Cross-sectional and longitudinal associations of adherence to WCRF/AICR cancer prevention recommendations with health-related quality of life in breast cancer survivors. Health-EpiGEICAM study.

OBJECTIVES: Adherence to healthy lifestyle recommendations has been reported to improve health-related quality of life (HRQL) in breast cancer (BC) patients, but the influence of long-term behavioral changes remains unknown. We evaluated the association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and HRQL both, at BC diagnosis and the change 7-12 years later. DESIGN: Prospective cohort study. SETTINGS AND PARTICIPANTS: A total of 406 breast cancer survivors, from the EpiGEICAM study, were recruited in 16 Spanish hospitals. MEASUREMENTS: Epidemiological, clinical, dietary, physical activity and HRQL information was collected both at recruitment and 7-12 years later. A 7-item score to measure compliance with recommendations was assessed according to the 2018 WCRF/AICR scoring criteria. HRQL was evaluated using SF-36 questionnaire. Linear mixed models for longitudinal data were used to assess the cross-sectional and longitudinal association between adherence score and the physical and mental component summary scores. RESULTS: At diagnosis, for each unit increase in WCRF/AICR score adherence, the HRQL physical domain increased 0.78 points (95%CI: -0.04 to 1.60; P trend:0.06). The mean change in physical HRQL from diagnosis to follow-up per unit increase in within-subject adherence score was 0.73 points (95%CI: -0.18 to 1.65; P trend: 0.12). For the mental domain, no association was observed with compliance with the recommendations at diagnosis, nor with changes in adherence over time. CONCLUSIONS: Our results suggest that Increased adherence to WCRF/AICR cancer prevention recommendations over time could contribute to slightly improved long-term physical HRQoL in BC survivors.

Risk of prostate cancer in the proximity of industrial installations: A multicase-control study in Spain (MCC-Spain).

BACKGROUND: Prostate cancer (PC) is the second most frequent tumor in men worldwide; however, its etiology remains largely unknown, with the exception of age and family history. The wide variability in incidence/mortality across countries suggests a certain role for environmental exposures that has not yet been clarified. OBJECTIVE: To evaluate the association between risk of PC (by clinical profile) and residential proximity to pollutant industrial installations (by industrial groups, groups of carcinogens, and specific pollutants released), within the context of a Spanish population-based multicase-control study of incident cancer (MCC-Spain). METHODS: This study included 1186 controls and 234 PC cases, frequency matched by age and province of residence. Distances from participants' residences to the 58 industries located in the study area were calculated and categorized into "near" (considering different limits between ≤1 km and ≤ 3 km) or "far" (>3 km). Odds ratios (ORs) and 95 % confidence intervals (95%CIs) were estimated using mixed and multinomial logistic regression models, adjusted for potential confounders and matching variables. RESULTS: No excess risk was detected near the overall industries, with ORs ranging from 0.66 (≤2 km) to 1.11 (≤1 km). However, positive associations (OR; 95%CI) were found, by industrial group, near (≤3 km) industries of ceramic (2.54; 1.28-5.07), food/beverage (2.18; 1.32-3.62), and disposal/recycling of animal waste (2.67; 1.12-6.37); and, by specific pollutant, near plants releasing fluorine (4.65; 1.45-14.91 at ≤1.5 km) and chlorine (5.21; 1.56-17.35 at ≤1 km). In contrast, inverse associations were detected near industries releasing ammonia, methane, dioxins+furans, polycyclic aromatic hydrocarbons, trichloroethylene, and vanadium to air. CONCLUSIONS: The results suggest no association between risk of PC and proximity to the overall industrial installations. However, some both positive and inverse associations were detected near certain industrial groups and industries emitting specific pollutants.

Moving Forward on Tumor Pathology Research Reporting: A Guide for Pathologists From the World Health Organization Classification of Tumors Living Evidence Gap Map by Tumour Type Group.

Evidence-based medicine (EBM) can be an unfamiliar territory for those working in tumor pathology research, and there is a great deal of uncertainty about how to undertake an EBM approach to planning and reporting histopathology-based studies. In this article, reviewed and endorsed by the Word Health Organization International Agency for Research on Cancer's International Collaboration for Cancer Classification and Research, we aim to help pathologists and researchers understand the basics of planning an evidence-based tumor pathology research study, as well as our recommendations on how to report the findings from these. We introduce some basic EBM concepts, a framework for research questions, and thoughts on study design and emphasize the concept of reporting standards. There are many study-specific reporting guidelines available, and we provide an overview of these. However, existing reporting guidelines perhaps do not always fit tumor pathology research papers, and hence, here, we collate the key reporting data set together into one generic checklist that we think will simplify the task for pathologists. The article aims to complement our recent hierarchy of evidence for tumor pathology and glossary of evidence (study) types in tumor pathology. Together, these articles should help any researcher get to grips with the basics of EBM for planning and publishing research in tumor pathology, as well as encourage an improved standard of the reports available to us all in the literature.

