Cause-specific mortality after a breast cancer diagnosis: a cohort study of 10,195 women in Girona and Tarragona.

INTRODUCTION: Evidence suggests an excess of long-term mortality due to cardiovascular diseases, second tumours and other causes in patients diagnosed with invasive breast cancer (BC). Our aim was to assess this risk of death in a cohort of patients diagnosed with BC in Girona and Tarragona, northeastern Spain. MATERIALS AND METHODS: Using data from the cancer registries in these areas, a population-based cohort study was carried out including all the women diagnosed with BC during 1985-2004 and followed up until December 31st 2014 (N = 10,195). The standardised mortality ratios (SMRs) were calculated for causes other than BC in the cohort at 10 years (periods 1985-1994/1995-2004) and 20 years (period 1985-1994). The impact of competing causes of death in the long-term survival was evaluated through competing risk analysis. RESULTS: The SMRs at 10 and 20 years for all-cause mortality, except BC, were 1.21 and 1.22. The main causes of mortality showing statistically significant SMR at 10 years were other tumours (colon, lung, corpus uteri, ovary, and haematological), diabetes mellitus, diseases of the nervous system, cardiovascular diseases (after BC, the second competing cause of death among patients diagnosed > 69 years) and diseases of the kidney. Globally, the 10-year SMR was higher in the first period. After 20 years of follow-up (1985-1994 cohort), there were 48.5 excess deaths per 10,000 patient-years for causes other than BC. CONCLUSIONS: Women who did not die from BC at 10 or 20 years after the BC diagnosis had 20% higher risk of dying from other causes than women without BC. This excess risk must be clinically considered during 20 years after the BC diagnosis.

Long-term crude probabilities of death among breast cancer patients by age and stage: a population-based survival study in Northeastern Spain (Girona-Tarragona 1985-2004)

Background: We provide population-based long-term survival indicators of breast cancer patients by quantifying the observed survival, and the probabilities of death due to breast cancer and to other causes by age and tumor stage at diagnosis. Methods; We included a total of 10,195 female patients diagnosed before 85 years with invasive primary breast cancer in Girona and Tarragona during the periods 1985-1994 and 1995-2004 and followed-up until December 31st 2014. The survival indicators were estimated at 5, 10, 15 and 20 years of follow-up comparing diagnostic periods. Results: Comparing diagnostic periods: I) the probability of death due to other causes did not change; II) the 20-year survival for women diagnosed ≤ 49 years increased 13% (1995-2004 = 68%; 1985-1994:55%), whereas their probability of death due to breast cancer decreased at the same pace (1995-2004 = 29%; 1985-1994 = 42%); III) at 10 years of follow-up, decreases in the probabilities of death due to breast cancer across age groups switched from 11 to 17% resulting in a risk of death reduction of 19% after adjusting by stage. During 1995-2004, the stage-specific 10-year probabilities of death due to breast cancer switched from: 3-6% in stage I, 18-20% in stage II, 34-46% in stage III and surpassed 70% in stage IV beyond 5 years after diagnosis. Conclusions: In our study, women diagnosed with breast cancer had higher long-term probability to die from breast cancer than from other causes. The improvements in treatment and the lead-time bias in detecting cancer in an early stage resulted in a reduction of 19% in the risk of death between diagnostic periods

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Cognitive impairment in early stages of multiple sclerosis is associated with high cerebrospinal fluid levels of chitinase 3-like 1 and neurofilament light chain.

BACKGROUND AND PURPOSE: Chitinase 3-like 1 (CHI3L1) and neurofilament light chain (NF-L) are promising biomarkers of disability in multiple sclerosis (MS). However, their role in cognitive dysfunction remains elusive. Here, we aimed to correlate cerebrospinal fluid (CSF) levels of CHI3L1 and NF-L with cognitive status in MS. METHODS: Fifty one recently diagnosed patients were cognitively evaluated and CSF was collected. Levels of CHI3L1 and NF-L were determined by ELISA. Spearman's partial correlation coefficient was performed. RESULTS: After adjusting cognitive scores by age, anxiety and EDSS, association was detected between CHI3L1 levels and Trail Making Test A (rs = 0.348; p = 0.016) and between NF-L levels and Word List Generation (rs = -0.324; p = 0.025). CONCLUSION: High levels of CSF CHI3L1 and NF-L are associated with cognitive impairment in the early phases of MS.

