Search

Background. Population-based relative survival is widely used as a method of monitoring the success of cancer control. This success may not be relevant only for an entire country but also regional developments over time are of interest. It would not only be important that the relative survival improved but also that the differences between regions decreased over time. Methods. In this paper the authors show how relative survival methods can be used to study such differences. In addition to standard methods, some more recently introduced approaches are used, most notably a method for checking the goodness of fit of the relative survival model. This gives confidence in the obtained results and provides additional insight when assumptions are not met. Results. An analysis of cancers of the colon and ovary by cancer control region in Finland in 1953-2003 shows an overall improvement in relative survival, accompanied in colon cancer also by a decrease of differences in relative survival between the regions. Thus, the desired course was observed in colon cancer but not in cancer of the ovary. Conclusions. These results, applied to further sites, should lead to investigation of differences in cancer control policies between regions. [ABSTRACT FROM AUTHOR]

Background. Ewing's sarcoma family of tumors (ESFTs) are rare bone and soft tissue tumors characterized by specific genetic alterations. Our aim was to carry out a nationwide analysis of ESFT, to survey the treatments used and to report the five-year disease specific and event-free survival rates (EFS and DSS). Material and methods. The study data was gathered from the Finnish National Cancer Registry and all five University Hospitals and consisted of 76 bone and soft tissue ESFT patients diagnosed during 1990-2009. Their medical records were reviewed and data on their disease, treatments, complications and outcome were analyzed. Results. The five-year EFS and DSS of patients with localized disease at diagnosis (n = 57) were 70% and 60%, respectively. Factors contributing to DSS and EFS were the axial vs. peripheral site of primary tumor and adequate surgical resection of the primary tumor. DSS was also affected by patient's age at diagnosis and the treatment employed. The five-year DSS of patients with metastatic disease at diagnosis (n = 19) was 33% and both preoperative and high dose chemotherapy were associated with improved survival. Conclusion. Population-based studies including both bone and soft tissue ESFTs are few. In this nationwide, population-based study on Finnish bone and soft tissue ESFT patients, we find their treatment successful and results comparable to those previously published. Absence of metastases, young age at diagnosis and a peripheral primary tumor site were associated with a better prognosis. It seems that surgical resection of the primary tumor should be performed whenever adequate resection margins can be achieved. The role of high dose chemotherapy merits further studies in this setting. [ABSTRACT FROM AUTHOR]

Background. Patients undergoing surgery for non-small cell lung cancer (NSCLC) are often elderly with co-morbid conditions and decreased performance status. Thus, the morbidity of lung resection via thoracotomy may be unacceptable for some patients. This is the reason why video-assisted thoracoscopic surgery (VATS) instead of open thoracotomy has gained more use and acceptance, especially in patients with stage I disease. The aim of this study was to evaluate the difference between VATS and open thoracotomy in treatment outcomes of stage I NSCLC patients. Methods. A total of 328 stage I NSCLC patients underwent lobectomy, bilobectomy or segmentectomy between January 2000 and February 2010. VATS was implemented in 116 patients, of which 16 were converted to thoracotomy. Muscle-sparing anterolateral thoracotomy was performed in 212. Propensity-matched groups were analyzed based on preoperative variables and stage. Results. VATS was associated with lower postoperative morbidity in both overall (p == 0.020) and propensity-matched analysis (p == 0.026) and shorter hospitalization (both p < 0.001). Patients selected for VATS were older (p == 0.001) with a significantly higher Charlson comorbidity index (p == 0.007) and poorer diffusion capacity (p < 0.001). The conversion rate was 14%. Between the two groups, no significant difference was observable in two-year overall and progression-free survival. Conclusions. Despite the VATS lobectomy and segmentectomy patients' being older, with more comorbid condition and poorer pulmonary function, the incidence of major complications was lower and hospitalization shorter than for open thoracotomy patients. For stage I NSCLC, VATS should be considered the primary surgical approach. [ABSTRACT FROM AUTHOR]

Material and methods. Based on a five-year follow-up of 130 692 women who participated in the five-yearly organised screening in Finland in 1995, we estimated the risk for incident invasive cervical cancer and severe precancerous lesion for groups of women with different combinations of high-risk determinants at baseline. Results. Compared to women with normal cytology and no symptoms at the index screen, the risk of developing invasive cervical cancer during the next screening interval was significantly elevated in women with abnormal cytology at baseline screen (RR 5.8, 95% CI 2.6-13.1); additionally, the risk of cervical intraepithelial neoplasia grade 3 (CIN3) lesions was even higher (RR 9.4, 95% CI 6.9-12.5), both results after removing respective screen detected cases at index screen. Among women with symptoms of vaginal bleeding or abnormal vaginal discharge but normal cytology the risk of invasive cervical cancer was increased but not significantly (RR 2.4, 95% CI 0.9-6.3) and the risk of CIN3 lesions was only slightly elevated (RR 1.5, 95% CI 0.95-2.4). In women less than 40 years of age, the risk of cervical cancer was 50% higher than in women 40 years or more in those with normal cytology and no symptoms, however not significantly. Symptoms indicated a similarly elevated risk for cancer in both age groups. After abnormal cytology there was a nine-fold risk for cancer in young women (under 40 years) and a six-fold risk in old women (40 years or more) when compared to women aged 40 or more with no symptoms and normal cytology. In young women CIN3 lesions were found in great excess, three times more often, compared to those aged 40 and over. Discussion. In all, selective intensified screening for cervical cancer complementing the five-yearly unselective programme is feasible for women with abnormal cytological findings at an acceptable level of incremental cost. [ABSTRACT FROM AUTHOR]