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Introduction: The joint Canadian Infectious Diseases Society and Canadian Thoracic Society guidelines for community-acquired pneumonia (CAP) recommend 48-72 hour telephone follow-up of patients discharged from the emergency department (ED). The guidelines provide no evidence supporting this practice, and neither the clinical utility nor the effectiveness of such recommendations has been assessed. Our objective was to assess the utility of a 48-72 hour telephone follow-up protocol for patients discharged from the ED with CAP.Methods: This was a retrospective chart audit covering a 2-year period (Jan. 3, 1999 to Jan. 3, 2001) after the introduction of a clinical practice guideline (CPG) that included routine 48-72 hour telephone follow-up of patients discharged from the ED with CAP. Eligible patients were identified in the ED database, rates of referral for telephone follow-up were recorded, and 30-day outcomes (death and readmission) for patients referred versus not referred were compared.Results: During the study period, 867 patients were identified as being eligible for the study. The mean age was 55.7 years (range 16-98 yr), and mean pneumonia severity index (PSI) was 68.9 (range 6-187). Despite the CPG, only 148 patients (17.1%) were referred for telephone follow-up. Age, demographics, comorbidity, clinical status and pneumonia severity were similar for referred and non-referred patients. Thirty-day death (2.5%) and readmission rates (3%) were strongly related to PSI score, but did not differ significantly in the 2 comparison groups.Conclusion: In this setting, physicians were poorly compliant with a routine telephone follow-up protocol. The likelihood of referral for follow-up did not correlate with pneumonia severity, and follow-up referral did not appear to affect patient outcome. These findings do not support recommendations for routine early follow-up mechanisms beyond those already existing in the community. [ABSTRACT FROM AUTHOR]

Background: Informed consent is the cornerstone of research ethics. One of its goals is that participants enter research with an understanding of what their participation entails. This paper is a study on how researchers understand the informed consent process. Previous studies have looked at this topic from a research participant perspective. However, few studies focus on the perspectives of the researchers. Therefore, this is an important paper that highlights an important issue (informed consent) from the perspective of those who administer it during research., Methods: In-depth interviews were conducted with 18 researchers from 3 different research centers in Malawi working in clinical trials. The data was analyzed using open code utilizing the thematic approach to qualitative data., Results: This study identified that researchers have good awareness of the role of informed consent, how important it is for participants to understand the given information and ways to adjust their practice accordingly when obtaining it in order to enhance participant understanding. According to the research staff, most participants do not really understand all the concepts of the study at the initial visit, they gain more understanding during subsequent visits. It was emphasized that the best method of facilitating informed consent is reading the informed consent to the participant, thus a face-to-face conversation. Long and complex informed consent was identified as one of the barriers to participant understanding of the informed consent. Shortening the informed consent form and having additional conversation with the participants was suggested as one way of improving participant comprehension., Conclusion: Most of the participants understand much of the information during subsequent visits as you keep reminding them since informed consent is an ongoing process. Existing relationship or trust between a participant and a researcher, may influence participants' decision and misguide their understanding on the purpose of the study. Adequate time should be allocated to informed consent discussions. Shortening the informed consent forms and having additional conversations with potential participants may help improve their understanding., (© 2024. The Author(s).)

There are marked disparities in cancer survival in low-income countries compared to high-income countries, yet population-based data in the first is largely lacking. In this study, data from the national cancer registry of Rwanda were examined for 542 patients diagnosed with eight of the most common cancers of adults stomach (C16), colorectum (C18-20), liver (C22), breast (female) (C50), cervix (C53), ovary (C56), prostate (C61), and non-Hodgkin lymphomas (C82-85) between 2014 and 2017. Subjects were randomly selected for active followed-up to calculate 1-, 3-, and 5-year observed and relative survival (RS) by cancer type and stage. Overall, 53.7% of cases had died within 5 years of diagnosis. Five-year RS varied by malignancy and ranged from 17.6% (95% confidence interval [CI]: 6.7%-32.6%) for liver cancer to 68% (CI: 51.6%-79.8%) for cancers of the prostate. Stage was assigned for 71.6% of patients (n = 388 of 542), with over half (58%) having advanced stage (III/IV) at diagnosis. For all except liver and ovary, stage was a strong predictor of survival; for example, three-year observed survival was 90.9% and 44.8% (p-value: .002) for early and advanced breast cancer, respectively. This study demonstrates that stage specific survival can be obtained from population based cancer registries in sub Saharan Africa, data that are invaluable for international benchmarking, and for local planning and evaluation of cancer control programs., (© 2024 UICC.)