Predicting the cancer burden in Catalonia between 2015 and 2025: the challenge of cancer management in the elderly

Background. Developing effective cancer control programmes requires information on the future cancer burden in an ageing population. In our study we predicted the burden of cancer in Catalonia from 2015 to 2025. Methods. Bayesian age-period-cohort models were used to predict the burden of cancer from 2015 to 2025 using incidence data from the Girona and Tarragona cancer registries and cancer mortality data from the Catalan mortality registry. Using the Bashir-Estève method, we divided the net change in the number of cases between 2015 and 2025 into changes due to population size (S), cancer risk (R) and age (A) distribution. Results. By 2025, there will be 21,743 new cancer cases in men (40% aged > 74 years) and 17,268 in women (37% aged > 74 years). More than 40% of the new cases will be diagnosed among population aged 74 and older in prostate, colorectal, lung, bladder, pancreatic and stomach cancers in men, and in colorectal, pancreatic and bladder cancers and leukaemia in women. During 2015-2025, the number of new diagnoses will increase by 5.5% in men (A + R + S = 18.1% − 13.3% + 0.7% = 5.5%) and 11.9% in women (A + R + S = 12.4% − 1.1% + 0.6% = 11.9%). Overall cancer mortality rates will continue to decrease during 2015-2025. Lung cancer will be the most lethal cancer among men (N = 2705) and women (N = 1174). Conclusions. The increase in the number of cancer cases in Catalonia from 2015 to 2025 will mostly affect the elderly, prompting the need for increased collaboration between geriatricians and oncologists

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Long-term crude probabilities of death among breast cancer patients by age and stage: a population-based survival study in Northeastern Spain (Girona-Tarragona 1985-2004).

BACKGROUND: We provide population-based long-term survival indicators of breast cancer patients by quantifying the observed survival, and the probabilities of death due to breast cancer and to other causes by age and tumor stage at diagnosis. METHODS: We included a total of 10,195 female patients diagnosed before 85 years with invasive primary breast cancer in Girona and Tarragona during the periods 1985-1994 and 1995-2004 and followed-up until December 31st 2014. The survival indicators were estimated at 5, 10, 15 and 20 years of follow-up comparing diagnostic periods. RESULTS: Comparing diagnostic periods: I) the probability of death due to other causes did not change; II) the 20-year survival for women diagnosed ≤ 49 years increased 13% (1995-2004 = 68%; 1985-1994:55%), whereas their probability of death due to breast cancer decreased at the same pace (1995-2004 = 29%; 1985-1994 = 42%); III) at 10 years of follow-up, decreases in the probabilities of death due to breast cancer across age groups switched from 11 to 17% resulting in a risk of death reduction of 19% after adjusting by stage. During 1995-2004, the stage-specific 10-year probabilities of death due to breast cancer switched from: 3-6% in stage I, 18-20% in stage II, 34-46% in stage III and surpassed 70% in stage IV beyond 5 years after diagnosis. CONCLUSIONS: In our study, women diagnosed with breast cancer had higher long-term probability to die from breast cancer than from other causes. The improvements in treatment and the lead-time bias in detecting cancer in an early stage resulted in a reduction of 19% in the risk of death between diagnostic periods.

Predicting the cancer burden in Catalonia between 2015 and 2025: the challenge of cancer management in the elderly.

