The Impact of the COVID-19 Pandemic on Adherence to Endocrine Therapy for Breast Cancer in Catalonia (Spain).

Purpose. To assess the impact of the COVID-19 pandemic on adherence to oral endocrine therapy in patients diagnosed with breast cancer in the public healthcare system in Catalonia (Spain). Methods. Retrospective cohort study in patients starting endocrine therapy from 2017 to 2021. Adherence was measured during the first year of treatment, and the impact of the pandemic was calculated according to the calendar year and whether the first year of treatment included the peak period of the pandemic in our setting (March-September 2020). Analyses were performed using a chi-square test and multivariable logistic regression, with results stratified by year, age group, and drug type. Results. Mean overall adherence during the first year of treatment was 89.6% from 2017 to 2021. In contrast, the patients who started treatment in 2019 and 2020 and whose treatment included the peak pandemic period presented an adherence of 87.0% and 86.5%, respectively. Young age and tamoxifen or combination therapy were predictors of low adherence. An increase in neoadjuvant therapy was also observed in 2020. Conclusions. The COVID-19 pandemic had only a modest impact on adherence to endocrine therapy (≈3%), despite the enormous disruptions for patients, the healthcare system in general, and cancer care in particular that were occurring in that period.

Cancer treatment data available in European cancer registries: Where are we and where are we going?

Population-based cancer registries are responsible for collecting incidence and survival data on all reportable neoplasms within a defined geographical area. During the last decades, the role of cancer registries has evolved beyond monitoring epidemiological indicators, as they are expanding their activities to studies on cancer aetiology, prevention, and quality of care. This expansion relies also on the collection of additional clinical data, such as stage at diagnosis and cancer treatment. While the collection of data on stage, according to international reference classification, is consolidated almost everywhere, data collection on treatment is still very heterogeneous in Europe. This article combines data from a literature review and conference proceedings together with data from 125 European cancer registries contributing to the 2015 ENCR-JRC data call to provide an overview of the status of using and reporting treatment data in population-based cancer registries. The literature review shows that there is an increase in published data on cancer treatment by population-based cancer registries over the years. In addition, the review indicates that treatment data are most often collected for breast cancer, the most frequent cancer in women in Europe, followed by colorectal, prostate and lung cancers, which are also more common. Treatment data are increasingly being reported by cancer registries, though further improvements are required to ensure their complete and harmonised collection. Sufficient financial and human resources are needed to collect and analyse treatment data. Clear registration guidelines are to be made available to increase the availability of real-world treatment data in a harmonised way across Europe.

How cancer registries can detect neoplasms in pathology laboratories that code with SNOMED CT terminology? An actual, simple and flexible solution.

BACKGROUND: Pathology laboratories are one of the main information sources for cancer registries and have traditionally been coded with SNOMED; some of them are migrating to SNOMED CT (SCT). Cancer registries encode topography and morphology of neoplasms by the International Classification of Diseases for Oncology (ICD-O). ICD-O updates morphology with WHO Classification of Tumors (Blue-Books). Morphological codes of the ICD-O, Blue-Books and SNOMED (former SNOMEDID) have always coincided. In 2017, SCT removed the SNOMEDID. OBJECTIVES: to define neoplastic and topographic subsets in SCT and map them to ICD-O-3.1/Blue-Books; reduce the original number of SCT concepts; correctly identify neoplasms in the laboratories in accordance with international cancer registry rules. METHODOLOGY: SCT neoplastic concepts were identified by manual revision and SCT resources ("is a", "Associated morphology" relationships; Simple Map Reference Set). Topographic concepts were extracted from the body structure hierarchy of SCT. Both subsets were mapped to ICD-O-3.1/Blue-Books, afterwards. Updating algorithms were designed to automate and update each subset with every SCT release. The process of neoplasms identification was validated in a sample of 5212 specimens with 7378 records from 8 Catalan hospitals. RESULTS: The number of concepts in neoplastic and topographic subsets (16,448 and 32,278) was reduced after the mapping to ICD-O-3.1/Blue-Books (2115 and 330, respectively). Neoplastic subset classified the specimens correctly in the 98.6% of the specimens. CONCLUSIONS: This article presents a flexible tool to exhaustively identify neoplasms in pathology laboratories that code with SCT, following international PBCRs standards and in line with the pathologists, oncologists and epidemiologists' needs.