Residential exposure to traffic pollution and mammographic density in premenopausal women.

BACKGROUND: Mammographic density (MD) is the most important breast cancer biomarker. Ambient pollution is a carcinogen, and its relationship with MD is unclear. This study aims to explore the association between exposure to traffic pollution and MD in premenopausal women. METHODOLOGY: This Spanish cross-sectional study involved 769 women attending gynecological examinations in Madrid. Annual Average Daily Traffic (AADT), extracted from 1944 measurement road points provided by the City Council of Madrid, was weighted by distances (d) between road points and women's addresses to develop a Weighted Traffic Exposure Index (WTEI). Three methods were employed: method-1 (1dAADT), method-2 (1dAADT), and method-3 (e1dAADT). Multiple linear regression models, considering both log-transformed percentage of MD and untransformed MD, were used to estimate MD differences by WTEI quartiles, through two strategies: "exposed (exposure buffers between 50 and 200 m) vs. not exposed (>200 m)"; and "degree of traffic exposure". RESULTS: Results showed no association between MD and traffic pollution according to buffers of exposure to the WTEI (first strategy) for the three methods. The highest reductions in MD, although not statistically significant, were detected in the quartile with the highest traffic exposure. For instance, method-3 revealed a suggestive inverse trend (eßQ1 = 1.23, eßQ2 = 0.96, eßQ3 = 0.85, eßQ4 = 0.85, p-trend = 0.099) in the case of 75 m buffer. Similar non-statistically significant trends were observed with Methods-1 and -2. When we examined the effect of traffic exposure considering all the 1944 measurement road points in every participant (second strategy), results showed no association for any of the three methods. A slightly decreased MD, although not significant, was observed only in the quartile with the highest traffic exposure: eßQ4 = 0.98 (method-1), and eßQ4 = 0.95 (methods-2 and -3). CONCLUSIONS: Our results showed no association between exposure to traffic pollution and MD in premenopausal women. Further research is needed to validate these findings.

Modifying effect of urban parks on socioeconomic inequalities in diabetes prevalence: a cross-sectional population study of Madrid City, Spain.

BACKGROUND: Evidence has shown contradicting results on how the density of urban green spaces may reduce socioeconomic inequalities in type 2 diabetes (equigenic hypothesis). The aim of this study is to test whether socioeconomic inequalities in diabetes prevalence are modified by park density. METHODS: We designed a population-wide cross-sectional study of all adults registered in the primary healthcare centres in the city of Madrid, Spain (n=1 305 050). We obtained georeferenced individual-level data from the Primary Care Electronic Health Records, and census-tract level data on socioeconomic status (SES) and park density. We modelled diabetes prevalence using robust Poisson regression models adjusted by age, country of origin, population density and including an interaction term with park density, stratified by gender. We used this model to estimate the Relative Index of Inequality (RII) at different park density levels. FINDINGS: We found an overall RII of 2.90 (95% CI 2.78 to 3.02) and 4.50 (95% CI 4.28 to 4.74) in men and women, respectively, meaning that the prevalence of diabetes was three to four and a half times higher in low SES compared with high SES areas. These inequalities were wider in areas with higher park density for both men and women, with a significant interaction only for women (p=0.008). INTERPRETATION: We found an inverse association between SES and diabetes prevalence in both men and women, with wider inequalities in areas with more parks. Future works should study the mechanisms of these findings, to facilitate the understanding of contextual factors that may mitigate diabetes inequalities.

Health service and psychotropic medication use for mental health conditions among healthcare workers active during the Spain Covid-19 Pandemic - A prospective cohort study using web-based surveys.

