Clinical markers of asthma and IgE assessed in parents before conception predict asthma and hayfever in the offspring.

BACKGROUND: Mice models suggest epigenetic inheritance induced by parental allergic disease activity. However, we know little of how parental disease activity before conception influences offspring's asthma and allergy in humans. OBJECTIVE: We aimed to assess the associations of parental asthma severity, bronchial hyperresponsiveness (BHR), and total and specific IgEs, measured before conception vs. after birth, with offspring asthma and hayfever. METHODS: The study included 4293 participants (mean age 34, 47% men) from the European Community Respiratory Health Survey (ECRHS) with information on asthma symptom severity, BHR, total and specific IgEs from 1991 to 1993, and data on 9100 offspring born 1972-2012. Adjusted relative risk ratios (aRRR) for associations of parental clinical outcome with offspring allergic disease were estimated with multinomial logistic regressions. RESULTS: Offspring asthma with hayfever was more strongly associated with parental BHR and specific IgE measured before conception than after birth [BHR: aRRR = 2.96 (95% CI: 1.92, 4.57) and 1.40 (1.03, 1.91), respectively; specific IgEs: 3.08 (2.13, 4.45) and 1.83 (1.45, 2.31), respectively]. This was confirmed in a sensitivity analysis of a subgroup of offspring aged 11-22 years with information on parental disease activity both before and after birth. CONCLUSION & CLINICAL RELEVANCE: Parental BHR and specific IgE were associated with offspring asthma and hayfever, with the strongest associations observed with clinical assessment before conception as compared to after birth of the child. If the hypothesis is confirmed in other studies, parental disease activity assessed before conception may prove useful for identifying children at risk for developing asthma with hayfever.

Geographical, urban/rural and socioeconomic variations in nonmelanoma skin cancer incidence: a population-based study in Ireland.

BACKGROUND: Nonmelanoma skin cancer (NMSC) is the most common cancer in white populations worldwide. International comparisons in incidence are limited because few registries collect comprehensive population-based data. OBJECTIVES: We describe spatial, urban/rural and socioeconomic variations in NMSC incidence in Ireland, overall and for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) separately. Methods NMSC cases (n=47 347) diagnosed during 1994-2003 were extracted from the National Cancer Registry. Each case was allocated to a small area (electoral district, ED) based on address at diagnosis. Standardized incidence ratios (SIRs) were calculated and smoothed using a Bayesian conditional autoregressive model. Associations between disease and census-derived area-based socioeconomic factors (unemployment, employment type, early school leavers, deprivation category, population density) were investigated using negative binomial regression. RESULTS: The spatial and socioeconomic distributions differed by subtype, suggesting aetiological differences. For BCC, areas of higher risk were concentrated around the main cities, with small patches on the south and west coast. Higher risks for SCC were seen in the north-east, on the south, mid and north-west coast. BCC risk in males and females, and SCC in males, was significantly higher in those living in the least deprived areas. Risk of BCC and SCC in females was higher in the most densely populated areas. CONCLUSIONS: We observed striking geographical variation in NMSC incidence, which cannot be satisfactorily explained on the basis of known risk factors. Differences by deprivation category and population density may reflect better access to cancer surveillance or care, as well as differences in risk factor exposure.

Have developments in palliative care services impacted on place of death of colorectal cancer patients in Ireland? A population-based study.

BACKGROUND: Whether developments in palliative care have impacted on where cancer patients die is unknown. We investigated time trends in place of death for colorectal cancer. METHODS: Details were abstracted on 10,175 colorectal cancer deaths during 1994-2004. Time trends were analysed by joinpoint regression. RESULTS: Nearly half (49%) of deaths occurred in acute hospitals, 29% at home, 13% in hospices and 7% in nursing homes. Hospital deaths were unchanged over time. Hospice deaths rose from 6% in 1994 to 17% in 2003. Home deaths decreased significantly, but only in health boards with hospices [estimated annual percentage change (EAPC) = -3.6%, 95%CI -4.19 to -2.97%, p < 0.001]. Nursing home deaths rose significantly in areas without hospices (EAPC = 8.0%, 95%CI 2.27 to -13.94%, p = 0.011). CONCLUSIONS: Most colorectal cancer deaths occur in hospital. Availability of hospice facilities is a key determinant of where the burden of death falls. The results suggest unmet demand for hospice care in Ireland.

