Predicting the cancer burden in Catalonia between 2015 and 2025: the challenge of cancer management in the elderly.

BACKGROUND: Developing effective cancer control programmes requires information on the future cancer burden in an ageing population. In our study we predicted the burden of cancer in Catalonia from 2015 to 2025. METHODS: Bayesian age-period-cohort models were used to predict the burden of cancer from 2015 to 2025 using incidence data from the Girona and Tarragona cancer registries and cancer mortality data from the Catalan mortality registry. Using the Bashir-Estève method, we divided the net change in the number of cases between 2015 and 2025 into changes due to population size (S), cancer risk (R) and age (A) distribution. RESULTS: By 2025, there will be 21,743 new cancer cases in men (40% aged > 74 years) and 17,268 in women (37% aged > 74 years). More than 40% of the new cases will be diagnosed among population aged 74 and older in prostate, colorectal, lung, bladder, pancreatic and stomach cancers in men, and in colorectal, pancreatic and bladder cancers and leukaemia in women. During 2015-2025, the number of new diagnoses will increase by 5.5% in men (A + R + S = 18.1% - 13.3% + 0.7% = 5.5%) and 11.9% in women (A + R + S = 12.4% - 1.1% + 0.6% = 11.9%). Overall cancer mortality rates will continue to decrease during 2015-2025. Lung cancer will be the most lethal cancer among men (N = 2705) and women (N = 1174). CONCLUSIONS: The increase in the number of cancer cases in Catalonia from 2015 to 2025 will mostly affect the elderly, prompting the need for increased collaboration between geriatricians and oncologists.

Cancer incidence and mortality projections up to 2020 in Catalonia by means of Bayesian models.

PURPOSE: To predict the burden of cancer in Catalonia by 2020 assessing changes in demography and cancer risk during 2010-2020. METHODS/PATIENTS: Data were obtained from Tarragona and Girona cancer registries and Catalan mortality registry. Population age distribution was obtained from the Catalan Institute of Statistics. Predicted cases in Catalonia were estimated through autoregressive Bayesian age-period-cohort models. RESULTS: There will be diagnosed 26,455 incident cases among men and 18,345 among women during 2020, which means an increase of 22.5 and 24.5 % comparing with the cancer incidence figures of 2010. In men, the increase of cases (22.5 %) can be partitioned in three components: 12 % due to ageing, 8 % due to increase in population size and 2 % due to cancer risk. In women, the role of each component was 9, 8 and 8 %, respectively. The increased risk is mainly expected to be observed in tobacco-related tumours among women and in colorectal and liver cancers among men. During 2010-2020 a mortality decline is expected in both sexes. CONCLUSION: The expected increase of cancer incidence, mainly due to tobacco-related tumours in women and colorectal in men, reinforces the need to strengthen smoking prevention and the expansion of early detection of colorectal cancer in Catalonia.

Time trends of cancer incidence and mortality in Catalonia during 1993-2007.

PURPOSE: To describe time trends of cancer in Catalonia, Spain, during the period 1993-2007. METHODS/PATIENTS: Data have been provided by two population-based cancer registries, Girona and Tarragona, and the Catalan mortality registry. Cancer incidence in Catalonia has been estimated through modeling methods using data from these health structures. RESULTS: During 2003-2007, there were 20,042 cancer cases and 9,842 deaths per year among men and 13,673 new cancer cases and 5,882 deaths among women. The most frequent incident cancers among men were prostate (N = 4,258), lung (N = 3,021), colorectal (N = 3,007) and bladder (N = 2,238), whereas among women they were breast (N = 3,907), colorectal (N = 2,088), corpus uteri (N = 734) and lung (N = 527). During 1993-2007, age-standardized incidence rates (ASIRs) rose 1.2 % per year among men [prostate (6.3 %), testis (5.7 %), kidney (2.9 %), liver (2.2 %) and colorectal (2.1 %)]. ASIRs decreased for stomach (-2.9 %), oral cavity and pharynx (-2.8 %), larynx (-2.7 %) and esophagus (-2 %). Among women, ASIRs only rose for lung (5.2 %), kidney (3.1 %), oral cavity and pharynx (2.6 %) and thyroid (1.6 %). ASIRs decreased for corpus uteri (-2.3 %), stomach (-1.7 %) and ovary (-1.6 %). Cancer mortality decreased -1.3 % per year among men and -2.1 % among women during the same period. CONCLUSION: Among men, the decrease of incidence/mortality of tobacco-related tumors was related to a reduction of smoking prevalence. Among women, the stabilization of breast cancer incidence and the rise of lung cancer incidence are similar to that observed in most European regions. These results allow assessing the effectiveness of public health strategies and they pose new frontiers for cancer control in Catalonia.

[Cancer survival trends in Catalonia and comparison with Europe]. / Evolución de la supervivencia del cáncer en Cataluña y comparación con Europa.