Background: The lack of accurate population-based information on childhood cancer stage and survival in low-income countries is a barrier to improving childhood cancer outcomes., Methods: In this study, data from the Rwanda National Cancer Registry (RNCR) were examined for children aged 0-14 diagnosed in 2013-2017 for the eight most commonly occurring childhood cancers: acute lymphoblastic leukaemia, Hodgkin lymphoma (HL), Burkitt lymphoma (BL), non-Hodgkin lymphoma excluding BL, retinoblastoma, Wilms tumour, osteosarcoma and rhabdomyosarcoma. Utilising the Toronto Childhood Cancer Stage Guidelines Tier 1, the study assigned stage at diagnosis to all, except HL, and conducted active follow-ups to calculate 1-, 3- and 5-year observed and relative survival by cancer type and stage at diagnosis., Results: The cohort comprised 412 children, of whom 49% (n = 202) died within 5 years of diagnosis. Five-year survival ranged from 28% (95% confidence interval [CI]: 12.5%-45.6%) for BL to 68% (CI: 55%-78%) for retinoblastoma. For the cancers for which staging was carried out, it was assigned for 83% patients (n = 301 of 362), with over half (58%) having limited or localised stage at diagnosis. Stage was a strong predictor of survival; for example, 3-year survival was 70% (95% CI: 45.1%-85.3%) and 11.8% (2.0%-31.2%) for limited and advanced non-HL, respectively (p < .001)., Conclusion: This study is only the second to report on stage distribution and stage-specific survival for childhood cancers in sub-Saharan Africa. It demonstrates the feasibility of the Toronto Stage Guidelines in a low-resource setting, and highlights the value of population-based cancer registries in aiding our understanding of the poor outcomes experienced by this population., (© 2024 Wiley Periodicals LLC.)

Ovarian cancer (OC) is the fourth most common cancer of women in sub-Saharan Africa (SSA), although few data have been published on population-level survival. We estimate ovarian cancer survival in SSA by human development index and histological subtype, using data from seven population-based cancer registries in six countries: Kenya (Nairobi and Eldoret), Mauritius, Uganda (Kampala), Cote d'Ivoire (Abidjan), Ethiopia (Addis Ababa) and South Africa (Eastern Cape). A total of 644 cases diagnosed during 2008-2014 were included, with 77% being of epithelial subtypes (range 47% [Abidjan]-80% [Mauritius]). The overall observed survival in the study cohort was 73.4% (95% CI: 69.8, 77.0) at 1 year, 54.4% (95% CI: 50.4, 58.7) at 3 years and 45.0% (95% CI: 41.0, 49.4) at 5 years. Relative survival at Year 1 ranged from 44.4% in Kampala to 86.3% in Mauritius, with a mean for the seven series of 67.4%. Relative survival was highest in Mauritius at 72.2% and lowest in Kampala, Uganda at 19.5%, with a mean of 47.8%. There was no difference in survival by age at diagnosis. Patients from high and medium HDI countries had significantly better survival than those from low HDI countries. Women with cancers of epithelial cell origin had much lower survival compared to women with other histological subtypes (p = .02). Adjusted for the young age of the African patients with ovarian cancer (44% aged <50) survival is much lower than in USA or Europe, and underlines the need for improvements in the access to diagnosis and treatment of OC in SSA., (© 2024 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Background: The Cancer Survival in Africa, Asia, and South America project (SURVCAN-3) of the International Agency for Research on Cancer aims to fill gaps in the availability of population-level cancer survival estimates from countries in these regions. Here, we analysed survival for 18 cancers using data from member registries of the African Cancer Registry Network across 11 countries in sub-Saharan Africa., Methods: We included data on patients diagnosed with 18 cancer types between Jan 1, 2005, and Dec 31, 2014, from 13 population-based cancer registries in Cotonou (Benin), Abidjan (CÔte d'Ivoire), Addis Ababa (Ethiopia), Eldoret and Nairobi (Kenya), Bamako (Mali), Mauritius, Namibia, Seychelles, Eastern Cape (South Africa), Kampala (Uganda), and Bulawayo and Harare (Zimbabwe). Patients were followed up until Dec 31, 2018. Patient-level data including cancer topography and morphology, age and date at diagnosis, vital status, and date of death (if applicable) were collected. The follow-up (survival) time was measured from the date of incidence until the date of last contact, the date of death, or until the end of the study, whichever occurred first. We estimated the 1-year, 3-year, and 5-year survival (observed, net, and age-standardised net survival) by sex, cancer type, registry, country, and human development index (HDI). 1-year and 3-year survival data were available for all registries and all cancer sites, whereas availability of 5-year survival data was slightly more variable; thus to provide medium-term survival prospects, we have focused on 3-year survival in the Results section., Findings: 10 500 individuals from 13 population-based cancer registries in 11 countries were included in the survival analyses. 9177 (87·4%) of 10 500 cases were morphologically verified. Survival from cancers with a high burden and amenable to prevention was poor: the 3-year age-standardised net survival was 52·3% (95% CI 49·4-55·0) for cervical cancer, 18·1% (11·5-25·9) for liver cancer, and 32·4% (27·5-37·3) for lung cancer. Less than half of the included patients were alive 3 years after a cancer diagnosis for eight cancer types (oral cavity, oesophagus, stomach, larynx, lung, liver, non-Hodgkin lymphoma, and leukaemia). There were differences in survival for some cancers by sex: survival was longer for females with stomach or lung cancer than males with stomach or lung cancer, and longer for males with non-Hodgkin lymphomas than females with non-Hodgkin lymphomas. Survival did not differ by country-level HDI for cancers of the oral cavity, oesophagus, liver, thyroid, and for Hodgkin lymphoma., Interpretation: For cancers for which population-level prevention strategies exist, and with relatively poor prognosis, these estimates highlight the urgent need to upscale population-level prevention activities in sub-Saharan Africa. These data are vital for providing the knowledge base for advocacy to improve access to prevention, diagnosis, and care for patients with cancers in sub-Saharan Africa., Funding: Vital Strategies, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer., Translations: For the French and Portuguese translations of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests. Where authors are identified as personnel of the International Agency for Research on Cancer and WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer and WHO., (This is an Open Access article published under the CC BY-NC-ND 3.0 IGO license which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is properly cited. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity. There should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)

