Global burden of bladder cancer mortality in 2020 and 2040 according to GLOBOCAN estimates.

INTRODUCTION: In 2020, bladder cancer (BC) was the seventh most prevalent cancer in the world, with 5-year prevalence of more than 1.7 million cases. Due to the main risk factors-smoking and chemical exposures-associated with BC, it is considered a largely preventable and avoidable cancer. An overview of BC mortality can allow an insight not only into the prevalence of global risk factors, but also into the varying efficiency of healthcare systems worldwide. For this purpose, this study analyzes the national mortality estimates for 2020 and projected future trends up to 2040. MATERIALS AND METHODS: Age-standardized mortality rates per 100,000 person-years of BC for 185 countries by sex were obtained from the GLOBOCAN 2020 database, operated by the International Agency for Research on Cancer (IARC). Mortality rates were stratified according to sex and Human Development Index (HDI). BC deaths were projected up to 2040 on the basis of demographic changes, alongside different scenarios of annually increasing, stable or decreasing mortality rates from the baseline year of 2020. RESULTS: In 2020, nearly three times more men died from BC than women, with more than 210,000 deaths in both sexes combined, worldwide. Regardless of gender, more than half of the total BC deaths were from countries with a very high HDI. According to our projections, while the number of deaths for men can only increase up to 54% (from 159 to around 163-245 thousand), for women it is projected to increase two- to three-fold (from 50 to around 119-176 thousand) by 2040. The burden of BC mortality in countries with a very high HDI versus high HDI appears to converge by 2040 for both sexes. CONCLUSION: Opposite mortality trends by gender highlight the urgent need for immediate interventions to expand anti-tobacco strategies, especially for women. The implementation of more strict occupational health and safety regulations could also prevent exposures associated with BC. Improving the ability to detect BC earlier and access to treatment can have a significant positive impact on reducing mortality rates, minimizing economic costs, and enhancing the quality of life for patients.

Effectiveness of SARS-CoV-2 primary vaccines and boosters in patients with type 2 diabetes mellitus in Hungary (HUN-VE 4 Study).

INTRODUCTION: Type 2 diabetes mellitus is a risk factor for severe COVID-19 infection and is associated with increased risk of complications. The present study aimed to investigate effectiveness and persistence of different COVID vaccines in persons with or without diabetes during the Delta wave in Hungary. RESEARCH DESIGN AND METHODS: Data sources were the national COVID-19 registry data from the National Public Health Center and the National Health Insurance Fund on the total Hungarian population. The adjusted incidence rate ratios and corresponding 95% CIs were derived from a mixed-effect negative binomial regression model. RESULTS: A population of 672 240 cases with type 2 diabetes and a control group of 2 974 102 non-diabetic persons free from chronic diseases participated. Unvaccinated elderly persons with diabetes had 2.68 (95% CI 2.47 to 2.91) times higher COVID-19-related mortality rate as the 'healthy' controls. Primary immunization effectively equalized the risk of COVID-19 mortality between the two groups. Vaccine effectiveness declined over time, but the booster restored the effectiveness against mortality to over 90%. The adjusted vaccine effectiveness of the primary Pfizer-BioNTech against infection in the 14-120 days of postvaccination period was 71.6 (95% CI 66.3 to 76.1)% in patients aged 65-100 years with type 2 diabetes and 64.52 (95% CI 59.2 to 69.2)% in the controls. Overall, the effectiveness tended to be higher in individuals with diabetes than in controls. The booster vaccines could restore vaccine effectiveness to over 80% concerning risk of infection (eg, patients with diabetes aged 65-100 years: 89.1 (88.1-89.9)% with Pfizer-on-Pfizer, controls 65-100 years old: 86.9 (85.8-88.0)% with Pfizer-on-Pfizer, or patients with diabetes aged 65-100 years: 88.3 (87.2-89.2)% with Pfizer-on-Sinopharm, controls 65-100 years old: 87.8 (86.8-88.7)% with Pfizer-on-Sinopharm). CONCLUSIONS: Our data suggest that people with type 2 diabetes may have even higher health gain when getting vaccinated as compared with non-diabetic persons, eliminating the marked, COVID-19-related excess risk of this population. Boosters could restore protection.