OBJECTIVE: To analyze survival in cancer patients in Catalonia for the diagnostic cohort for the period 1995-1999 and the survival trend for the period 1985-1999 and to compare this trend with that observed in the rest of Europe. MATERIAL AND METHOD: We present the observed and relative 5-year survival rates for adult cancer patients resident in Tarragona and Gerona diagnosed between 1995 and 1999. To analyze the trend in survival, rates for the periods 1985-1989, 1990-1994 and 1995-1999 for patients living in Tarragona were analyzed. Relative survival rates for the 1995-1999 Tarragona and Gerona diagnosis cohort as a whole were compared with the European mean obtained in the EUROCARE- 4 project. RESULTS: From 1995-1999, relative survival rates were 46.0% in males and 56.4% in females. For the most frequent types of cancer in males the rates were as follows: 76.5% prostate, 9.2% lung, 53.5% colon and rectum, 69.7% urinary bladder and 25.7% stomach. In females, the rates were 80.9% breast, 50.7% colon and rectum, 76.1% corpus uterine, 24.9% stomach and 36.9% ovary. For quinquenniums and for all cancers as a whole, the rates were 35.1%, 40.8% and 47.5% in males and 49.0%, 55.7% and 57.3% in females. The rate for all people combined in the period 1995-1999 was 50.2% in Tarragona- Gerona and was 51.9% in Europe. CONCLUSIONS: Between the periods 1985-1989 and 1995-1999, relative survival rates increased 12 points in males and eight points in females. Similar values to the European mean were maintained throughout the 15 years of the study.

[Cancer mortality trends in Catalonia, 1985-2004]. / Tendencias de la mortalidad por cáncer en Cataluña, 1985-2004.

BACKGROUND AND OBJECTIVE: In the last two decades, major changes have occurred in both the epidemiology and the healthcare of cancer, which have had a substantial impact on the mortality due to this disease. The objective of this study was to analyze cancer mortality trends in Catalonia in the previous 20 years and to compare these trends with those in Europe. SUBJECTS AND METHODS: Mortality data were gathered from the mortality register of the Department of Health of Catalonia, which includes all deaths in Catalonia from 1985-2004. The causes of death are coded according to the International Classification of Diseases (ICD-9 for 1985-1998 and ICD-10 for 1999-2004). The population data used were inter-census (1985-2000), census (2001) and post-census (2002-2004) estimates from the Catalan Institute of Statistics. Ageadjusted rates (AR) (to the world population of 1960) and accumulated rates from 0 to 74 years old were calculated. A Poisson model was adjusted to the AR to estimate the mortality trend and the annual percentage of change was calculated for the years 1985-1994 and 1995- 2004 and for the period 1985-2002 as a whole. RESULTS: From 1985-2004, the risk of dying from cancer decreased from 18.54 % to 17.49% in men and from 9.24% to 7.69% in women. The adjusted rate of mortality decreased in cancer of the larynx (2,52%), prostate (1.11%) and stomach (2.89%) in men and in stomach cancer (-3.64) in women. In men, there was a significant increase in mortality from colorectal cancer (an increase of 2.8% to 1994 with subsequent stabilization) and from lung cancer (an increase of 1.36% to 1994 with a subsequent decrease). Cancer of the liver showed a nonsignificant increase until 1994 with a subsequent decrease of 3.13%. In women, breast cancer increased until 1994 (1.48%) and subsequently significantly decreased (2.72%). Lung cancer increased throughout the entire period but this increase was only significant (4,81%) in the last decade. CONCLUSIONS: In the last two decades, cancer mortality has shown a general decreasing trend, although mortality from several tumors has substantially increased. Compared with other European countries, Catalonia shows lower cancer mortality in women than in men. Nevertheless, the trends shown in the last decade are similar to those followed by the countries in the best positions.

The impact of avoidable mortality on life expectancy at birth in Spain: changes between three periods, from 1987 to 2001.

OBJECTIVE: To evaluate the impact of avoidable mortality on the changes in life expectancy at birth in Spain. METHODS: Standard life table techniques and the Arriaga method were used to calculate and to decompose life expectancy (LE) changes by age, effects and groups of causes of avoidable mortality among three periods (1987-91, 1992-6 and 1997-2001). A list of causes of avoidable mortality reached by consensus and previously published in Spain was used. MAIN RESULTS: Life expectancy increased in all ages and both sexes. The main contribution to the increase of LE at birth was due to people over 50. Mortality in young adults produced a reduction in LE between the first two periods, but there was an important increase in LE between the last two periods; in both cases, this was the result of factors amenable to health policy interventions. The highest improvement in LE was due to non-avoidable causes, but avoidable mortality through health service interventions showed improvements in LE in those younger than 1 year and in those aged 45-75 years. CONCLUSIONS: Making a distinction between several groups of causes of avoidable mortality and using decomposition by causes, ages and effects allowed us to better explain the impact of avoidable mortality on the LE of the whole population and gave a new dimension to this indicator that could be very useful in public health.