BACKGROUND: Developing effective cancer control programmes requires information on the future cancer burden in an ageing population. In our study we predicted the burden of cancer in Catalonia from 2015 to 2025. METHODS: Bayesian age-period-cohort models were used to predict the burden of cancer from 2015 to 2025 using incidence data from the Girona and Tarragona cancer registries and cancer mortality data from the Catalan mortality registry. Using the Bashir-Estève method, we divided the net change in the number of cases between 2015 and 2025 into changes due to population size (S), cancer risk (R) and age (A) distribution. RESULTS: By 2025, there will be 21,743 new cancer cases in men (40% aged > 74 years) and 17,268 in women (37% aged > 74 years). More than 40% of the new cases will be diagnosed among population aged 74 and older in prostate, colorectal, lung, bladder, pancreatic and stomach cancers in men, and in colorectal, pancreatic and bladder cancers and leukaemia in women. During 2015-2025, the number of new diagnoses will increase by 5.5% in men (A + R + S = 18.1% - 13.3% + 0.7% = 5.5%) and 11.9% in women (A + R + S = 12.4% - 1.1% + 0.6% = 11.9%). Overall cancer mortality rates will continue to decrease during 2015-2025. Lung cancer will be the most lethal cancer among men (N = 2705) and women (N = 1174). CONCLUSIONS: The increase in the number of cancer cases in Catalonia from 2015 to 2025 will mostly affect the elderly, prompting the need for increased collaboration between geriatricians and oncologists.

Reflexiones bioéticas sobre el cuidado prematuro desencadenado por el diagnóstico precoz de la enfermedad de Alzheimer / Bioethical reflections on ill-considered care due to an early diagnosis of Alzheimer disease

El diagnóstico precoz de la enfermedad de Alzheimer presenta importantes problemas bioéticos. Entre la detección temprana de la enfermedad y la aparición de sus síntomas media un período de tiempo en el cual la autonomía, la intimidad y la dignidad de quien la sufre pueden verse lesionadas por las eventuales medidas de apoyo y atención sanitaria o familiar que se decida adoptar. Éstas pueden terminar por transformar al paciente en un objeto de cuidado, impidiéndole asumir la enfermedad, elaborar la identidad y reordenar el espacio vital. Debe procurarse entonces que el cuidar no se traduzca en un asedio compasivo y un efecto invasivo que lleve a la anulación del paciente con Alzheimer (AU)

Early diagnosis of Alzheimer disease raises important bioethical issues. In the interval between early disease detection and symptom onset, there is a time in which the patient's autonomy, privacy, and dignity may be undermined by certain healthcare measures or by family care and support. These measures may eventually turn patients into an object of care, preventing them from accepting the disease, developing an identity, and rearranging their living spaces. Every effort should be made to ensure that care does not become compassionate harassment or an invasive act, annulling the patient's autonomy, identity, and self-determination (AU)

Cancer incidence and mortality projections up to 2020 in Catalonia by means of Bayesian models

PURPOSE: To predict the burden of cancer in Catalonia by 2020 assessing changes in demography and cancer risk during 2010-2020. ETHODS/PATIENTS: Data were obtained from Tarragona and Girona cancer registries and Catalan mortality registry. Population age distribution was obtained from the Catalan Institute of Statistics. Predicted cases in Catalonia were estimated through autoregressive Bayesian age-period-cohort models. RESULTS: There will be diagnosed 26,455 incident cases among men and 18,345 among women during 2020, which means an increase of 22.5 and 24.5 % comparing with the cancer incidence figures of 2010. In men, the increase of cases (22.5 %) can be partitioned in three components: 12 % due to ageing, 8 % due to increase in population size and 2 % due to cancer risk. In women, the role of each component was 9, 8 and 8 %, respectively. The increased risk is mainly expected to be observed in tobacco-related tumours among women and in colorectal and liver cancers among men. During 2010-2020 a mortality decline is expected in both sexes. CONCLUSION: The expected increase of cancer incidence, mainly due to tobacco-related tumours in women and colorectal in men, reinforces the need to strengthen smoking prevention and the expansion of early detection of colorectal cancer in Catalonia (AU)

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[Bioethical reflections on ill-considered care due to an early diagnosis of Alzheimer disease]. / Reflexiones bioéticas sobre el cuidado prematuro desencadenado por el diagnóstico precoz de la enfermedad de Alzheimer.