Opposite trends in incidence of breast cancer in young and old female cohorts in Hungary and the impact of the Covid-19 pandemic: a nationwide study between 2011-2020.

Background: This nationwide study examined breast cancer (BC) incidence and mortality rates in Hungary between 2011-2019, and the impact of the Covid-19 pandemic on the incidence and mortality rates in 2020 using the databases of the National Health Insurance Fund (NHIF) and Central Statistical Office (CSO) of Hungary. Methods: Our nationwide, retrospective study included patients who were newly diagnosed with breast cancer (International Codes of Diseases ICD)-10 C50) between Jan 1, 2011 and Dec 31, 2020. Age-standardized incidence and mortality rates (ASRs) were calculated using European Standard Populations (ESP). Results: 7,729 to 8,233 new breast cancer cases were recorded in the NHIF database annually, and 3,550 to 4,909 all-cause deaths occurred within BC population per year during 2011-2019 period, while 2,096 to 2,223 breast cancer cause-specific death was recorded (CSO). Age-standardized incidence rates varied between 116.73 and 106.16/100,000 PYs, showing a mean annual change of -0.7% (95% CI: -1.21%-0.16%) and a total change of -5.41% (95% CI: -9.24 to -1.32). Age-standardized mortality rates varied between 26.65-24.97/100,000 PYs (mean annual change: -0.58%; 95% CI: -1.31-0.27%; p=0.101; total change: -5.98%; 95% CI: -13.36-2.66). Age-specific incidence rates significantly decreased between 2011 and 2019 in women aged 50-59, 60-69, 80-89, and ≥90 years (-8.22%, -14.28%, -9.14%, and -36.22%, respectively), while it increased in young females by 30.02% (95%CI 17,01%- 51,97%) during the same period. From 2019 to 2020 (in first COVID-19 pandemic year), breast cancer incidence nominally decreased by 12% (incidence rate ratio [RR]: 0.88; 95% CI: 0.69-1.13; 2020 vs. 2019), all-cause mortality nominally increased by 6% (RR: 1.06; 95% CI: 0.79-1.43) among breast cancer patients, and cause-specific mortality did not change (RR: 1.00; 95%CI: 0.86-1.15). Conclusion: The incidence of breast cancer significantly decreased in older age groups (≥50 years), oppositely increased among young females between 2011 and 2019, while cause-specific mortality in breast cancer patients showed a non-significant decrease. In 2020, the Covid-19 pandemic resulted in a nominal, but not statistically significant, 12% decrease in breast cancer incidence, with no significant increase in cause-specific breast cancer mortality observed during 2020.

Gains in life expectancy from decreasing cardiovascular disease and cancer mortality - an analysis of 28 European countries 1995-2019.

BACKGROUND: Life expectancy (LE) is an indicator of societal progress among rapidly aging populations. In recent decades, the displacement of deaths from cardiovascular disease (CVD) and cancer have been key drivers in further extending LE on the continent, though improvements vary markedly by country, sex, and over time. This study provides a comparative overview of the age-specific contributions of CVD and cancer to increasing LE in the 27 European Union member states, plus the U.K. METHODS: Cause-by-age decompositions of national changes in LE were conducted for the years 1995-1999 and 2015-2019 based on the standard approach of multiple decrement life tables to quantify the relative impact over time. The contributions of CVD and cancer mortality changes to differences in LE were computed by sex and age for each of the 28 countries. We examine the difference between the member states before 2004 ("founding countries") and those which accessed the EU after 2004 ("A10 countries"). RESULTS: Among men, declines in CVD mortality in the founding countries of the EU were larger contributors to increasing LE over the last decades than malignant neoplasms: 2.26 years were gained by CVD declines versus 1.07 years for cancer, with 2.23 and 0.84 years gained in A10 countries, respectively. Among women in founding countries, 1.81 and 0.54 additional life years were attributable to CVD and cancer mortality declines, respectively, while in A10 countries, the corresponding values were 2.33 and 0.37 years. Lung and stomach cancer in men, and breast cancer in women were key drivers of gains in LE due to cancer overall, though rising mortality rates from lung cancer diminished the potential impact of increasing female LE in both EU founding (e.g., France, Spain, and Sweden) and A10 countries (e.g., Croatia, Hungary, and Slovenia), notably among cohorts aged 55-70 years. Over the 25 years, the LE gap between the two sets of countries narrowed from 6.22 to 5.59 years in men, and from 4.03 to 3.12 years for women, with diminishing female mortality from CVD as a determinative contributor. CONCLUSION: This study underscores the continued existence of an East-West divide in life expectancy across the EU27 + 1, evident on benchmarking the founding vs. A10 countries. In EU founding countries, continuous economic growth alongside improved health care, health promotion and protection policies have contributed to steady declines in mortality from chronic diseases, leading to increases in life expectancy. In contrast, less favourable mortality trends in the EU A10 countries indicate greater economic and health care challenges, and a failure to implement effective health policies.