Background/purpose: Stage at diagnosis is an important metric in treatment and prognosis of cancer, and also in planning and evaluation of cancer control. In sub-Saharan Africa (SSA), for the latter, the only data source is the population-based cancer registry (PBCR). For childhood cancers, the 'Toronto Staging Guidelines' have been developed to facilitate abstraction of stage by cancer registry personnel. Although the feasibility of staging using this system has been shown, there is limited information on the accuracy of staging., Methods: A panel of case records of six common childhood cancers was established. A total of 51 cancer registrars from 20 SSA countries staged these records, using Tier 1 of the Toronto guidelines. The stage that they assigned was compared with that decided by two expert clinicians., Results: The registrars assigned the correct stage for 53%-83% of cases (71% overall), with the lowest values for acute lymphocytic leukaemia (ALL), retinoblastoma and non-Hodgkin lymphoma (NHL), and the highest for osteosarcoma (81%) and Wilms tumour (83%). For ALL and NHL, many unstageable cases were mis-staged, probably due to confusion over the rules for dealing with missing data; for the cases with adequate information, accuracy was 73%-75%. Some confusion was observed over the precise definition of three stage levels of retinoblastomas., Conclusions: A single training in staging resulted in an accuracy, for solid tumours, that was not much inferior to what has been observed in high-income settings. Nevertheless, some lessons were learned on how to improve both the guidelines and the training course., (© 2023 Wiley Periodicals LLC.)

The brown marmorated stink bug (BMSB), Halyomorpha halys , is a phytophagous invasive pest native to south-eastern Asia, and it is now distributed worldwide. This species is considered to be one of the most damaging insect pests in North America and in Europe. In agriculture, the predominant approach to managing BMSB is based on the use of insecticides, specifically pyrethroids and neonicotinoids. Unfortunately, the biology of the species and its facility to develop mechanisms of resistance to available pesticides has induced farmers and scientists to develop different, least-toxic, and more effective strategies of control. In a territorial area-wide approach, the use of a classical biological control program in combination with other least-toxic strategies has been given prominent consideration. Following exploratory surveys in the native range, attention has focused on Trissolcus japonicus , a small scelionid egg parasitoid wasp that is able to oviposit and complete its larval development in a single egg of H. halys . A common method for detecting egg parasitoids in the native range involves the placement of so-called 'sentinel' egg masses of the pest in the environment for a short period, which are then returned to the laboratory to determine if any of them are parasitized. Outside of the area of origin, the use of fertile sentinel eggs of the alien species may lead to the further release of the pest species; an alternative is to use sterile sentinel eggs to record the presence of new indigenous egg parasitoids or to detect the dispersal of alien species (in this case, T. japonicus ) released in a new environment to control the target insect pest species. This study evaluated the performance of three types of sterile sentinel eggs as a suitable substrate for the oviposition and larval development of the egg parasitoid T. japonicus in a context of combining classical biological control with a Sterile Insect Technique (SIT) approach.

