Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales.

OBJECTIVE: To present recent trends in cervical and uterine cancer adjusted for true population at risk, using accurate estimates of the prevalence of hysterectomy where the cervix has been removed or not. To describe trends and projections of hysterectomy incidence and prevalence with and without cervix removal. DESIGN: Collation of available NHS and private sector information. SETTING: England and Wales. SAMPLE: NHS operations from Hospital Inpatient Enquiry, Hospital Episode Statistics and Hospital Activity Analysis for England and Wales. Private sector data from surveys with up to 97% coverage. METHODS AND MAIN OUTCOME: Measures NHS data by 5-year age group, year and operation type were collated for 1961-1995. non-NHS operations for 1981, 1986, and 1992/3 were back-projected. Hysterectomy incidence rates, 1961-95, were back-projected to estimate prevalence rates by accumulation. True populations at risk of disease and hysterectomy were calculated by applying one minus the relevant hysterectomy prevalence rates to the population by age group and year. RESULTS: When based on the true population at risk, the age standardised cervical cancer incidence rate in 1992 was 14.4 per 100,000, compared with 12.6 when based on the all women population estimate. Incidence rates for earlier years were also affected, but there was no important effect on the rate of change over time. Absolute changes for uterine cancer are greater because the true population at risk is proportionally smaller particularly at the older ages, but there are again no major effects on the rate of change. By 1995 2.3 million women in England and Wales were without a uterus, with a peak prevalence of 21.3% in the age group 55-59. Projections based on 1995 incidence rates show hysterectomy prevalence for the screened age groups, 25-64, will now fall. Subtotal hysterectomy is 3.5% of operations and increasing. CONCLUSIONS: True populations at risk must be used to assess the impact of screening if further reductions in cervix cancer incidence rates are not to be masked. It is essential to monitor hysterectomy by type, as subtotal hysterectomy is becoming more common. Hysterectomy incidence may have peaked. Hysterectomy prevalence in England and Wales may not be as high as would be estimated from some regional studies.

The incidence and prognosis of nail apparatus melanoma. A retrospective study of 105 patients in four English regions.

Our population-based study establishes epidemiological data on age-specific incidence rates, clinical presentation, Breslow microstaging, treatment and survival of nail apparatus melanoma (NAM) patients in England. Four cancer registries, covering a population of 10.6 million, recorded 105 cases of NAM during the period 1984-93. During the same decade there was a total of 7585 patients with cutaneous melanoma and NAM represents 1.4% of all cutaneous melanoma. The incidence rate of NAM in English patients is 0.1 per 100,000 of the population per annum. Amelanotic melanoma was the clinical presentation in 24 of our NAM cases. The overall prognosis is poor with an observed 5 year survival of only 51%. Patients with NAM less than 2.5 mm Breslow depth have a 5 year survival of 88% and are twice as likely to survive compared with those with tumours greater or equal to 2.5 mm in thickness (P < 0. 05). NAM patients are best managed by a multidisciplinary team approach in a few key skin cancer centres.

Improving survival of melanoma patients in Europe since 1978. EUROCARE Working Group.

Within the EUROCARE study 45 cancer registries have contributed survival data on 3.5 million cancer sufferers within 17 countries in Europe. This paper reports on survival in 16,113 cutaneous malignant melanoma cases diagnosed between 1985 and 1989. Relative survival rates were calculated according to the Hakulinen computer program with data stratified according to country, age group and period of diagnosis. Relative 5-year survival was higher in women (81%) than in men (69%) but there was wide variation in relative survival across Europe at both 1 and 5 years, ranging at 5 years between 54 and 89%. At both 1 and 5 years, survival was lowest in the Eastern countries. Between 1978 and 1989 there was an improvement in survival rates probably attributable to the detection of increasing proportions of better prognosis, thinner tumours. In the younger age groups, this may be related to public awareness campaigns. The discrepancy in survival between men and women also narrowed. The single most important prognostic factor is the depth of invasion at diagnosis and there is some evidence that underlying variation in stage at presentation as well as histological type accounts for much of the observed variation in survival.