Where do people with lung cancer die and how is this changing? A population-based study.

Investigating trends in where cancer patients die may help inform decisions about how healthcare should be organised to support those in need of end-of-life care. We analysed time trends in place of death for lung cancer during 1994-2005, based on 18,078 death certificates. Time trends were analysed by joinpoint regression. 9,485 (53%) deaths occurred in an acute hospital, 5,239 (29%) at home, 2,178 (12%) in hospices and 728 (4%) in nursing homes. Hospice deaths rose from 7% (108/1539) in 1994 to 15% (234/1560) in 2003, falling slightly in 2004-05. Hospital deaths were unchanged over time, but were more common in areas without hospices. Home deaths decreased significantly (annual percentage change (APC)=-2.2%, 95%CI -3.0% to -1.3%). Nursing home deaths rose significantly (APC=5.7%, 95%CI 2.5% to 8.9%). These trends were not explained by temporal changes in the age-sex distribution of deaths. Despite evidence suggesting most cancer patients would prefer to die at home, and developments in palliative care services, home deaths are declining and most lung cancer deaths occur in hospital.

Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern Ireland.

OBJECTIVES: To investigate the impact of different PSA testing policies and health-care systems on prostate cancer incidence and mortality in two countries with similar populations, the Republic of Ireland (RoI) and Northern Ireland (NI). METHODS: Population-level data on PSA tests, prostate biopsies and prostate cancer cases 1993-2005 and prostate cancer deaths 1979-2006 were compiled. Annual percentage change (APC) was estimated by joinpoint regression. RESULTS: Prostate cancer rates were similar in both areas in 1994 but increased rapidly in RoI compared to NI. The PSA testing rate increased sharply in RoI (APC = +23.3%), and to a lesser degree in NI (APC = +9.7%) to reach 412 and 177 tests per 1,000 men in 2004, respectively. Prostatic biopsy rates rose in both countries, but were twofold higher in RoI. Cancer incidence rates rose significantly, mirroring biopsy trends, in both countries reaching 440 per 100,000 men in RoI in 2004 compared to 294 in NI. Median age at diagnosis was lower in RoI (71 years) compared to NI (73 years) (p < 0.01) and decreased significantly over time in both countries. Mortality rates declined from 1995 in both countries (APC = -1.5% in RoI, -1.3% in NI) at a time when PSA testing was not widespread. CONCLUSIONS: Prostatic biopsy rates, rather than PSA testing per se, were the main driver of prostate cancer incidence. Because mortality decreases started before screening became widespread in RoI, and mortality remained low in NI, PSA testing is unlikely to be the explanation for declining mortality.

Trends in prostate specific antigen testing in Ireland: lessons from a country without guidelines.

BACKGROUND: Prostate specific antigen (PSA) testing is associated with increased prostate cancer (PCa) incidence. Ireland has no national guidelines on PCa screening and had the highest PCa incidence in Europe, 2006. AIMS: To investigate trends in PSA testing in Ireland. METHODS: Data on PSA tests, 1994-2005, was collated. RESULTS: Age-standardised rates of PSA testing increased 39 and 25% annually in men <50 and >or=50 years, respectively. Most tests were performed in men 50-69 years; 26 and 22% were performed in men <50 and >or=70 years, respectively. Baseline PSA tests peaked in 2004, at 16% of men. 83% of baseline tests were <4.0 ng/ml. Repeat testing increased with age and PSA level (P < 0.001); men <50 years and with levels <4.0 ng/ml had >1 tests in <21 months. PCa incidence increased 9% annually, 1994-2005. CONCLUSIONS: Uptake of PSA testing was rapid: increased use was simultaneous with increased PCa incidence. National guidelines are needed to manage this important public health issue.

