by CR; 46% of stage III colon cancer cases (range 24-73% by CR) and 22% of stage II cases (not then recommended) received adjuvant chemotherapy; 12% of rectal cancer cases received adjuvant radiotherapy, range < or =2% in five CRs to >51% in two CRs. For only 29% of curative intent resections were 12 or more lymph nodes examined. CONCLUSIONS: This study reveals that, although most patients received surgery with curative intent, disparities in treatment for colorectal cancer across Europe in the late 1990s were unexpectedly large, with many patients not receiving treatments indicated by published clinical trials. Consensus guidelines for CRC management are now becoming available and should be adopted across Europe. It is hoped that dissemination of guidelines will improve the use of scientifically proven treatments for the disease, but this should be monitored by further population-based studies.
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Quimioterapia Adyuvante/estadística & datos numéricos , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Disparidades en Atención de Salud/estadística & datos numéricos , Ganglios Linfáticos/cirugía , Radioterapia Adyuvante/estadística & datos numéricos , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/radioterapia , Europa (Continente)/epidemiología , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Sistema de RegistrosRESUMEN
In the article were presented the important breast cancer risk factors: genetic factors, family history, age, procreation behaviors, women's physiology (menarche, menopause), obesity, low physical activity, alcohol intake, oral contraceptive and menopausal hormonal replacement therapy. Possibilities of primary prevention and methods of calculation of individual breast cancer risk were also described. The value of the secondary prevention of the disease was emphasized. The primary and secondary prevention could substantially reduce burden of the breast cancer.
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Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Estado de Salud , Prevención Primaria/organización & administración , Salud de la Mujer , Adolescente , Adulto , Edad de Inicio , Anciano , Anciano de 80 o más Años , Ejercicio Físico , Femenino , Humanos , Estilo de Vida , Menarquia , Persona de Mediana Edad , Obesidad , Polonia/epidemiología , Posmenopausia , Factores de RiesgoRESUMEN
INTRODUCTION: For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established. MATERIALS AND METHODS: We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use. RESULTS: Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (Pâ¯<â¯0.001). Chemotherapy timing did not vary (Pâ¯=â¯0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time. CONCLUSIONS: Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.
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Antineoplásicos/uso terapéutico , Neoplasias del Colon/terapia , Estadificación de Neoplasias , Vigilancia de la Población , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/epidemiología , Terapia Combinada/métodos , Comorbilidad , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Tiempo de Tratamiento , Adulto JovenRESUMEN
The aim of this study was to estimate the availability of medical records (MR) in population study based on Cancer Registries (CR) data, and to investigate weather the availability of MR correlates with favourable prognostic factors in cervical cancer patients. The cohort consisted of 1386 patients diagnosed between 1993 and 1996 and registered at CR in three Polish cities: Kielce, Opole and Warsaw. Population of these areas covers about 10% of Polish population. The data became amended with information from MR on stage, histopathology and first treatment. The place of living and availability of MR were also considered as prognostic factors. Chi square test was used to compare the differentiation of distribution of prognostic factors between two groups: patients for whom MR were available and remaining group with information available from CR only. A multivariate regression analysis was applied for the evaluation of prognostic factors. MR, available for 75,4% patients, combined with CR data, formed the high quality database allowing analysis of prognostic factors. The availability of MR correlated with more favourable prognostic factors (p<0.0001): earlier stage of disease, younger age and category of microscopic diagnosis. Multivariate analysis confirmed the prognostic meaning of the stage of disease, place of living and availability of MR, however, the last factor was not significant. The analysis confirmed the necessity of including selected clinical prognostic factors into routinely collected data by population CR to allow monitoring of effectiveness of any cancer control project and evaluation of cancer health indicators as recommended by IARC/WHO in EUROCHIP Project.