Little is known about healthcare workers' (HCW) use of healthcare services for mental disorders. This study presents data from a 16-month prospective cohort study of Spanish HCW (n = 4,809), recruited shortly after the COVID-19 pandemic onset, and assessed at four timepoints using web-based surveys. Use of health services among HCW with mental health conditions (i.e., those having a positive screen for mental disorders and/or suicidal thoughts and behaviours [STB]) was initially low (i.e., 18.2 %) but increased to 29.6 % at 16-month follow-up. Service use was positively associated with pre-pandemic mental health treatment (OR=1.99), a positive screen for major depressive disorder (OR=1.50), panic attacks (OR=1.74), suicidal thoughts and behaviours (OR=1.22), and experiencing severe role impairment (OR=1.33), and negatively associated with being female (OR = 0.69) and a higher daily number of work hours (OR=0.95). Around 30 % of HCW with mental health conditions used anxiolytics (benzodiazepines), especially medical doctors. Four out of ten HCW (39.0 %) with mental health conditions indicated a need for (additional) help, with most important barriers for service use being too ashamed, long waiting lists, and professional treatment not being available. Our findings delineate a clear mental health treatment gap among Spanish HCW.

Toenail zinc and risk of prostate cancer in the MCC-Spain case-control study.

BACKGROUND: Some researchers have suggested that zinc (Zn) could reduce the risk of prostate cancer (PC). However, research from observational studies on the relationship between PC risk and biomarkers of Zn exposure shows conflicting results. OBJECTIVES: To evaluate the association between toenail Zn and PC, considering tumour extension and aggressiveness, along with a gene-environment approach, exploring the interaction of individual genetic susceptibility to PC in the relationship between toenail Zn and PC. METHODS: In MCC-Spain study we invited all incident PC cases diagnosed in the study period (2008-2013) and recruited randomly selected general population controls. In this report we included 913 cases and 1198 controls with toenail Zn determined by inductively coupled plasma mass spectrometry. To measure individual genetic susceptibility, we constructed a polygenic risk score based on known PC-related single nucleotide polymorphisms. The association between toenail Zn and PC was explored with mixed logistic and multinomial regression models. RESULTS: Men with higher toenail Zn had higher risk of PC (OR quartile 4 vs.1: 1.41; 95% CI: 1.07-1.85). This association was slightly higher in high-grade PC [(ISUP≤2 Relative risk ratio (RRR) quartile 4 vs.1: 1.36; 1.01-1.83) vs. (ISUP3-5 RRR quartile 4 vs.1: 1.64; 1.06-2.54)] and in advanced tumours [(cT1-cT2a RRR quartile 4 vs.1: 1.40; 95% CI: 1.05-1.89) vs. (cT2b-cT4 RRR quartile 4 vs.1: 1.59; 1.00-2.53)]. Men with lower genetic susceptibility to PC were those at higher risk of PC associated with high toenail Zn (OR quartile 4 vs.1: 2.18; 95% CI: 1.08-4.40). DISCUSSION: High toenail Zn levels were related to a higher risk for PC, especially for more aggressive or advanced tumours. This effect was stronger among men with a lower genetic susceptibility to PC.

A nation-wide analysis of socioeconomic and geographical disparities in the prevalence of obesity and excess weight in children and adolescents in Spain: Results from the ENE-COVID study.

OBJECTIVE: To estimate national and provincial prevalence of obesity and excess weight in the child and adolescent population in Spain by sex and sociodemographic characteristics, and to explore sources of inequalities in their distribution, and their geographical patterns. METHODS: ENE-COVID is a nationwide representative seroepidemiological survey (68 287 participants) stratified by province and municipality size (April-June 2020). Participants answered a questionnaire which collected self-reported weight and height, that allowed estimating crude and model-based standardized prevalences of obesity and excess weight in the 10 543 child and adolescent participants aged 2-17 years. RESULTS: Crude prevalences (WHO growth reference) were higher in boys than in girls (obesity: 13.4% vs. 7.9%; excess weight: 33.7% vs. 26.0%; severe obesity: 2.9% vs. 1.2%). These prevalences varied with age, increased with the presence of any adult with excess weight in the household, while they decreased with higher adult educational and census tract average income levels. Obesity by province ranged 1.8%-30.5% in boys and 0%-17.6% in girls; excess weight ranged 15.2%-49.9% in boys and 10.8%-40.8% in girls. The lowest prevalences of obesity and excess weight were found in provinces in the northern half of Spain. Sociodemographic characteristics only partially explained the observed geographical variability (33.6% obesity; 44.2% excess weight). CONCLUSIONS: Childhood and adolescent obesity and excess weight are highly prevalent in Spain, with relevant sex, sociodemographic and geographical differences. The geographic variability explained by sociodemographic variables indicates that there are other potentially modifiable factors on which to focus interventions at different geographic levels to fight this problem.