Lung cancer mortality in the wake of the changing smoking epidemic: a descriptive study of the global burden in 2020 and 2040.

OBJECTIVES: Lung cancer (LC) is the leading cause of cancer death in 2020, responsible for almost one in five (18.0%) deaths. This paper provides an overview of the descriptive epidemiology of LC based on national mortality estimates for 2020 from the International Agency for Research on Cancer (IARC), and in the context of recent tobacco control policies. DESIGN AND SETTING: For this descriptive study, age-standardised mortality rates per 100 000 person-years of LC for 185 countries by sex were obtained from the GLOBOCAN 2020 database and stratified by Human Development Index (HDI). LC deaths were projected to 2040 based on demographic changes alongside scenarios of annually increasing, stable or decreasing rates from the baseline year of 2020. RESULTS: LC mortality rates exhibited marked variations by geography and sex. Low HDI countries, many of them within sub-Saharan Africa, tend to have low levels of mortality and an upward trend in LC deaths is predicted for both sexes until 2040 according to demographic projections, irrespective of trends in rates. In very high HDI countries, including Europe, Northern America and Australia/New Zealand, there are broadly decreasing trends in men whereas in women, rates are still increasing or reaching a plateau. CONCLUSION: The current and future burden of LC in a country or region largely depends on the present trajectory of the smoking epidemic in its constituent populations, with distinct gender differences in smoking patterns, both in transitioning and transitioned countries. Further elevations in LC mortality are expected worldwide, raising important social and political questions, especially in low-income and middle-income countries.

Evaluation of data quality at the Hungarian National Cancer Registry, 2000-2019.

BACKGROUND: The Hungarian National Cancer Registry (HNCR) was legally established as a population-based cancer registry in 1999, and its operation started in 2000 supporting the planning and development of the Hungarian oncology network as well as informing national cancer control policies. Ensuring comparable, accurate, and complete data on malignant and in situ neoplasms is critical in determining the applicability of the database. The aim of this study was to perform a comprehensive evaluation of the data quality at the HNCR. METHODS: Based on qualitative and semiquantitative methods from current international guidelines, we assess the comparability, completeness, validity, and timeliness of the collected data over the diagnostic period 2000-2019, with a focus on the year 2018. RESULTS: Coding practices and the classification system used at the HNCR are based on the International Classification of Diseases (ICD-10), which differs from the internationally recommended ICD-O. The annual trends in incidence did not indicate major fluctuations, that may have resulted from data collection discrepancies, while comparisons of the mortality-to-incidence ratio (M:I) compared with 1 minus 5-year observed survival indicated some systematic differences requiring further exploration. The age-standardized (European standard) incidence rate per 100 000 measured by the HNCR in 2018 was very high: 647.9 for men and 501.6 for women, 11.6% and 14.6% higher than the International Agency for Research on Cancer (IARC) estimates respectively. Behind the overall differences between the two data sources, we identified that the vast majority were due to ill-defined ICD codes: malignant neoplasm of other and ill-defined sites (C76), and malignant neoplasm without specification of site (C80). Otherwise, there were no major discrepancies by localization. The proportion of morphologically verified cancer cases was 57.8% overall, that of death certificates was 2.3%, and that of unknown primary tumors was 1.4%. CONCLUSION: Further implementations and interventions are required to ensure that the operations, coding practices, and the classification system used at the national registry are in accordance with international standards, and to increase the completeness and validity of the collected cancer data. In particular, the low morphologically verified proportion questions the overall accuracy of the stated diagnoses within the database. Nevertheless, our examination implies that the data of the HNCR are reasonably comparable, and without doubt fulfill the requirements to support national oncology services and cancer planning. However, most importantly, a review of registry personnel and resource requirements to run the national population-based cancer registry should be an essential part of Hungary's national cancer strategy.

