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Background: Five-year survival is an important index for evaluating the overall effectiveness of cancer diagnosis and treatment. The aim of this study was to monitor trends in 5-year cancer survival in Osaka, Japan, during 1975-94, with adjustment for trends in age and stage at diagnosis., Methods: Five-year crude survival was estimated for cancers of the stomach (39,697 patients), lung (17,400 patients) and breast (11,988 women) in four consecutive 5-year periods, with adjustment for age and/or stage, using the age and stage distribution of cases diagnosed during 1975-79 as standard weights. We estimated the impact of adjusting for either age or stage alone by their proportionate impact on the trend in fully (age- and stage-) adjusted survival., Results: The absolute increase in unadjusted 5-year survival over 20 years was about 20% for stomach cancer, 14% for breast cancer and 5% for lung cancer. Lack of age adjustment would have caused proportionate under-estimation of these trends by 13-14% (stomach), 7% (breast), 14% (lung, men) and 4% (lung, women). Lack of adjustment for the trend toward earlier stage would have caused proportionate over-estimation (152%, men: 133%, women) of stomach cancer survival trends, which seemed more influenced by earlier diagnosis than more effective treatment. For breast cancer, the 31% over-estimation of trend from lack of stage adjustment suggests the impact of earlier diagnosis, while the improvement of survival after additional adjustment for age may be due to more effective treatment. Failure to adjust for stage led to a proportionate 21% under-estimation of lung cancer survival trends for men, and 4% over-estimation for women., Conclusion: This study confirms the importance of adjusting for trends in age and stage distribution when evaluating time trends in cancer survival.

Background and Aims: Little is known about the prognosis of patients with malignant digestive endocrine tumors (MDETs), primarily because of their rarity., Methods: Survival from these tumors has been evaluated in a large, well-defined, national population. All patients diagnosed and registered in England and Wales during the 14-year period from 1986 to 1999 were followed up for vital status to the end of 2001. Relative survival was estimated and the impact of age, sex, period, histology, and anatomic site modeled., Results: Among 4104 cases of MDETs, 21.2% were small cell tumors. Relative survival for all MDETs combined was 45.9% at 5 years and 38.4% at 10 years. Five-year survival was 56.8% for well-differentiated tumors but only 5.2% for small cell tumors (P < .0001). Survival was highest for large bowel tumors and lowest for esophageal tumors. Among well-differentiated pancreatic tumors, 5-year relative survival was 49.2% for insulinomas, 39.9% for gastrinomas, 17.1% for glucagonomas, 26.3% for carcinoid tumors, and 29.3% for nonfunctioning tumors. There was no difference in survival between socioeconomic groups. Five-year survival did not improve between 1986 and 2001. Survival was higher for women and for younger patients. Gender, age at diagnosis, and anatomic site were independent prognostic factors., Conclusions: The prognosis of patients with MDETs in the general population is considerably worse than is often reported from small hospital case series. Prognosis varies with tumor differentiation, anatomic site, and histologic type. Early diagnosis is difficult; new therapeutic options appear to represent the best approach to improved prognosis.

It is well established that socio-economic status is a major prognostic factor for many cancers, including colorectal cancer. The aims of this review are (i) to report epidemiological data showing how socio-economic status influences colorectal cancer survival, (ii) to attempt to describe the mechanisms underlying these survival inequalities, and (iii) to assess their impact on survival of colorectal cancer.

Background: Cancer survival is known to vary by socio-economic group. A review of studies published by 1995 showed this association to be universal and resilient to the many different ways in which socio-economic status was determined. Differences were most commonly attributed to differences in stage of disease at diagnosis., Materials and Methods: A review of research published since 1995 examining the association of cancer survival with socio-economic variables., Results: An association between socio-economic status and cancer survival has continued to be demonstrated in the last decade of research. Stage at diagnosis and differences in treatment have been cited as the most important explanatory factors. Some research has evaluated the psychosocial elements of this association., Conclusions: Socio-economic differences in cancer survival are now well documented. The explanatory power of stage at diagnosis, although great, should not detract from the evidence of differential treatment between social groups. Neither factor can completely explain the observed socio-economic differences in survival, however, and the importance of differences in tumour and patient factors should now be quantified.