Desigualdades sociales en la mortalidad cardiovascular en España desde una perspectiva interseccional / Social inequalities in cardiovascular mortality in Spain from an intersectional perspective

INTRODUCCIÓN Y OBJETIVOS: El sexo, la edad y el nivel de estudios, entre otros factores, interaccionan e influyen sobre la mortalidad. En España aún no se ha analizado de manera comprehensiva las desigualdades sociales en la mortalidad cardiovascular considerando la influencia conjunta del sexo, la edad y el nivel de estudios (perspectiva interseccional). MÉTODOS: Estudio de todos los fallecidos en España ≥ 30 años durante 2015 (datos del Instituto Nacional de Estadística) por enfermedad cardiovascular total, cardiopatía isquémica, insuficiencia cardiaca y enfermedad cerebrovascular. El índice relativo de desigualdad (IRD) y el índice de desigualdad de la pendiente (IDP) se estimaron mediante modelos de regresión de Poisson utilizando mortalidad ajustada por edad; el IRD se interpreta como el riesgo relativo de mortalidad entre el nivel de estudios más bajo y el más alto, y el IDP como la diferencia absoluta de mortalidad. RESULTADOS: El IRD en mortalidad por enfermedad cardiovascular total fue 1,88 (IC95%, 1,80-1,96) en mujeres y 1,44 (IC95%, 1,39-1,49) en varones. Los IDP fueron 178,46 y 149,43 muertes/100.000 respectivamente. Las mayores desigualdades se observaron en cardiopatía isquémica e insuficiencia cardiaca en mujeres más jóvenes, con IRD> 4. No hubo diferencias entre sexos en desigualdades por enfermedad cerebrovascular. CONCLUSIONES: La mortalidad cardiovascular está inversamente asociada con el nivel educativo. Esta desigualdad afecta más a la mortalidad prematura por causas cardiacas, especialmente entre mujeres. Su monitorización podría orientar la Estrategia de Salud Cardiovascular del Sistema Nacional de Salud, para reducir la desigualdad en la primera causa de muerte

INTRODUCTION AND OBJECTIVES: There is an interaction between age, sex, and educational level, among other factors, that influences mortality. To date, no studies in Spain have comprehensively analyzed social inequalities in cardiovascular mortality by considering the joint influence of age, sex, and education (intersectional perspective). METHODS: Study of all deaths due to all-cause cardiovascular disease, ischemic heart disease, heart failure, and cerebrovascular disease among people aged ≥ 30 years in Spain in 2015. Data were obtained from the Spanish Office of Statistics. The relative index of inequality (RII) and the slope index of inequality (SII) were calculated by using Poisson regression models with age-adjusted mortality. The RII is interpreted as the relative risk of mortality between the lowest and the highest educational level, and the SII as the absolute difference in mortality. RESULTS: The RII for all-cause cardiovascular mortality was 1.88 (95%CI, 1.80-1.96) in women and 1.44 (95%CI, 1.39-1.49) in men. The SII was 178.46 and 149.43 deaths per 100 000, respectively. The greatest inequalities were observed in ischemic heart disease and heart failure in younger women, with a RII higher than 4. There were no differences between sexes in inequalities due to cerebrovascular disease. CONCLUSIONS: Cardiovascular mortality is inversely associated with educational level. This inequality mostly affects premature mortality due to cardiac causes, especially among women. Monitoring this problem could guide the future Cardiovascular Health Strategy in the National Health System, to reduce inequality in the first cause of death

Population-based multicase-control study in common tumors in Spain (MCC-Spain): rationale and study design / / Estudio multicaso-control de base poblacional de tumores comunes en España (MCC-Spain): razón y diseño del estudio

Introduction: We present the protocol of a large population-based case-control study of 5 common tumors in Spain (MCC-Spain) that evaluates environmental exposures and genetic factors. Methods: Between 2008-2013, 10,183 persons aged 20-85 years were enrolled in 23 hospitals and primary care centres in 12 Spanish provinces including 1,115 cases of a new diagnosis of prostate cancer, 1,750 of breast cancer, 2,171 of colorectal cancer, 492 of gastro-oesophageal cancer, 554 cases of chronic lymphocytic leukaemia (CLL) and 4,101 population-based controls matched by frequency to cases by age, sex and region of residence. Participation rates ranged from 57% (stomach cancer) to 87% (CLL cases) and from 30% to 77% in controls. Participants completed a face-to-face computerized interview on sociodemographic factors, environmental exposures, occupation, medication, lifestyle, and personal and family medical history. In addition, participants completed a self-administered food-frequency questionnaire and telephone interviews. Blood samples were collected from 76% of participants while saliva samples were collected in CLL cases and participants refusing blood extractions. Clinical information was recorded for cases and paraffin blocks and/or fresh tumor samples are available in most collaborating hospitals. Genotyping was done through an exome array enriched with genetic markers in specific pathways. Multiple analyses are planned to assess the association of environmental, personal and genetic risk factors for each tumor and to identify pleiotropic effects. Discussion: This study, conducted within the Spanish Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), is a unique initiative to evaluate etiological factors for common cancers and will promote cancer research and prevention in Spain (AU)