Prediction of advanced colonic neoplasm in symptomatic patients: a scoring system to prioritize colonoscopy (COLONOFIT study).

BACKGROUND: Fast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. The aim was to derive a predictive score of advanced colonic neoplasia in symptomatic patients in fast-track programs. METHODS: All patients referred for fast-track colonoscopy were evaluated. Faecal immunological haemoglobin test (3 samples; positive> 4 µg Hb/g), and a survey to register clinical variables of interest were performed. Colorectal cancer and advanced adenoma were considered as advanced colonic neoplasia. A sample size of 600 and 500 individuals were calculated for each phase 1 and phase 2 of the study, respectively (Phase 1, derivation and Phase 2, validation cohort). A Bayesian logistic regression analysis was used to derive a predictive score. RESULTS: 1495 patients were included. Age (OR, 21), maximum faecal-Hb value (OR, 2.3), and number of positive samples (OR, 28) presented the highest ORs predictive of advanced colonic neoplasia. The additional significant predictive variables adjusted for age and faecal-Hb variables in Phase 1 were previous colonoscopy (last 5 years) and smoking (no, ex/active). With these variables a predictive score of advanced colonic neoplasia was derived. Applied to Phase 2, patients with a Score > 20 had an advanced colonic neoplasia probability of 66% (colorectal cancer, 32%), while those with a Score ≤ 10, a probability of 10% (colorectal cancer, 1%). Prioritizing patients with Score > 10, 49.4% of patients would be referred for fast-track colonoscopy, diagnosing 98.3% of colorectal cancers and 77% of advanced adenomas. CONCLUSIONS: A scoring system was derived and validated to prioritize fast-track colonoscopies according to risk, which was efficient, simple, and robust.

Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test.

BACKGROUND: An on-site, rapid, fingertip, whole-blood point-of-care test (POCT) is attractive for active case-finding of coeliac disease (CD) in primary care because of its simplicity. AIM: The aim of this article is to assess the usefulness and cost-effectiveness of adult case-finding using a POCT based on deamidated gliadin peptide antibodies (IgA/IgG-DGP) in primary care for CD diagnosis. METHODS: A case-finding study for CD was conducted by using an easy-to-use, on-site, whole-blood for IgA/IgG-DGP-based fingertip POCT compared with tTG2 in 350 individuals. Sample size was calculated based on 0.28% prevalence in the reference population. Duodenal biopsies for histology, intraepithelial lymphocytes and in situ deposition of tTG2 were obtained if tTG2 and/or POCT were positive. Accuracy and cost-effectiveness of strategies using serology or POCT were calculated. RESULTS: Prevalence of CD was 1.14% (95% CI, 0.3-3.4), almost double what was previously observed. Four patients were diagnosed with CD. tTG2 was positive in three (0.85%) and POCT in 29 (8.2%). Sensitivity of POCT for CD was 100%, specificity 93%, PPV 14%, and NPV 100%. POCT followed by duodenal biopsy was the most cost-effective approach in our setting (standard diagnosis: €13,033/case; POCT + duodenal biopsy: €7360/case). CONCLUSIONS: A negative POCT allows ruling out CD in primary care, making it suitable for case-finding. POCT strategy was the most cost effective.

Definition of a SNOMED CT pathology subset and microglossary, based on 1.17 million biological samples from the Catalan Pathology Registry.

SNOMED CT terminology is not backed by standard norms of encoding among pathologists. The vast number of concepts ordered in hierarchies and axes, together with the lack of rules of use, complicates the functionality of SNOMED CT for coding, extracting, and analyzing the data. Defining subgroups of SNOMED CT by discipline could increase its functionality. The challenge lies in how to choose the concepts to be included in a subset from a total of over 300,000. Besides, SNOMED CT does not cover daily need, as the clinical reality is dynamic and changing. To adapt SNOMED CT to needs in a flexible way, the possibility exists to create extensions. In Catalonia, most pathology departments have been migrating from SNOMED II to SNOMED CT in a bid to advance the development of the Catalan Pathology Registry, which was created in 2014 as a repository for all the pathological diagnoses. This article explains the methodology used to: (a) identify the clinico-pathological entities and the molecular diagnostic procedures not included in SNOMED CT; (b) define the theoretical subset and microglossary of pathology; (c) describe the SNOMED CT concepts used by pathologists of 1.17 million samples of the Catalan Pathology Registry; and (d) adapt the theoretical subset and the microglossary according to the actual use of SNOMED CT. Of the 328,365 concepts available for coding the diagnoses (326,732 in SNOMED CT and 1576 in Catalan extension), only 2% have been used. Combining two axes of SNOMED CT, body structure and clinical findings, has enabled coding most of the morphologies.