Study Objective: To describe the population mortality profile of England and Wales by deprivation and in each government office region (GOR) during 1998, and to quantify the influence of geography and deprivation in determining life expectancy., Design: Construction of life tables describing age specific mortality rates and life expectancy at birth from death registrations and estimated population counts. Life tables were created for (a) quintiles of income deprivation based on the income domain score of the index of multiple deprivation 2000, (b) each GOR and Wales, and (c) every combination of deprivation and geography., Setting: England and Wales.PATIENTS/ PARTICIPANTS: Residents of England and Wales, 1998., Main Results: Life expectancy at birth varies with deprivation quintile and is highest in the most affluent groups. The differences are mainly attributable to differences in mortality rates under 75 years of age. Regional life expectancies display a clear north-south gradient. Linear regression analysis shows that deprivation explains most of the geographical variation in life expectancy., Conclusions: Geographical patterns of life expectancy identified within these data for England and Wales in 1998 are mainly attributable to variations in deprivation status as defined by the IMD 2000 income domain score.

Up-to-date monitoring of long-term survival is an important task of population-based and clinical cancer registries. A few years ago, a new method of survival analysis, denoted period analysis, was introduced to provide more up-to-date estimates of long-term survival. However, a prototypical period analysis may not be applicable in situations with delayed recording of incident cases. We introduce herein a hybrid type of analysis that combines elements of both traditional and period analyses which may still be feasible in such settings. The performance of the hybrid type of analysis compared with other design options is empirically evaluated and illustrated for children diagnosed with cancer in the United States. The empirical evaluation indicates that hybrid analysis may be useful to derive more up-to-date estimates of long-term survival compared with traditional design options if there is a strong improvement of survival over time, even in situations with a substantial delay in recording of incident cases.

Objective: Despite the established causal association between cigarette smoking and lung cancer, the relative contributions of age started, duration, years since quitting, and daily amount smoked have not been well characterized. We estimated the contribution of each of these aspects of smoking behavior., Study Design and Setting: A case-control study was conducted in Montreal on the etiology of lung cancer. There were 640 cases and 938 control subjects for whom lifetime smoking histories were collected. We used generalized additive models, incorporating cubic smoothing splines to model nonlinear effects of various smoking variables. We adopted a multistep approach to deal with the multicollinearity among time-related variables., Results: The main findings are that (1) risk increases independently by daily amount and by duration; (2) among current smokers, lung cancer risk doubles for every 10 cigarettes per day up to 30 to 40 cigarettes per day and tails off thereafter; (3) among ex-smokers, the odds ratio decreases with increasing time since quitting, the rate of decrease being sharper among heavy smokers than among light smokers; and (4) absolute risks demonstrate the dramatic public health benefits of long-term smoking cessation., Conclusion: Our results reinforce some previous findings on this issue.

Cancer survival statistics are needed by health authorities (HAs) to develop local policies and manage resources optimally. Methodological issues can affect the interpretation of these and similar statistics. More reliable indicators of cancer survival are obtained by using regional life tables, rather than a single national life table, to take into account background mortality. As cancer survival varies widely with age, age standardisation is required to improve the comparability of survival rates in cancer patient groups with different age structures. The standards based on cases diagnosed in England and Wales during 1986-1990 provide valuable continuity with earlier published results. Estimates of annual rates of change in survival (based on linear regression) together with their statistical significance, give reliable indications of trends.

We examined national trends and socioeconomic inequalities in cancer survival in England and Wales during the 1990s, using population-based data on 2.2 million patients who were diagnosed with one of the 20 most common cancers between 1986 and 1999 and followed up to 2001. Patients were assigned to one of five deprivation categories (from 'affluent' to 'deprived') using characteristics of their electoral ward of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting separately in each deprivation category for background mortality by age, sex and calendar period. We estimated trends in survival and in the difference in survival between deprivation categories ('deprivation gap') over the periods 1986-90, 1991-95 and 1996-99. We used period analysis to examine likely survival rates in the near future. Survival improved for most cancers in both sexes during the 1990s, and appears likely to continue improving for most cancers in the near future. The deprivation gap in survival between rich and poor was wider for patients diagnosed in the late 1990s than in the late 1980s. Increases in cancer survival in England and Wales during the 1990s are shown to be significantly associated with a widening deprivation gap in survival.