Introducción: Presentamos el protocolo del estudio caso-control de base poblacional de 5 tumores comunes en España (MCC-Spain) que evalúa factores ambientales y genéticos. Métodos: Durante 2008-2013, se reclutaron 10.183 sujetos entre 20-85 años en 23 hospitales de 12 provincias españolas, incluyendo 1.115 casos de cáncer de próstata, 1.750 de mama, 2.171 colorrectal, 492 gastro-esofágicos, 554 de leucemia linfática crónica (LLC) y 4.101 controles poblacionales emparejados por frecuencia por edad, sexo y región de residencia. Las tasas de participación varían del 57% (cáncer de estómago) al 87% (casos de LLC) y del 30% al 77% en controles. Los participantes respondieron una entrevista personal informatizada sobre factores socio-demográficos, exposiciones ambientales, ocupación, medicación, estilos de vida, e historia médica personal y familiar. Además, cumplimentaron un cuestionario alimentario y realizaron entrevistas telefónicas. Se recogió sangre del 76% de los participantes y saliva para los casos de LLC y participantes que rechazaron la donación de sangre. En los casos, se recogió información clínica y se dispone de muestras de tumor fresco o parafinado a través de los biobancos de los hospitales. Se realizó el genotipado con un array de exoma suplementado con marcadores en pathways específicos. Se han planificado diversos análisis para evaluar la asociación de factores genéticos, personales y ambientales para cada tumor e identificar efectos pleiotrópicos. Discusión: Este estudio, desarrollado en el Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), es una iniciativa única para evaluar factores etiológicos de tumores comunes y promoverá la investigación en cáncer y prevención en España (AU)

¿Quién teme al open access? Un movimiento en crecimiento, oportuno y necesario / Who’s afraid of open access? A growing, timely and necessary movement

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Epidemiología del cáncer de cérvix in situe invasor en la provincia de Girona 1990-2004: incidencia, mortalidad, supervivencia e historial de cribado / In situand invasive cervical cancer epidemiology in the province of Girona, Spain 1990-2004: incidence, mortality, survival and screening history

Fundamento y objetivo: La vigilancia epidemiológica del cáncer de cérvix (CC) debería extenderse desde el cribado hasta la mortalidad. El objetivo de este trabajo es proporcionar una visión global del CC en la provincia de Girona entre 1990-2004. Se trata de un estudio longitudinal que incluye la incidencia de carcinoma in situ (CISC) e invasor (CIC), mortalidad, supervivencia e historial de cribado (HdC) en 1/3 de las afectadas.Pacientes y método: Se han calculado las tasas anuales y quinquenales de incidencia cruda y ajustada por edad de CISC, de CIC y de mortalidad, así como la supervivencia relativa a los 5 años. Se han utilizado modelos de regresión Joinpointpara estimar el porcentaje de cambio anual (PCA) y cambios de tendencia. Se han revisado las citologías de cribado. Resultados: Se diagnosticaron 373 casos incidentes de CIC y 1.093 de CISC. Tras un ascenso inicial en la incidencia de ambos tipos, la tasa ajustada de CISC se estabilizó alrededor de los 28 casos por 100.000 y la de CIC descendió hasta 5,8 casos por 100.000 en el período 2000-2004. La mortalidad se ha mantenido estable y la supervivencia ha aumentado, aunque de forma no significativa. En los casos con HdC un 50% de las mujeres con CIC no tenía citología previa, en contraste con el alto porcentaje de mujeres con CISC que disponían de ésta (92% en 2000-2004). Conclusiones: La incidencia de cáncer de cérvix está descendiendo en Girona, aunque los datos sobre HdC sugieren que ésta podría reducirse aún más (AU)