Potential coeliac disease markers and autoimmunity in olmesartan induced enteropathy: A population-based study.

AIMS: (1) Assess the population-based incidence of severe olmesartan-associated enteropathy. (2) To describe patients of the Spanish registry. (3) Evaluate markers of potential coeliac disease and associated autoimmunity. METHODS: Crude incidence rates in the area of Terrassa (Catalonia) were calculated. Clinical characteristics of patients in the Spanish registry were collected. Duodenal lymphocyte subpopulations and anti-TG2 IgA deposits were assessed in a subset of patients. RESULTS: Annual incidence rates (2011-2014) ranged from 0 to 22 cases per 10(4) treated patients. Twenty patients were included in the Spanish registry. Nineteen (95%) exhibited villous atrophy and 16 (80%) had severe enteropathy. Lupus-like disease occurred during olmesartan treatment in 3 patients. HLA-DQ2/DQ8 was positive in 64%. Markers of potential coeliac disease were present in 4 out of 8 patients (positive anti-TG2 deposits and/or increased CD3+gammadelta+ intraepithelial lymphocytes and reduced CD3-). Histopathological changes and clinical manifestations including autoimmune disorders improved after olmesartan discontinuation but not after gluten-free diet, irrespective of the presence or absence of coeliac markers. CONCLUSIONS: Incidence of severe olmesartan-associated enteropathy was low. Autoimmune phenomena were present in a subset of cases and reversed after olmesartan removal. A genetic coeliac disease background and the presence of potential coeliac markers might uncover predisposing factors.

Trends in the surgical procedures of women with incident breast cancer in Catalonia, Spain, over a 7-year period (2005-2011).

BACKGROUND: Breast cancer (BC) is the most frequent cancer in women, accounting for 28% of all tumors among women in Catalonia (Spain). Mastectomy has been replaced over time by breast-conserving surgery (BCS) although not as rapidly as might be expected. The aim of this study was to assess the evolution of surgical procedures in incident BC cases in Catalonia between 2005 and 2011, and to analyze variations based on patient and hospital characteristics. METHODS: We processed data from the Catalonian Health Service's Acute Hospital Discharge database (HDD) using ASEDAT software (Analysis, Selection and Extraction of Tumor Data) to identify all invasive BC incident cases according to the codes 174.0-174.9 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that were attended for the one-year periods in 2005, 2008 and 2011. Patients were classified according to surgical procedures (BCS vs mastectomy, and immediate vs delayed reconstruction), and results were compared among periods according to age, stage, comorbidity and hospital level. RESULTS: BC surgical procedures were performed in more than 80% of patients. Surgical cases showed a significant increasing trend in the proportion of women aged 50-69 years, more advanced disease stages, higher comorbidity and they were attended in hospitals of less complexity level throughout the study period. Similar pattern was found for patients treated with BCS, which increased significantly from 67.9% in 2005 to 74.0% in 2011.Simple lymph node removal increased significantly (from 48.8% to 71.4% and from 63.6% to 67.8% for 2005 and 2011 in conservative and radical surgery, respectively). A slightly increase in the proportion of mastectomized young women (from 28% in 2005 to 34% in 2011) was detected, due to multiple factors. About 22% of women underwent post-mastectomy breast reconstruction, this being mostly immediate. CONCLUSIONS: The use of HDD linked to the ASEDAT allowed us to evaluate BC surgical treatment in Catalonia. A consolidating increasing trend of BCS was observed in women aged 50-69 years, which corresponds with the pattern in most European countries. Among the mastectomized patients, immediate breast reconstructions have risen significantly over the period 2005-2011.

REGSTATTOOLS: freeware statistical tools for the analysis of disease population databases used in health and social studies.