Underlying reasons for post-mortem diagnosed lung cancer cases - A robust retrospective comparative study from Hungary (HULC study).

Objective: The Hungarian Undiagnosed Lung Cancer (HULC) study aimed to explore the potential reasons for missed LC (lung cancer) diagnosis by comparing healthcare and socio-economic data among patients with post-mortem diagnosed LC with those who were diagnosed with LC during their lives. Methods: This nationwide, retrospective study used the databases of the Hungarian Central Statistical Office (HCSO) and National Health Insurance Fund (NHIF) to identify patients who died between January 1, 2019 and December 31, 2019 and were diagnosed with lung cancer post-mortem (population A) or during their lifetime (population B). Patient characteristics, socio-economic factors, and healthcare resource utilization (HCRU) data were compared between the diagnosed and undiagnosed patient population. Results: During the study period, 8,435 patients were identified from the HCSO database with LC as the cause of death, of whom 1,203 (14.24%) had no LC-related ICD (International Classification of Diseases) code records in the NHIF database during their lives (post-mortem diagnosed LC population). Post-mortem diagnosed LC patients were significantly older than patients diagnosed while still alive (mean age 71.20 vs. 68.69 years, p<0.001), with a more pronounced age difference among female patients (difference: 4.57 years, p<0.001), and had significantly fewer GP (General Practitioner) and specialist visits, X-ray and CT scans within 7 to 24 months and 6 months before death, although the differences in GP and specialist visits within 7-24 months did not seem clinically relevant. Patients diagnosed with LC while still alive were more likely to be married (47.62% vs. 33.49%), had higher educational attainment, and had more children, than patients diagnosed with LC post-mortem. Conclusions: Post-mortem diagnosed lung cancer accounts for 14.24% of total lung cancer mortality in Hungary. This study provides valuable insights into patient characteristics, socio-economic factors, and HCRU data potentially associated with a high risk of lung cancer misdiagnosis.

Comparison of Hungarian Central Statistical Office's causes of death data with the database of the Hungarian National Cancer Registry / A Központi Statisztikai Hivatal halálozási adatainak összevetése a Nemzeti Rákregiszter adatbázisával. Egy adat-összekapcsolás tanulságai

Introduction: In international comparison, Hungary is in the forefront of cancer incidence and mortality statistics. Based on paper-based death certificates, mortality statistics are compiled by the Hungarian Central Statistical Office, while population-based measures of cancer incidences are performed by the Hungarian National Cancer Registry. Objective: Linking the records of these two independent databases can highlight their weaknesses and provide an opportunity to reconcile and verify collected data, which may emphasize the need to expand current data exchange protocols. Method: Based on the Hungarian unique health care insurance ID, the mortality database of the Hungarian Central Statistical Office between 2012 and 2020 was compared with the data of the Hungarian National Cancer Registry from 2001 to 2020. Deaths in 2018, in particular those related to lung cancer, were examined in more depth to demonstrate the biases resulting from erroneous data collection. Results: The mortality database of the Hungarian Central Statistical Office contained 32 586 cases with an underlying cause of death of malignant neoplasm for 2018, of which 29 970 were identified in the Hungarian National Cancer Registry. Out of the 8716 deaths coded to lung cancer, 7957 corresponding individuals were also found in the Registry. From the matches, 7381 cases were marked with lung cancer in the Hungarian National Cancer Registry. For the remaining 576 cases, the Registry recorded different types of cancers, of which in 69 cases with lung metastasis. Discussion: The differences between the two databases may be caused by methodological differences in data collection, incomplete, inaccurate reporting and differences in processing algorithms. Nevertheless, the majority of the data in the examined databases were found to be appropriate for epidemiological studies. Conclusion: Based on the outcomes of the present analysis, a revision of the data transfer between the two institutions is in order. The introduction of electronic Death certificate recording and validity checks are expected to improve the reliability of ID numbers and may shorten data processing times.