Background and objective: The epidemiological vigilance of cervical cancer (CC) should comprise from screening to mortality. The objective of the work is to show a global vision of CC in the Province of Girona (Spain) between the years 1990-2004. It is a longitudinal study that includes incidence for in situ (ISCC) and invasive (ICC) carcinoma of the cervix, mortality, relative survival rates and the screening history of 1/3 of the affected women.Patients and method: The crude and the age-adjusted annual and five years incidence rates for ISCC and ICC and the mortality for ICC were calculated. Regression Joinpointmodels were used to estimate the annual percentage change (APC) and the changes in the trend. The five-year relative survival rate was estimated. Cytology screening smears were reviewed. Results: Three hundred seventy-three incident cases of ICC and 1,093 cases of ISCC were diagnosed. After an initial rise of the incidence in both types, the adjusted rate of ISCC stabilized around 28 cases per 100,000 and that of ICC declined to 5.8 cases per 100,000 women in the period 2000-2004. The mortality remained steady and the survival rate had a non-significant increase. In the cases with screening history almost 50% of the women diagnosed of ICC had no previous cytology in contrast with the high percentage of the women with ISCC that had it done (92% in 200-2004). Conclusions: Cervical cancer incidence is decreasing in Girona, although the dates of the screening histories suggest that it can be further reduced (AU)

Evolución de la mortalidad por cáncer de cérvix por regiones en España entre 1975 y 2004 / Temporal trends of cervical cancer mortality rates among regions in Spain: 1975–2004

Fundamento y objetivo: Estimar la tendencia temporal de las tasas de mortalidad por cáncer de cérvix en las diferentes comunidades autónomas (CC. AA.) de España. Material y método: Se utilizaron los registros individuales de defunciones certificadas como cáncer de cérvix, endometrio y útero inespecífico (UI) (códigos 180, 182 y 179 en la Clasificación Internacional de Enfermedades [CIE] octava y novena ediciones, y códigos C53, C54 y C55 en la CIE décima edición), así como las estimaciones anuales de población femenina por edad y las CC. AA. del Instituto Nacional de Estadística. Para corregir los sesgos debidos a la mejora de la certificación, se reasignaron las muertes de UI. Se calcularon tasas estandarizadas por edad, usando la población estándar europea, para cada año y CC. AA. Se estimó el porcentaje de cambio anual (PCA) y la presencia de puntos de cambio en las tendencias mediante un análisis de regresión joinpoint. Resultados: En general, la mortalidad sigue un patrón descendente en España, aunque hay importantes diferencias entre las CC. AA. Cataluña (PCA de −4,55; intervalo de confianza [IC] del 95%: −4,85 a −4,23) y Navarra (PCA de −4,31; IC del 95%: −5,85 a 2,75) han mostrado una reducción más acusada en sus cifras de mortalidad; mientras que el menor descenso se observa en Madrid (PCA de −2,32; IC del 95%: −2,93 a 1,70), Canarias (PCA de −2,36; IC del 95%: −3,00 a −1,72) y Galicia (PCA de −2,60; IC del 95%: −3,07 a −2,10). Conclusiones: La mortalidad por cáncer de cérvix está disminuyendo en España. La diferente velocidad de descenso en las CC. AA. podría relacionarse con la frecuencia de exposición al virus del papiloma humano, con diferencias en la implantación de los programas de cribado y con factores socioeconómicos (AU)

Background and objectives: To estimate the temporal trend of the cervical cancer mortality rates among Autonomous Communities (AACC) in Spain. Material and methods: Individual death cases recorded as “cervical cancer’, ‘corpus uteri cancer’ and ‘uterus, site unspecified’–codes 180,182 and 179 in ICD8 and 9 and codes C53, C54 and C55 in ICD 10- were obtained, as well as women population estimates broken down by age and AACC from the Spanish National Institute for Statistics (INE). To correct distortions due to increasing improvement in death certification, deaths from ‘uterus, site unspecified’ were reallocated. Using the European standard population, age-adjusted mortality rates were calculated per year and AACC. Annual percent change (APC) and joinpoints, if existed, were estimated using Joinpoint regression analysis for all women and two broad age-groups: younger and older than 50 years. Results: Cervical cancer mortality rates follow a decreasing trend, with important differences among AACC. Catalonia (PCA −4.55; IC95%: −4.85,−4.23), and Navarra (PCA −4.31; IC95% −5.85,−2.75) decreased more their annually mortality rates than Madrid (PCA −2.32; IC95%: −2.93, −1.70), Canarias (PCA -2,36; IC95% −3.00,−1.72) or Galicia (PCA −2.60; IC95% −3.07,−2.10), which showed the less marked decreased. Conclusions: Cervical cancer mortality is decreasing in Spain. Trend differences among CCAA could be related to organizational differences and coverages of their screening programs, disparities in exposure to HPV and socioeconomic level as well as to differences in socioeconomic factors (AU)