Early diagnosis of Alzheimer disease raises important bioethical issues. In the interval between early disease detection and symptom onset, there is a time in which the patient's autonomy, privacy, and dignity may be undermined by certain healthcare measures or by family care and support. These measures may eventually turn patients into an object of care, preventing them from accepting the disease, developing an identity, and rearranging their living spaces. Every effort should be made to ensure that care does not become compassionate harassment or an invasive act, annulling the patient's autonomy, identity, and self-determination.

Time trends of cancer incidence and mortality in Catalonia during 1993-2007

PURPOSE: To describe time trends of cancer in Catalonia, Spain, during the period 1993-2007. METHODS/PATIENTS: Data have been provided by two population-based cancer registries, Girona and Tarragona, and the Catalan mortality registry. Cancer incidence in Catalonia has been estimated through modeling methods using data from these health structures. RESULTS: During 2003-2007, there were 20,042 cancer cases and 9,842 deaths per year among men and 13,673 new cancer cases and 5,882 deaths among women. The most frequent incident cancers among men were prostate (N = 4,258), lung (N = 3,021), colorectal (N = 3,007) and bladder (N = 2,238), whereas among women they were breast (N = 3,907), colorectal (N = 2,088), corpus uteri (N = 734) and lung (N = 527). During 1993-2007, age-standardized incidence rates (ASIRs) rose 1.2 % per year among men [prostate (6.3 %), testis (5.7 %), kidney (2.9 %), liver (2.2 %) and colorectal (2.1 %)]. ASIRs decreased for stomach (-2.9 %), oral cavity and pharynx (-2.8 %), larynx (-2.7 %) and esophagus (-2 %). Among women, ASIRs only rose for lung (5.2 %), kidney (3.1 %), oral cavity and pharynx (2.6 %) and thyroid (1.6 %). ASIRs decreased for corpus uteri (-2.3 %), stomach (-1.7 %) and ovary (-1.6 %). Cancer mortality decreased -1.3 % per year among men and -2.1 % among women during the same period. CONCLUSION: Among men, the decrease of incidence/mortality of tobacco-related tumors was related to a reduction of smoking prevalence. Among women, the stabilization of breast cancer incidence and the rise of lung cancer incidence are similar to that observed in most European regions. These results allow assessing the effectiveness of public health strategies and they pose new frontiers for cancer control in Catalonia (AU)

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Time trends of cancer incidence and mortality in Catalonia during 1993-2007.

PURPOSE: To describe time trends of cancer in Catalonia, Spain, during the period 1993-2007. METHODS/PATIENTS: Data have been provided by two population-based cancer registries, Girona and Tarragona, and the Catalan mortality registry. Cancer incidence in Catalonia has been estimated through modeling methods using data from these health structures. RESULTS: During 2003-2007, there were 20,042 cancer cases and 9,842 deaths per year among men and 13,673 new cancer cases and 5,882 deaths among women. The most frequent incident cancers among men were prostate (N = 4,258), lung (N = 3,021), colorectal (N = 3,007) and bladder (N = 2,238), whereas among women they were breast (N = 3,907), colorectal (N = 2,088), corpus uteri (N = 734) and lung (N = 527). During 1993-2007, age-standardized incidence rates (ASIRs) rose 1.2 % per year among men [prostate (6.3 %), testis (5.7 %), kidney (2.9 %), liver (2.2 %) and colorectal (2.1 %)]. ASIRs decreased for stomach (-2.9 %), oral cavity and pharynx (-2.8 %), larynx (-2.7 %) and esophagus (-2 %). Among women, ASIRs only rose for lung (5.2 %), kidney (3.1 %), oral cavity and pharynx (2.6 %) and thyroid (1.6 %). ASIRs decreased for corpus uteri (-2.3 %), stomach (-1.7 %) and ovary (-1.6 %). Cancer mortality decreased -1.3 % per year among men and -2.1 % among women during the same period. CONCLUSION: Among men, the decrease of incidence/mortality of tobacco-related tumors was related to a reduction of smoking prevalence. Among women, the stabilization of breast cancer incidence and the rise of lung cancer incidence are similar to that observed in most European regions. These results allow assessing the effectiveness of public health strategies and they pose new frontiers for cancer control in Catalonia.