Comparison of Cancer Survival Trends in Hungary in the Periods 2001-2005 and 2011-2015 According to a Population-Based Cancer Registry.

Background: Assessment of population-based cancer survival may provide the most valuable feedback about the effectiveness of oncological surveillance and treatment. Aims: Based on the database of the Hungarian National Cancer Registry, standardized incidence rates of lung, breast, colorectal, prostate and cervical cancer were compared to standardized mortality data of the Hungarian Central Statistical Office in the period between 2001 and 2015. Then survival analysis was performed on cleansed database. Results: The incidence of colorectal, breast and prostate cancer increased, while standardized rates of lung and cervical cancer declined. The survival of colorectal, breast and prostate cancer showed improvement. Contrarily, lung cancer exhibited a mild decline, while that of cervical cancer did not change significantly. In earlier stages survival was improved among almost every studied tumor type, while in advanced stages improvement was not observed. Comparison of stage distribution revealed that in the 2011-2015 period colorectal, breast and prostate cancer cases were diagnosed at earlier stages, while lung and cervical cancer patients were typically discovered at more advanced stages. Discussion: The outcome of advanced cancer treatments is better in earlier stages, which highlighted the importance of screening network. However, growth of oncological treatment costs with longer patient survival imposes a constantly increasing burden on society.

Effectiveness and Waning of Protection With Different SARS-CoV-2 Primary and Booster Vaccines During the Delta Pandemic Wave in 2021 in Hungary (HUN-VE 3 Study).

Background: In late 2021, the pandemic wave was dominated by the Delta SARS-CoV-2 variant in Hungary. Booster vaccines were offered for the vulnerable population starting from August 2021. Methods: The nationwide HUN-VE 3 study examined the effectiveness and durability of primary immunization and single booster vaccinations in the prevention of SARS-CoV-2 infection, Covid-19 related hospitalization and mortality during the Delta wave, compared to an unvaccinated control population without prior SARS-CoV-2 infection. Results: The study population included 8,087,988 individuals who were 18-100 years old at the beginning of the pandemic. During the Delta wave, after adjusting for age, sex, calendar day, and chronic diseases, vaccine effectiveness (VE) of primary vaccination against registered SARS-CoV-2 infection was between 11% to 77% and 18% to 79% 14-120 days after primary immunization in the 16-64 and 65-100 years age cohort respectively, while it decreased to close to zero in the younger age group and around 40% or somewhat less in the elderly after 6 months for almost all vaccine types. In the population aged 65-100 years, we found high, 88.1%-92.5% adjusted effectiveness against Covid-19 infection after the Pfizer-BioNTech, and 92.2%-95.6% after the Moderna booster dose, while Sinopharm and Janssen booster doses provided 26.5%-75.3% and 72.9%-100.0% adjusted VE, respectively. Adjusted VE against Covid-19 related hospitalization was high within 14-120 days for Pfizer-BioNTech: 76.6%, Moderna: 83.8%, Sputnik-V: 78.3%, AstraZeneca: 73.8%, while modest for Sinopharm: 45.7% and Janssen: 26.4%. The waning of protection against Covid-19 related hospitalization was modest and booster vaccination with mRNA vaccines or the Janssen vaccine increased adjusted VE up to almost 100%, while the Sinopharm booster dose proved to be less effective. VE against Covid-19 related death after primary immunization was high or moderate: for Pfizer-BioNTech: 81.5%, Moderna: 93.2%, Sputnik-V: 100.0%, AstraZeneca: 84.8%, Sinopharm: 58.6%, Janssen: 53.3%). VE against this outcome also showed a moderate decline over time, while booster vaccine types restored effectiveness up to almost 100%, except for the Sinopharm booster. Conclusions: The HUN-VE 3 study demonstrated waning VE with all vaccine types for all examined outcomes during the Delta wave and confirmed the outstanding benefit of booster vaccination with the mRNA or Janssen vaccines, and this is the first study to provide clear and comparable effectiveness results for six different vaccine types after primary immunization against severe during the Delta pandemic wave.