Background: Cancer survival is an important indicator for evaluating cancer prognosis and cancer care outcomes. The incidence dates used in calculating survival differ between population-based registries and hospital-based registries. Studies examining the effects of the left truncation of incidence dates and delayed reporting on survival estimates are scarce in real-world applications., Methods: Cancer cases hospitalized at Nantong Tumor Hospital during the years 2002-2017 were traced with their records registered in the Qidong Cancer Registry. Survival was calculated using the life table method for cancer patients with the first visit dates recorded in the hospital-based cancer registry (HBR) as the diagnosis date ( OS H ), those with the registered dates of population-based cancer (PBR) registered as the incidence date ( OS P ), and those with corrected dates when the delayed report dates were calibrated ( OS C )., Results: Among 2,636 cases, 1,307 had incidence dates registered in PBR prior to the diagnosis dates of the first hospitalization registered in HBR, while 667 cases with incidence dates registered in PBR were later than the diagnosis dates registered in HBR. The 5-year OS H , OS P , and OS C were 36.1%, 37.4%, and 39.0%, respectively. The "lost" proportion of 5-year survival due to the left truncation for HBR data was estimated to be between 3.5% and 7.4%, and the "delayed-report" proportion of 5-year survival for PBR data was found to be 4.1%., Conclusion: Left truncation of survival in HBR cases was demonstrated. The pseudo-left truncation in PBR should be reduced by controlling delayed reporting and maximizing completeness. Our study provides practical references and suggestions for evaluating the survival of cancer patients with HBR and PBR., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chen, Chen, Zhu, Shen, Sun and Parkin.)

The brown marmorated stink bug, Halyomorpha halys , is a pentatomid bug of Eastern Asian origin that became an economically relevant pest in the Eurasian and American continents. Management of this species is limited to use of chemical insecticides: an inefficient method due to the strong adaptability of the target pest. The sterile insect technique (SIT) is potentially a valid tactic in the search for nontoxic alternatives. In this work, we investigated the suitability of mass-trapped overwintering males, collected during the aggregation phase before the winter diapause, for their release as competitive sterile males in an SIT programme. Differently from previous studies, irradiation was applied with a linear accelerator device that produced high-energy photons. Following a similar scientific protocol with newly emerged irradiated males, the effects of X-ray irradiation on physiological parameters (longevity, fecundity and fertility) were assessed. In addition, behavioural bioassays were carried out in no-choice conditions to evaluate if irradiation interferes with mating processes. The results are very encouraging; the effects of the irradiation at 32 Gy did not differ from the controls in the longevity or fecundity of the exposed overwintering adults. The hatching rate of the eggs laid by the fertile females that had mated with the irradiated males was less than 5%. The results of behavioural bioassays showed that the irradiation did not cause a significant impact on the quality of the sterile males. More research is warranted to evaluate the mating competitiveness of sterile males in semi-field and field conditions.