Cancer incidence and mortality projections up to 2020 in Catalonia by means of Bayesian models.

PURPOSE: To predict the burden of cancer in Catalonia by 2020 assessing changes in demography and cancer risk during 2010-2020. METHODS/PATIENTS: Data were obtained from Tarragona and Girona cancer registries and Catalan mortality registry. Population age distribution was obtained from the Catalan Institute of Statistics. Predicted cases in Catalonia were estimated through autoregressive Bayesian age-period-cohort models. RESULTS: There will be diagnosed 26,455 incident cases among men and 18,345 among women during 2020, which means an increase of 22.5 and 24.5 % comparing with the cancer incidence figures of 2010. In men, the increase of cases (22.5 %) can be partitioned in three components: 12 % due to ageing, 8 % due to increase in population size and 2 % due to cancer risk. In women, the role of each component was 9, 8 and 8 %, respectively. The increased risk is mainly expected to be observed in tobacco-related tumours among women and in colorectal and liver cancers among men. During 2010-2020 a mortality decline is expected in both sexes. CONCLUSION: The expected increase of cancer incidence, mainly due to tobacco-related tumours in women and colorectal in men, reinforces the need to strengthen smoking prevention and the expansion of early detection of colorectal cancer in Catalonia.

[Predictions of cancer incidence and mortality in Catalonia to 2015 by means of Bayesian models]. / Proyección de la incidencia y la mortalidad del cáncer en Cataluña hasta el año 2015 mediante un modelo bayesiano.

BACKGROUND AND OBJECTIVE: To perform cancer incidence and mortality projections in Catalonia for the period 2005-2019. To assess the projected increase in the incidence in 2015 compared with that in 2005, and to determine whether this increase is attributable to changes in risk or in demographics. POPULATION AND METHOD: Bayesian age-period-cohort models were fitted to age-specific rates for 1985-2004 to obtain the expected number of cases for the 5-year periods 2005-2009, 2010-2014 and 2015- 2019. Annual cases were estimated through a polynomial interpolation model. Incidence and mortality data were obtained from the Tarrragona and Gerona cancer registries, while population pyramids for the period 1985-2019 were obtained from the Catalan Institute of Statistics. RESULTS: In Catalonia, 27,438 cancer cases will be diagnosed among men and 19,986 among women in 2015, representing an increase in the number of cases diagnosed of 31% and 34%, respectively, when compared with those diagnosed in 2005 (20,999 and 14,141, respectively). In men, the increases attributable to risk, aging and demographic changes are 10%, 14% and 7%, respectively, whereas in women these changes are 6%, 13% and 15%. In the next decade, cancer mortality is expected to stabilize in men and to continue to decrease in women. Major increases in cancer incidence and mortality are expected among old age groups. CONCLUSIONS: The present study highlights the need to reorganize the resources and infrastructures required for cancer control and care, taking into account the predicted burden of oncology patients.

Proyección de la incidencia y la mortalidad del cáncer en Cataluña hasta el año 2015 mediante un modelo bayesiano / Predictions of cancer incidence and mortality in Catalonia to 2015 by means of Bayesian models