BACKGROUND: The repertoire of statistical methods dealing with the descriptive analysis of the burden of a disease has been expanded and implemented in statistical software packages during the last years. The purpose of this paper is to present a web-based tool, REGSTATTOOLShttp://regstattools.net intended to provide analysis for the burden of cancer, or other group of disease registry data. Three software applications are included in REGSTATTOOLS: SART (analysis of disease's rates and its time trends), RiskDiff (analysis of percent changes in the rates due to demographic factors and risk of developing or dying from a disease) and WAERS (relative survival analysis). RESULTS: We show a real-data application through the assessment of the burden of tobacco-related cancer incidence in two Spanish regions in the period 1995-2004. Making use of SART we show that lung cancer is the most common cancer among those cancers, with rising trends in incidence among women. We compared 2000-2004 data with that of 1995-1999 to assess percent changes in the number of cases as well as relative survival using RiskDiff and WAERS, respectively. We show that the net change increase in lung cancer cases among women was mainly attributable to an increased risk of developing lung cancer, whereas in men it is attributable to the increase in population size. Among men, lung cancer relative survival was higher in 2000-2004 than in 1995-1999, whereas it was similar among women when these time periods were compared. CONCLUSIONS: Unlike other similar applications, REGSTATTOOLS does not require local software installation and it is simple to use, fast and easy to interpret. It is a set of web-based statistical tools intended for automated calculation of population indicators that any professional in health or social sciences may require.

Predicting the change in breast cancer deaths in Spain by 2019: a Bayesian approach.

BACKGROUND: Breast cancer mortality rates have been decreasing in Spain since 1992. Recent changes in demography, breast cancer therapy, and early detection of breast cancer may change this trend. METHODS: Using breast cancer mortality data from years 1990 to 2009, we sought to predict the changes in the burden of breast cancer mortality during the years 2005-2019 through a Bayesian age-period-cohort model. The net change in the number of breast cancer deaths between the periods of 2015-2019 and 2005-2009 was separated into changes in population demographics and changes in the risk of death from breast cancer. RESULTS: During the period 1990-2009, breast cancer mortality rates decreased (age-standardized rates per 100,000 women-years 50.6 in 1990-1994 vs. 41.1 in 2005-2009), whereas the number of breast cancer deaths increased (28,149 in 1990-1994; 29,926 in 2005-2009). There was a decrease in the number of cases among women 45-64 years of age (10,942 in 1990-1994; 8,647 in 2005-2009). Changes in population demographics contribute to a total increase of 12.5-12.8% comparing periods 2005-2009 versus 2015-2019, whereas changes in the risk of death from breast cancer contribute to a reduction of 12.9-13.7%. We predict a net decline of 0.1-1.2% in the absolute number of breast cancer deaths comparing these time periods. CONCLUSIONS: The decrease in the risk of death from breast cancer may exceed the projected increase in deaths from growing population size and aging in Spain. These changes may also explain the decrease in the absolute number of breast cancer deaths in Spain since 2005.

Relative survival of patients with uveal melanoma managed in a single center.

To assess the 5-year relative survival of patients diagnosed with uveal melanoma (UM) in a single center. UM patients were recruited from 1995 to 2004 (N = 155) and were followed until December 2008. Relative survival (RS) methods were used to assess excess mortality. An RS regression model was fitted by sex, age, tumor origin, treatment, and tumor size to estimate the excess hazard rate (EHR) of death from UM. The overall 5-year RS was 90%, lower in women (84.6%) than in men (100%), lower in patients older than 60 years (88.8%) compared with those younger than or of 60 years of age (94.8%). Large tumors (80.8%) showed lower RS than medium (95.1%) and small ones (98.3%). Enucleated patients (80.5%) had lower RS compared with those who received brachytherapy (93.6%) and other treatments (94.7%). A significant EHR was found for women (EHR: 3.65), patients older than 60 years (EHR: 2.25), large-sized melanoma (EHR: 2.45), and during the third (EHR: 5.37) and fourth year (EHR: 3.01) of follow-up. This is the first Spanish study in a single center reporting RS among UM patients, taking into account clinical characteristics. Prognostic factors that explained RS among UM patients were sex, age, tumor size, and the year of follow-up. We also found a peak of excess mortality from the third until the fourth year after diagnosis, which warrants strict follow-up of these patients during this time interval.

BootstRatio: A web-based statistical analysis of fold-change in qPCR and RT-qPCR data using resampling methods.