Ovarian cancer (OC) is one of the commonest cancers of women in sub-Saharan Africa (SSA), although to date no data have been available on time trends in incidence to better understand the disease pattern in the region. We estimate time trends by histological subtype from 12 population-based cancer registries in 11 countries: Kenya (Nairobi), Mauritius, Seychelles, Uganda (Kampala), Congo (Brazzaville), Zimbabwe (Bulawayo and Harare), Cote d'Ivoire (Abidjan), The Gambia, Mali (Bamako), Nigeria (Ibadan) and South Africa (Eastern Cape). The selected registries were those that could provide consistent estimates of the incidence of ovarian cancer and with quality assessment for periods of 10 or more years. A total of 5423 cases of OC were included. Incidence rates have been increasing in all registries except Brazzaville, Congo, where a nonsignificant decline of 1% per year was seen. Statistically significant average annual increases were seen in Mauritius (2.5%), Bamako (5.3%), Ibadan (3.9%) and Eastern Cape (8%). Epithelial ovarian cancer was responsible for the increases observed in all registries. Statistically significant average annual percentage changes (AAPC) for epithelial OC were present in Bamako (AAPC = 5.9%), Ibadan (AAPC = 4.7%) and Eastern Cape (AAPC = 11.0%). Creating awareness among professionals of the growing importance of the disease is surely an important step to improving availability of, and access to, diagnosis and treatment of OC in SSA. Support must be given to the cancer registries to improve the availability of good-quality data on this important cancer., (© 2022 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Background/purpose: Stage at diagnosis is an important metric in treatment and prognosis of cancer, and also in planning and evaluation of cancer control. For the latter purposes, the data source is the population-based cancer registry (PBCR), but, although stage is usually among the variables collected by cancer registries, it is often missing, especially in low-income settings. Essential TNM has been introduced to facilitate abstraction of stage data by cancer registry personnel, but the accuracy with which they can do so is unknown., Methods: 51 cancer registrars from 20 countries of sub-Saharan Africa (13 anglophone, 7 francophone) were tasked with abstracting stage at diagnosis, using Essential TNM, from scanned extracts of case. The panel comprised 28 records of each of 8 common cancer types, and the participants chose how many to attempt (between 48 and 128). Stage group (I-IV), derived from the eTNM elements that they assigned to each cancer, was compared with a gold standard, as decided by two expert clinicians., Results: The registrars assigned the correct stage (I-IV) in between 60 and 80% of cases, with the lowest values for ovary, and the highest for oesophagus. The weighted kappa statistic suggested a moderate level of agreement between participant and expert (0.41-0.60) for 5 cancers, and substantial agreement (0.61-0.80) for three, with the best for cervix, large bowel, oesophagus and ovary, and the worst (weighted kappa 0.46) for non-Hodgkin lymphoma (NHL). For all except NHL, early stage (I/II) and late stage (III/IV) was correctly identified in 80% or more of the cases., Conclusions: A single training in staging using Essential TNM resulted in an accuracy that was not much inferior to what has been observed in clinical situations in high income settings. Nevertheless, some lessons were learned on how to improve both the guidelines for staging, and the training course.

Background: Population-based cancer survival is a key measurement of cancer control performance linked to diagnosis and treatment, but benchmarking studies that include lower-income settings and that link results to health systems and human development are scarce. SURVCAN-3 is an international collaboration of population-based cancer registries that aims to benchmark timely and comparable cancer survival estimates in Africa, central and south America, and Asia., Methods: In SURVCAN-3, population-based cancer registries from Africa, central and south America, and Asia were invited to contribute data. Quality control and data checks were carried out in collaboration with population-based cancer registries and, where applicable, active follow-up was performed at the registry. Patient-level data (sex, age at diagnosis, date of diagnosis, morphology and topography, stage, vital status, and date of death or last contact) were included, comprising patients diagnosed between Jan 1, 2008, and Dec 31, 2012, and followed up for at least 2 years (until Dec 31, 2014). Age-standardised net survival (survival where cancer was the only possible cause of death), with 95% CIs, at 1 year, 3 years, and 5 years after diagnosis were calculated using Pohar-Perme estimators for 15 major cancers. 1-year, 3-year, and 5-year net survival estimates were stratified by countries within continents (Africa, central and south America, and Asia), and countries according to the four-tier Human Development Index (HDI; low, medium, high, and very high)., Findings: 1 400 435 cancer cases from 68 population-based cancer registries in 32 countries were included. Net survival varied substantially between countries and world regions, with estimates steadily rising with increasing levels of the HDI. Across the included cancer types, countries within the lowest HDI category (eg, CÔte d'Ivoire) had a maximum 3-year net survival of 54·6% (95% CI 33·3-71·6; prostate cancer), whereas those within the highest HDI categories (eg, Israel) had a maximum survival of 96·8% (96·1-97·3; prostate cancer). Three distinct groups with varying outcomes by country and HDI dependant on cancer type were identified: cancers with low median 3-year net survival (<30%) and small differences by HDI category (eg, lung and stomach), cancers with intermediate median 3-year net survival (30-79%) and moderate difference by HDI (eg, cervix and colorectum), and cancers with high median 3-year net survival (≥80%) and large difference by HDI (eg, breast and prostate)., Interpretation: Disparities in cancer survival across countries were linked to a country's developmental position, and the availability and efficiency of health services. These data can inform policy makers on priorities in cancer control to reduce apparent inequality in cancer outcome., Funding: Tata Memorial Hospital, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer., Competing Interests: Declaration of interests We declare no competing interests., (© 2022 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)