Biomonitorización de la exposición a contaminantes ambientales en recién nacidos y sus progenitores en Madrid [BioMadrid]: diseño del estudio y resultados del trabajo de campo / Biomonitoring of exposure to environmental pollutants in newborns and their parents in Madrid, Spain (BioMadrid): study design and field work results

In Spain environmental surveillance has mainly relied on measuresof selected pollutants in air, water, food and soil. A studywas conducted in Madrid to assess the feasibility of implementinga surveillance system of exposure among the generalpopulation to specific environmental pollutants, using biomarkers.The project was basically focused on the environmentsurrounding newborns. Hence, the study population was madeup of 145 triplets of pregnant women at around 8 months’ gestation,their partners, and newborns from two areas, representingthe two main types of urban environments in the region,i.e., the City of Madrid and its outlying metropolitan belt.Multiple biologic substrates were collected from each participantin order to assess the most suitable samples for an environmentalsurveillance system. The selected contaminantsrepresent the main agents to which a population like that ofMadrid is exposed every day, including certain heavy metals,persistent organic pollutants and polycyclic aromatic hydrocarbons,as well as micronuclei in peripheral blood, a commonlyused unspecific index of cytogenetic damage. In addition,passive air samplers were placed around subjects’ placeof residence. This paper reports in detail on the design andresponse rates, summarizes field work results, and discussessome lessons learned(AU)

En España, la vigilancia medioambiental se basa principalmenteen medidas de ciertos contaminantes en muestrasde aire, agua, alimentos y suelos. En Madrid se ha realizadoun estudio para valorar la posibilidad de poner en marchaun sistema de vigilancia de exposiciones a contaminantesambientales en la población general utilizando biomarcadores.El proyecto ha tenido como eje el estudio del entornode los recién nacidos. Por tanto, la población de estudio laconstituyen 145 ®tríos» formados por mujeres en su octavomes de embarazo, sus parejas y los recién nacidos de dosáreas geográficas, que representan los dos principales entornosurbanos de la región, es decir, Madrid capital y su áreametropolitana. Se recogieron múltiples sustratos biológicosde cada participante con el objeto de valorar las muestrasmás adecuadas para un sistema de vigilancia de exposicionesambientales. Los contaminantes elegidos representan losprincipales agentes tóxicos a los que una población como lade Madrid está expuesta diariamente, e incluyen metales pesados,contaminantes orgánicos persistentes e hidrocarburosaromáticos policíclicos; se ha añadido también una medidainespecífica de daño citogenético, los micronúcleos ensangre periférica. Además, se han colocado muestreadorespasivos de aire en los alrededores del domicilio de los participantes.Este artículo describe en detalle el diseño del estudioy la tasa de respuesta, resume los resultados del trabajode campo y comenta algunas enseñanzas prácticas deéste(AU)

Situación epidemiológica del cáncer de mama en España / Epidemiological situation of breast cancer in Spain

El cáncer de mama es el tumor más frecuente en Europa. Según la Agencia Internacional de Investigación del Cáncer, en 2006 se diagnosticaron unos 429.900 casos nuevos de cáncer de mama en Europa, con una tasa estandarizada de incidencia de 100 casos por 100.000 mujeres. También es la localización más frecuente en mujeres españolas: supone casi la cuarta parte de los casos de cáncer femeninos, y su incidencia está aumentando en 2-3% anual. Entre las posibles causas de este incremento están los cambios en los patrones reproductivos y en los hábitos de vida y la introducción de la terapia hormonal sustitutiva. Nuestro país, con una tasa de incidencia estandarizada estimada de 93,6 casos por 100.000 mujeres-año para 2006, ocupa una posición intermedia entre los países de Europa occidental los del este. Es también una importante causa de mortalidad femenina. En 2005 causó la muerte de 5.703 mujeres españolas, con una tasa de mortalidad estandarizada de 18,6 por 100.000 mujeres-año. Desde los años 90 la mortalidad por cáncer de mama está descendiendo debido al diagnóstico precoz por programas de cribado y a los avances terapéuticos. En España esta tendencia decreciente se observa a partir de 1993, con un descenso de un 2,4% anual. La supervivencia global en Europa a los 5 años es cercana al 79%, inferior a la observada en EEUU (90%) y ha aumentado en los últimos años. En España, se sitúa en un 83%, significativamente más alta que la media europea (AU)