Real-time quantitative polymerase chain reaction (qPCR) is widely used in biomedical sciences quantifying its results through the relative expression (RE) of a target gene versus a reference one. Obtaining significance levels for RE assuming an underlying probability distribution of the data may be difficult to assess. We have developed the web-based application BootstRatio, which tackles the statistical significance of the RE and the probability that RE>1 through resampling methods without any assumption on the underlying probability distribution for the data analyzed. BootstRatio perform these statistical analyses of gene expression ratios in two settings: (1) when data have been already normalized against a control sample and (2) when the data control samples are provided. Since the estimation of the probability that RE>1 is an important feature for this type of analysis, as it is used to assign statistical significance and it can be also computed under the Bayesian framework, a simulation study has been carried out comparing the performance of BootstRatio versus a Bayesian approach in the estimation of that probability. In addition, two analyses, one for each setting, carried out with data from real experiments are presented showing the performance of BootstRatio. Our simulation study suggests that Bootstratio approach performs better than the Bayesian one excepting in certain situations of very small sample size (N≤12). The web application BootstRatio is accessible through http://regstattools.net/br and developed for the purpose of these intensive computation statistical analyses.

Bayesian approach to predicting cancer incidence for an area without cancer registration by using cancer incidence data from nearby areas.

This paper compares three different methods for performing cancer incidence prediction in an area without a cancer registry under a Bayesian framework, using linear and log-linear age-period models with either age-specific slopes or a common slope across age groups. The three methods assume that a nearby area with a cancer registration has similar incidence and mortality patterns as the area of interest without a cancer registry where the cancer incidence prediction is carried out. The three methods differ in modeling strategies: (i) modeling the incidence rate directly; (ii) modeling the ratio of the number of incident cases to that of mortality cases; and (iii) modeling the difference between the incidence rate and the mortality rate. Strategy (iii) is a new approach in this type of projection. Empirical assessment is made using real data from the cancer registry of Tarragona, Spain, to predict cancer incidence in Girona, Spain, and vice versa. Predictions of short-term (3-4 years) incidence were made for 2001 in Tarragona using observed cancer incidence and mortality data for 1994-1998 from Girona. Short-term predictions were made for 2002 in Girona using Tarragona's 1994-1998 data. Additionally, long-term (10 years) incidence rate predictions were made for 2002 in Girona using data from Tarragona for the period 1985-1992. Our results suggest that extrapolating time-trends of incidence rates minus mortality rates may have the best predictive performance overall. These methods of population-level disease-incidence prediction are highly relevant to health care planning and policy decisions.

SART ( Statistical Analysis of Rates and Trends): herramienta vía web para el cálculo estadístico de indicadores poblacionales / Statistical Analysis of Rates and Trends (SART): a web-based tool for statistical calculation of population indicators

Se propone una herramienta vía web (SART: http://regstattools.net/sart.html) que automatiza los cálculos para la obtención de distintos indicadores poblacionales importantes para el control de enfermedades o eventos de la salud. Se estructura en cuatro módulos: a) una descriptiva que incluye el cálculo del porcentaje, el número de casos, la tasa cruda, la tasa ajustada, la tasa truncada y la tasa acumulada; b) la estimación del porcentaje de cambio anual de las tasas; c) el cálculo de casos esperados, y d) la razón de incidencia o mortalidad estandarizada. La aplicación solicita unos parámetros de entrada al usuario. Una vez procesados los datos y obtenidos los resultados, éstos se envían por correo electrónico al usuario. Los resultados se obtienen para cada una de las causas de estudio (enfermedades, etnias, zonas geográficas...) y cada uno de los sexos introducidos en el fichero base (AU)

We propose a web-based tool (SART: http://regstattools.net/sart.html) that automates calculations to obtain various population indicators that can be used for the control of diseases or health events. SART has four modules: a) a descriptive module that allows calculation of the number of cases and their percentage, the crude rate, the adjusted rate, the truncated rate and the cumulative rate; b) the estimated annual percentage change of rates; c) calculation of expected cases; and d) the standardized incidence of mortality ratio. SART requests a base file and input parameters from the user before processing the data. The data and the results obtained are processed and then sent by email to the user. The results are provided by sex and for each of the study variables (diseases, ethnic groups, geographic areas...) introduced into the base file (AU)

[Statistical Analysis of Rates and Trends (SART): a web-based tool for statistical calculation of population indicators]. / SART (Statistical Analysis of Rates and Trends): herramienta vía web para el cálculo estadístico de indicadores poblacionales.