FUNDAMENTOS Y OBJETIVOS: Proyectar la incidencia y la mortalidad por cáncer en Cataluña en el período 2005-2019. Analizar el incremento pronosticado de la incidencia en 2015 respecto a la del año 2005 y determinar si es debida a cambios en el riesgo o a componentes demográficos. POBLACIÓN Y MÉTODO: Mediante modelos edad-período-cohorte bayesianos se han ajustado para Cataluña las tasas brutas de incidencia y mortalidad por cáncer en el período 1985-2004 y el número de casos esperados en los quinquenios 2005-2009, 2010-2014 y 2015-2019. Los casos anuales se calcularon mediante una interpolación polinómica. La incidencia y la mortalidad por cáncer se obtuvieron de los registros de cáncer de Girona y Tarragona y del Registro de mortalidad de Cataluña; las pirámides poblacionales del período 1985-2019, del Instituto de Estadística de Cataluña. RESULTADOS: En 2015 se diagnosticarán 27.438 casos de cáncer en los varones y 19.986 en las mujeres, con lo que se producirá un incremento del 31% y el 34% respecto a los del año 2005 (20.999 y 14.141, respectivamente). En los varones, el aumento esperado de casos de cáncer debido a cambios en el riesgo, el envejecimiento y en el tamaño poblacional son respectivamente del 10, el 14 y el 7% y, en las mujeres, del 6, el 13 y el 15%. En los varones se augura una estabilización de la mortalidad por cáncer en los próximos años, mientras que se espera que siga disminuyendo en las mujeres. Los incrementos de la incidencia y la mortalidad serán más importantes en los individuos de edad avanzada. CONCLUSIONES: El presente estudio remarca la necesidad de reorganizar los recursos y las infraestructuras necesarias en el control y la asistencia del cáncer en Cataluña, a fin de anticiparse al incremento de pacientes oncológicos

BACKGROUND AND OBJECTIVE: To perform cancer incidence and mortality projections in Catalonia for the period 2005-2019. To assess the projected increase in the incidence in 2015 compared with that in 2005,and to determine whether this increase is attributable to changes in risk or in demographics. POPULATION AND METHOD: Bayesian age-period-cohort models were fitted to age-specific rates for 1985-2004 to obtain the expected number of cases for the 5-year periods 2005-2009, 2010-2014 and 2015- 2019. Annual cases were estimated through a polynomial interpolation model. Incidence and mortality data were obtained from the Tarrragona and Gerona cancer registries, while population pyramids for the period 1985-2019 were obtained from the Catalan Institute of Statistics. RESULTS: In Catalonia, 27,438 cancer cases will be diagnosed among men and 19,986 among women in 2015, representing an increase in the number of cases diagnosed of 31% and 34%, respectively, when compared with those diagnosed in 2005 (20,999 and 14,141, respectively). In men, the increases attributable to risk, aging and demographic changes are 10%, 14% and 7%, respectively, whereas in women these changes are 6%, 13% and 15%. In the next decade, cancer mortality is expected to stabilize in men and to continue to decrease in women. Major increases in cancer incidence and mortality are expected among old age groups. CONCLUSIONS: The present study highlights the need to reorganize the resources and infrastructures required for cancer control and care, taking into account the predicted burden of oncology patients

[Carriers of hepatitis B and C virus, level of their information]. / Portadores de los virus de la hepatitis B y C. Estudio sobre su nivel de información.

OBJECTIVES: 1) To determine the degree of health information patients infected by Hepatitis B or C have regarding their illness. 2) To ascertain if relatives of these patients are also infected by Hepatitis B or C. METHOD: This was an observational cross study which analyzed the data obtained from 100 questionnaires filled out by patients infected by Hepatitis B or C under the control of the Digestive Pathologies Dispensary at the Sant Pau Hospital in Barcelona. The questionnaire was designed in order to evaluate the degree of information patients have concerning: A) means of transmission, B) preventative measures and their use, C) home/family environment. RESULTS: 85 patients indicate they had received information; of these, 73% consider their information to be satisfactory and of these, only 24% were familiar with the means of transmission this disease has. Finally, only 11 stated they correctly followed preventative measures. CONCLUSIONS: 1) The vast majority of the patients affected by Hepatitis B or C have a deficient level of information concerning the means of transmission and of prophylactic measures. 2) The prevalence of intrafamily infection cases studied is high. 3) We conclude that patients infected by Hepatitis B have significantly more information regarding the means of infection than do those patients infected by Hepatitis C. 4) The majority of the patients studied do not recognize the educational role nurses have concerning their health.