Breast cancer is the most frequent neoplasm in Europe. According to the International Agency for Research on Cancer, there were an estimated 429,900 cases diagnosed in Europe in 2006, with an age-standardised incidence rate of 110 cases per 100,000 women. It is also the most frequent cancer in Spanish women, accounting for one forth of female cancer cases, and its incidence is increasing around 2-3% per year. Changes in reproductive behavior and life style along with the introduction of hormone replacement therapy are partially responsible of this trend. Our country, with an estimated age-standardised incidence rate of 93.6 cases per 100,000 women-years in 2006, occupies an intermediate position between Western and Eastern European countries. This tumour also represents an important cause of female mortality. In 2005, it caused 5,703 deaths in Spanish women, with an age-standardised mortality rate of 18.6 per 100,000 women year. However, since the 90´s breast cancer mortality is declining thanks to earlier diagnosis derived from population screening programs and to therapeutical advances. In Spain this downward trend has started in 1993, declining a 2,4% per year. In Europe, 5-year global survival is close to 79%, lower than EEUU survival estimates (90%): Breast cancer survival has risen in recent years. In Spain, 5 year survival is around 83%, significantly higher than European average (AU)

Accuracy of cancer death certificates in Spain: a summary of available information / Validez de la certificación de la muerte por cáncer en España: resumen de la evidencia disponible

Objectives: Differences in mortality rates within Europe might be partly due to the quality of mortality statistics. The present article summarizes the available data on the quality of cancer death certification in Spain. A short description of the temporal distribution of the proportion of deaths due to ill-defined tumors in Spain –an indirect indicator of the quality of cancer death certification– is also provided. Methods: Relevant studies were identified from electronic databases (MEDLINE, EMBASE, IME and IBECS) and from manual searches of the references contained in the articles retrieved. Quality data on death certificates for all tumors and for each specific cancer location were summarized, and all main cancer sites were classified according to their pooled accuracy indicators. Trends for the percentage of deaths due to illdefined tumors and conditions were studied for the period from 1980 to 2002. Results: In Spain, deaths from cancer as a whole and leading cancer sites (lung, colon-rectum, prostate, stomach, pancreas, female breast, uterus, brain, leukemia, lymphomas and myeloma) were well-certified. However, other frequent locations, such as the larynx, esophagus and liver were overcertified, while deaths from bladder, kidney and ovarian cancer were undercertified. The percentage of deaths due to ill-defined tumors and causes was regularly higher in females and decreased in both sexes during the study period. However, the recent introduction of the International Classification of Diseases (ICD)-10 has reversed this trend. Conclusions: Spanish death certificates can be considered as accurate and useful to estimate the burden of cancer, though certification of some frequent sites should be improved. The possible effect of the introduction of the ICD-10 requires careful surveillance (AU)

Objetivos: Parte de las diferencias en tasas de mortalidad por cáncer entre países europeos podrían deberse a diferencias de calidad en las estadísticas de mortalidad. Nuestro objetivo es sintetizar la información cuantitativa que hay acerca de la calidad de los certificados de defunción de cáncer en España, y se añade una somera descripción de la evolución temporal de la proporción de defunciones por tumores mal definidos, indicador indirecto de calidad. Métodos: Se identificaron los estudios relevantes mediante búsquedas en bases de datos electrónicas (MEDLINE, IME, EMBASE e IBECS), y posteriormente se añadieron referencias presentes en los artículos encontrados. Se extrajo la información acerca de calidad de certificación para cáncer en conjunto y para las principales localizaciones tumorales, y se clasificaron los tumores según sus indicadores de calidad. Se estudió también la tendencia del porcentaje de muertes mal definidas o tumores mal definidos entre 1980-2002. Resultados: En España, el cáncer en conjunto y las principales localizaciones –pulmón, colon-recto, próstata, estómago, páncreas, mama, útero, cerebro, leucemia, linfomas y mieloma– están bien certificados. Sin embargo, otras localizaciones como laringe, hígado y esófago están sobrecertificadas, mientras que el cáncer de vejiga, riñón y ovario están infracertificados. Los porcentajes de muertes por tumores o condiciones mal definidas, mayores en mujeres, han disminuido en el período estudiado, aunque la introducción de la CIE-10 ha invertido esta tendencia. Conclusiones: En general, los certificados de cáncer pueden considerarse válidos y útiles para estimar el impacto del cáncer en España, aunque la certificación de algunas localizaciones importantes tendría que mejorar. Debería estudiarse el posible efecto de la introducción de la CIE-10 (AU)