We propose a web-based tool (SART: http://regstattools.net/sart.html) that automates calculations to obtain various population indicators that can be used for the control of diseases or health events. SART has four modules: a) a descriptive module that allows calculation of the number of cases and their percentage, the crude rate, the adjusted rate, the truncated rate and the cumulative rate; b) the estimated annual percentage change of rates; c) calculation of expected cases; and d) the standardized incidence of mortality ratio. SART requests a base file and input parameters from the user before processing the data. The data and the results obtained are processed and then sent by email to the user. The results are provided by sex and for each of the study variables (diseases, ethnic groups, geographic areas...) introduced into the base file.

Monitoring the decreasing trend of testicular cancer mortality in Spain during 2005-2019 through a Bayesian approach.

PURPOSE: To assess time trends of testicular cancer (TC) mortality in Spain for period 1985-2019 for age groups 15-74 years old through a Bayesian age-period-cohort (APC) analysis. METHODS: A Bayesian age-drift model has been fitted to describe trends. Projections for 2005-2019 have been calculated by means of an autoregressive APC model. Prior precision for these parameters has been selected through evaluation of an adaptive precision parameter and 95% credible intervals (95% CRI) have been obtained for each model parameter. RESULTS: A decrease of -2.41% (95% CRI: -3.65%; -1.13%) per year has been found for TC mortality rates in age groups 15-74 during 1985-2004, whereas mortality showed a lower annual decrease when data was restricted to age groups 15-54 (-1.18%; 95% CRI: -2.60%; -0.31%). During 2005-2019 is expected a decrease of TC mortality of 2.30% per year for men younger than 35, whereas a leveling off for TC mortality rates is expected for men older than 35. CONCLUSIONS: A Bayesian approach should be recommended to describe and project time trends for those diseases with low number of cases. Through this model it has been assessed that management of TC and advances in therapy led to decreasing trend of TC mortality during the period 1985-2004, whereas a leveling off for these trends can be considered during 2005-2019 among men older than 35.

RiskDiff: a web tool for the analysis of the difference due to risk and demographic factors for incidence or mortality data.

BACKGROUND: Analysing the observed differences for incidence or mortality of a particular disease between two different situations (such as time points, geographical areas, gender or other social characteristics) can be useful both for scientific or administrative purposes. From an epidemiological and public health point of view, it is of great interest to assess the effect of demographic factors in these observed differences in order to elucidate the effect of the risk of developing a disease or dying from it. The method proposed by Bashir and Estève, which splits the observed variation into three components: risk, population structure and population size is a common choice at practice. RESULTS: A web-based application, called RiskDiff has been implemented (available at http://rht.iconcologia.net/riskdiff.htm), to perform this kind of statistical analyses, providing text and graphical summaries. Code from the implemented functions in R is also provided. An application to cancer mortality data from Catalonia is used for illustration. CONCLUSIONS: Combining epidemiological with demographical factors is crucial for analysing incidence or mortality from a disease, especially if the population pyramids show substantial differences. The tool implemented may serve to promote and divulgate the use of this method to give advice for epidemiologic interpretation and decision making in public health.

Diagnóstico de cáncer en los trabajadores de un centro sanitario / Cancer diagnosis in hospital workers

Fundamento y objetivo: Identificar los casos de cáncer diagnosticados en los trabajadores de un centro sanitario durante un período y establecer si existe un exceso de casos. Material y método: Para cada caso, ocurrido durante el período 1990–2005, se ha analizado: fecha de nacimiento durante un determinado período, sexo, localización de la neoplasia, fecha de diagnóstico de la neoplasia, categoría laboral, servicio/unidad e historia laboral en la empresa. Se ha calculado la razón de incidencia estandarizada (RIE) para cada tipo de cáncer. Resultados: Se han registrado 51 neoplasias (21 en varones y 30 en mujeres). Las más frecuentes fueron mama (19 casos), leucemia-linfoma (7 casos), pulmón (4 casos) y próstata (4 casos). La edad media (desviación estándar) en el diagnóstico fue de 47,3 (9,2) años. Se detectaron 22 casos en médicos, 18 en enfermeras y auxiliares y 4 en administrativos. No se ha detectado un exceso de incidencia de cáncer. Respecto a los registros poblacionales de cáncer, tuvieron una incidencia inferior a la esperada los casos de cáncer de colon (RIE=0,25; intervalo de confianza [IC] del 95%, 0,03–0,89) y gástrico (RIE=0,19; IC del 95%, 0,02–0,69). Conclusiones: No se ha detectado un exceso de riesgo de cáncer en el colectivo estudiado. La dificultad en obtener información sobre personas en riesgo y sobre la incidencia de casos plantea la mejora de las fuentes de información para este tipo de estudios en España (AU)