Is there under-treatment of pancreatic cancer? Evidence from a population-based study in Ireland.

Although clinical trials suggest that chemotherapy can improve survival for both resected and unresected pancreatic cancer patients, the extent to which it is used in routine clinical practice is unclear. We conducted a population-based investigation of treatment patterns and factors influencing treatment receipt and mortality for pancreatic cancer. We included 3173 patients with primary invasive pancreatic cancer, diagnosed in 1994-2003, from the National Cancer Registry (Ireland). Analysis was done by joinpoint regression, logistic regression and Cox proportional hazards. Propensity score methods were used to compare mortality in those who received chemotherapy and in 'matched' patients who did not. Seven percent of patients had a resection and 12% received chemotherapy. The resection rate did not change significantly over time and less than a quarter of patients with localised disease underwent resection. Chemotherapy use increased by 20% per annum, reaching 20% among unresected and 39% among resected patients in 2002-2003. Forty two percent of patients were untreated, and this percentage was unchanged over time. After adjusting for clinical factors, patient characteristics were significantly associated with treatment receipt; older and unmarried patients were less likely to be treated. Among resected patients, risk of death fell by 10% per annum. Chemotherapy receipt was associated with significantly reduced mortality among both surgical (hazard ratio (HR)=0.50, 95% confidence intervals (CIs) 0.27-0.91) and non-surgical patients (HR=0.48, 95% CI 0.38-0.61). Our findings suggest that there may be potential for extended dissemination of chemotherapy, and possibly also for greater utilisation of curative resection, in routine practice which, in turn, has potential to improve survival at the population level.

Inequity in colorectal cancer treatment and outcomes: a population-based study.

Several uncertainties surround optimal management of colorectal cancer. We investigated treatment patterns and factors influencing treatment receipt and mortality in routine clinical practice. We included 15 249 individuals, recorded by the National Cancer Registry (Ireland), with primary invasive colon or rectal tumours, diagnosed during 1994-2002. Logistic regression and Cox proportional hazards were used to determine factors associated with treatment receipt within 1 year of diagnosis and with mortality, respectively. A total of 78% had colorectal resection, 31% chemotherapy, and 13% radiotherapy (4% colon; 28% rectum). Half of stage IV patients underwent resection. Chemotherapy and radiotherapy use increased by at least 10% per annum. There was a notable increase in pre-operative radiotherapy from 2000 onwards. Patient-related factors were significantly associated with treatment receipt. Patients who were male, older, not married, or smokers had significantly higher risks of death. Chemotherapy was significantly associated with lower mortality for stage III, but not stage II, colon cancer. For rectal cancer, pre-operative radiotherapy was associated with reduced mortality. Surgery and chemotherapy were associated with longer survival for stage IV patients. The observed inequities in treatment and outcomes suggest that there is potential for further dissemination of therapies in routine practice. Improving treatment availability overall, and equity, has the potential to reduce mortality.

Patterns of care and effects on mortality for cancers of the oesophagus and gastric cardia: a population-based study.

BACKGROUND: We investigated temporal trends in treatment, and factors influencing treatment receipt and survival, for upper gastrointestinal cancers in routine community-based clinical practice. PATIENTS AND METHODS: Oesophageal and gastric-cardia cancers, diagnosed during the period 1994-2001, were sourced from the National Cancer Registry (Ireland). Analysis was by Joinpoint regression and multivariate logistic and Cox models. RESULTS: Thirty-five percent of patients received surgery, 35% radiotherapy and 24% chemotherapy. Over time chemo- and radiotherapy receipt increased significantly, whilst surgery decreased. Treatment patterns varied by tumour site, histology and stage. Older and/or unmarried patients were significantly less likely to receive treatment. Among surgically treated patients, those aged 70+ had higher mortality. Among both surgical and non-surgical patients, those receiving chemotherapy or radiotherapy had a modest, short-term, survival benefit. CONCLUSIONS: The use of adjuvant therapies is increasing in routine practice. After adjusting for clinical factors, patient-related factors predicted treatment and mortality. Improving equity in gastrointestinal cancer treatment may help improve survival.