The impact of cigarette smoking on various diseases is studied frequently in epidemiology. However, there is no consensus on how to model different aspects of smoking history. The aim of this investigation was to elucidate the impact of several decisions that must be made when modeling smoking variables. The authors used data on lung cancer from a case-control study undertaken in Montreal, Quebec, Canada, in 1979-1985. The roles of smoking status, intensity, duration, cigarette-years, age at initiation, and time since cessation were investigated using time-dependent variables in an adaptation of Cox's model to case-control data. The authors reached four conclusions. 1) The estimated hazard ratios for current and ex-smokers depend strongly on how long subjects are required to not have smoked to be considered "ex-smokers." 2) When the aim is to estimate the effect of continuous smoking variables, a simple approach can be used (and is proposed) to separate the qualitative difference between never and ever smokers from the quantitative effect of smoking. 3) Using intensity and duration as separate variables may lead to a better model fit than using their product (cigarette-years). 4) When estimating the effects of time since cessation or age at initiation, it is still useful to use cigarette-years, because it reduces multicollinearity.

Objective: To estimate the effects of alcohol consumption on the risk of colorectal cancer according to anatomical subsite., Methods: Between 1979 and 1985 a population-based case-control study of cancer at multiple sites was carried out in Montreal. This analysis was restricted to the 585 cases with adenocarcinoma of the large bowel, aged 35-70 years, who underwent face-to-face interviews. Controls (n = 500) were selected either from electoral lists or by random-digit dialing and were frequency-matched to the cases on age. Polytomous logistic regression was used to estimate the risk of cancer of the proximal colon, distal colon, and rectum in relation to the consumption of alcoholic beverages., Results: Daily consumption of alcohol of any type was associated with increased risks of cancer of the distal colon [odds ratio (OR)= 2.3; 95% confidence interval (CI) 1.4-3.7] and the rectum (OR = 1.6; 95% Cl 1.0-2.6), but not with an increased risk of cancer of the proximal colon (OR = 1.0; 95% CI: 0.6-1.7). When type of beverage was considered, beer showed strong associations with cancer at all three subsites (ORs among the heaviest drinkers ranging from 1.8 to 2.4), spirits showed weaker associations with cancer at all three subsites (ORs ranging from 1.4 to 1.6), and wine showed null associations., Conclusions: The results are consistent with the hypothesis that consumption of alcoholic beverages increases the risk of colorectal cancer. The evidence is strongest for effects on the distal colon and rectum, and, among the three types of beverage, it most strongly implicates beer.

Background: At the end of the 1980s, several cancer clusters were observed in biological research laboratories. Over time, biological research and the technologies used have been diverse and have involved a wide range of mutagenic or carcinogenic chemical, physical and biological agents., Methods: We reviewed 45 published studies on cancer risk among biological research personnel and workers in closely related fields, and numerous reports based on routinely collected data., Results: Biological research could be associated with an elevated risk for pancreatic cancer, brain tumors, and certain hemopathies. A common limitation of available studies was low statistical power and the absence or inaccuracy of data on individual past exposure., Conclusions: Overall, this study suggests a low overall risk of cancer, albeit a higher risk may be suggested for cancers of the pancreas (risk ratios ranging from 0.5 to 6.3) and brain (0.7-9.4), and for non-Hodgkin's lymphoma (0.6-51.5). We suggest ways in which multiple past exposures could be assessed more precisely and emphasize a pressing need to take into account known confounders., (Copyright 2000 Wiley-Liss, Inc.)

We report a recent case of late post-partum hemorrhage attributed to a consecutive aneurysm breaking in the uterine cavity. Childbirth by cesarean section was the main cause of the consecutive aneurysm which was maintained by a wound from the uterine vessels. The diagnosis was confirmed by the angiography. This procedure permits treatment by fistula embolization with decreased morbidity, while preserving future prospects of pregnancy. Consecutive aneurysm is of an unknown etiology and not as rare as commonly thought. Wounds of the uterine vessels caused by cesarean section may occur spontaneously.