Background and objective: We aimed to identify cases of cancer diagnosis in hospital workers and to establish if an excess of cases exist. Material and method: For cases occurring during 1990–2005 the following data about workers were checked: birth date, sex, location of the neoplasm, date of diagnosis of the neoplasm, working category, hospital service/unit and work duration at the hospital. The standard incidence ratio (SIR) was calculated for each type of cancer. Results: Fifty one neoplasms were registered (21 male and 30 women) Most frequent types of cancer were breast (19 cases), leukemia-lymphoma (7 cases), lung (4 cases) and prostate (4 cases). At the time of diagnosis the average age was 47,3 years (DE 9,2). 22 cases were detected in doctors, 18 in nurses and assistant nurses and 4 in assistants. An excess of cases was not found. Comparing data with cancer cases in the whole population, the prevalence of colon cancer was lower than the average (SIR: 0,25; CI 95%: 0,03–0,89) as well as the prevalence of gastric cancer (SIR: 0,19; CI 95%: 0,02–0,69). Conclusions: An excess of cancer risk was not found in the studied group. Difficulties in obtaining information about people at risk and cancer incidence reveal the need to improve the sources of information for this kind of studies in Spain (AU)

[Cancer diagnosis in hospital workers]. / Diagnóstico de cáncer en los trabajadores de un centro sanitario.

BACKGROUND AND OBJECTIVE: We aimed to identify cases of cancer diagnosis in hospital workers and to establish if an excess of cases exist. MATERIAL AND METHOD: For cases occurring during 1990-2005 the following data about workers were checked: birth date, sex, location of the neoplasm, date of diagnosis of the neoplasm, working category, hospital service/unit and work duration at the hospital. The standard incidence ratio (SIR) was calculated for each type of cancer. RESULTS: Fifty one neoplasms were registered (21 male and 30 women) Most frequent types of cancer were breast (19 cases), leukemia-lymphoma (7 cases), lung (4 cases) and prostate (4 cases). At the time of diagnosis the average age was 47,3 years (DE 9,2). 22 cases were detected in doctors, 18 in nurses and assistant nurses and 4 in assistants. An excess of cases was not found. Comparing data with cancer cases in the whole population, the prevalence of colon cancer was lower than the average (SIR: 0,25; CI 95%: 0,03-0,89) as well as the prevalence of gastric cancer (SIR: 0,19; CI 95%: 0,02-0,69). CONCLUSIONS: An excess of cancer risk was not found in the studied group. Difficulties in obtaining information about people at risk and cancer incidence reveal the need to improve the sources of information for this kind of studies in Spain.

Colorectal cancer mortality in Spain: trends and projections for 1985-2019.

BACKGROUND AND AIM: To describe colorectal cancer (CRC) mortality trends during 1985-2004 and to estimate CRC mortality projections for the period 2005-2019 in Spain. MATERIAL AND METHODS: A Bayesian age-period-cohort analysis has been carried out to investigate the effect of the age, period, and birth cohort on CRC mortality in Spain. Mortality projections until 2019 were based on the age-period-cohort model. RESULTS: During 1985-1994, CRC mortality increased in both sexes (3.9% yearly in men and 1.5% in women). After 1995, CRC mortality increased in men (1.6%) and leveled off in women (-0.6%). Colon cancer mortality increased for the whole period in men, this increase being lower in the second decade (1985-1994: 5.0%; 1995-2004: 1.8%). In women, colon cancer mortality increased in the first decade (2.8%) and leveled off during the second decade (-0.1%). Rectal cancer mortality increased in men (1.2%) and decreased in women (-1.1%) during the whole study period. Projections showed an increase in the number of CRC deaths in men older than 60 years and a level off in women. CONCLUSION: Although mass screening for CRC in Spain has not been available, the favorable recent changes in CRC mortality trends observed after 1995 could be related to progress in diagnosis and treatment. The projected number of deaths could be used as reference scenario for assessing future impact of new treatments as well as the potential impact of future population-based screening when introduced.