Nationwide Effectiveness of First and Second SARS-CoV2 Booster Vaccines During the Delta and Omicron Pandemic Waves in Hungary (HUN-VE 2 Study).

Background: In Hungary, the pandemic waves in late 2021 and early 2022 were dominated by the Delta and Omicron SARS-CoV-2 variants, respectively. Booster vaccines were offered with one or two doses for the vulnerable population during these periods. Methods and Findings: The nationwide HUN-VE 2 study examined the effectiveness of primary immunization, single booster, and double booster vaccination in the prevention of Covid-19 related mortality during the Delta and Omicron waves, compared to an unvaccinated control population without prior SARS-CoV-2 infection during the same study periods. The risk of Covid-19 related death was 55% lower during the Omicron vs. Delta wave in the whole study population (n=9,569,648 and n=9,581,927, respectively; rate ratio [RR]: 0.45, 95% confidence interval [CI]: 0.44-0.48). During the Delta wave, the risk of Covid-19 related death was 74% lower in the primary immunized population (RR: 0.26; 95% CI: 0.25-0.28) and 96% lower in the booster immunized population (RR: 0.04; 95% CI: 0.04-0.05), vs. the unvaccinated control group. During the Omicron wave, the risk of Covid-19 related death was 40% lower in the primary immunized population (RR: 0.60; 95% CI: 0.55-0.65) and 82% lower in the booster immunized population (RR: 0.18; 95% CI: 0.16-0.2) vs. the unvaccinated control group. The double booster immunized population had a 93% lower risk of Covid-19 related death compared to those with only one booster dose (RR: 0.07; 95% CI. 0.01-0.46). The benefit of the second booster was slightly more pronounced in older age groups. Conclusions: The HUN-VE 2 study demonstrated the significantly lower risk of Covid-19 related mortality associated with the Omicron vs. Delta variant and confirmed the benefit of single and double booster vaccination against Covid-19 related death. Furthermore, the results showed the additional benefit of a second booster dose in terms of SARS-CoV-2 infection and Covid-19 related mortality.

[Hungarian situation of melanoma incidence and mortality in the first two decades of 21st century]. / A melanóma hazai morbiditási és mortalitási helyzete a XXI. század elso két évtizedében.

Skin melanoma is not among malignancies with the highest incidences and mortalities worldwide; however, the observed constant increase in newly diagnosed cases is troublesome. According to the database of the Hungarian Cancer Registry, the number of newly reported cases doubled between 2001 and 2019, which is consistent with international data. Notwithstanding, within the same interval, Hungarian mortality did not change significantly according to the database of the Hungarian Statistical Office, which is in contrast to international trends. The increasing incidence together with unchanging mortality resulted in better survival rates and hence more favorable follow-up data in our country. Advancements in secondary prevention programs and better efficacy of modern therapeutic interventions in the last decade may have contributed to the observed improvement in the survival rates of Hungarian melanoma patients.

Az orvosi kódtárak gyakorlati alkalmazása az onkológiában ­ szakmai útmutató a Nemzeti Rákregiszter tapasztalatai alapján.

The incidence and mortality of malignant diseases show constant increase worldwide. Proper epidemiological data may establish the planning and development of oncological network, which is provided by population-based registries (in Hungary: National Cancer Registry). The quality of the reported data determines the reliability of the Registry. Recorded medical codes during everyday physician-patient encounters are part of the official documentation as well as a permanent imprint of the medical activity in the Registry's database. Uncritical coding degrades the quality of epidemiological data, moreover, leads to unnecessary patient stigmatization, which may be the base of legal procedure against the physician who authenticated the false code. However, neither graduate nor postgraduate medical training focus on coding. In addition, hospitals apply obsolete versions of coding systems which does not follow developments in medicine. The aim of the present review is presentation of proper coding in oncology, which may contribute to avoid that kind of basic professional pitfalls, and improve quality of medical activity.