Background: With the cancer burden rising in sub-Saharan Africa, countries in the region need surveillance systems to measure the magnitude of the problem and monitor progress in cancer control planning. Based on the national estimates built from data provided by cancer registries in sub-Saharan Africa, we summarise key patterns of the regional burden and argue for investments in locally produced data., Methods: To present national estimates of the cancer incidence and mortality burden in sub-Saharan Africa countries, new cancer cases and deaths were extracted from International Agency for Research on Cancers' GLOBOCAN database for the year 2020. Given weak vital statistics systems, almost all of the information on the cancer burden in sub-Saharan Africa was derived from population-based cancer registries. Of the 48 countries included in GLOBOCAN (national populations must be larger than 150 000 inhabitants in 2020), relatively recent cancer registry data (up to 2019) were directly used to produce national incidence estimates in 25 countries, while the absence of such data for 16 meant that estimates were based on data from neighbouring countries. Tables and figures present the estimated numbers of new cases and deaths, as well as age-standardised (incidence or mortality) rates per 100 000 person-years and the cumulative risk of developing or dying from cancer before the age of 75 years., Findings: 801 392 new cancer cases and 520 158 cancer deaths were estimated to have occurred in sub-Saharan Africa in 2020. Cancers of the breast (129 400 female cases) and cervix (110 300 cases) were responsible for three in ten of the cancers diagnosed in both sexes. Breast and cervical cancer were the most common cancers, ranking first in 28 and 19 countries, respectively. In men, prostate cancer led in terms of incidence (77 300 cases), followed by liver cancer (24 700 cases) and colorectal cancer (23 400 cases). Prostate cancer was the leading incident cancer in men in 40 sub-Saharan Africa countries. The risk of a woman in sub-Saharan Africa developing cancer by the age of 75 years was 14·1%, with breast cancer (4·1%) and cervical cancer (3·5%) responsible for half of this risk. For men, the corresponding cumulative incidence was lower (12·2%), with prostate cancer responsible for a third of this risk (4·2%). Cervical cancer was the leading form of cancer death among women in 27 countries, followed by breast cancer (21 countries). Prostate cancer led as the most common type of cancer death in 26 countries, with liver cancer ranking second (11 countries)., Interpretation: The estimates indicate substantial geographical variations in the major cancers in sub-Saharan Africa. Rational cancer control planning requires capacity to be built for data production, analysis, and interpretation within the countries themselves. Cancer registries provide important information in this respect and should be prioritised for sustainable investment in the region., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

A man in his 60s underwent percutaneous biopsy and cryoablation of a right upper pole clear cell renal cell carcinoma followed by repeat cryoablation 8 months later for possible residual disease. The patient was followed with imaging with documented stability for 19 months after repeat ablation. However, imaging at 32 months demonstrated intrahepatic nodular enhancing lesions along the initial percutaneous biopsy and ablation tract, consistent with metastatic implantation. The patient underwent repeat percutaneous biopsy and two rounds of microwave ablation for treatment of the intrahepatic implants, with no residual disease at 10 months postablation. While needle tract seeding is a known complication of percutaneous manipulation of various abdominopelvic malignancies, there have been no prior reports of intrahepatic metastatic implants related to percutaneous renal cell carcinoma ablation. Awareness of this potential complication is important for treatment planning, informed consent and surveillance. This report shares our experience of the management of intrahepatic metastatic implants., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Comparisons of population-based cancer survival between countries are important to benchmark the overall effectiveness of cancer management. The International Cancer Benchmarking Partnership (ICBP) Survmark-2 study aims to compare survival in seven high-income countries across eight cancer sites and explore reasons for the observed differences. A critical aspect in ensuring comparability in the reported survival estimates are similarities in practice across cancer registries. While ICBP Survmark-2 has shown these differences are unlikely to explain the observed differences in cancer-specific survival between countries, it is important to keep in mind potential biases linked to registry practice and understand their likely impact., Methods: Based on experiences gained within ICBP Survmark-2, we have developed a set of recommendations that seek to optimally harmonise cancer registry datasets to improve future benchmarking exercises., Results: Our recommendations stem from considering the impact on cancer survival estimates in five key areas: (1) the completeness of the registry and the availability of registration sources; (2) the inclusion of death certification as a source of identifying cases; (3) the specification of the date of incidence; (4) the approach to handling multiple primary tumours and (5) the quality of linkage of cases to the deaths register., Conclusion: These recommendations seek to improve comparability whilst maintaining the opportunity to understand and act upon international variations in outcomes among cancer patients., (© 2022. The Author(s).)

Background: Accurately recorded vital status of individuals is essential when estimating cancer patient survival. When deaths are ascertained by linkage with vital statistics registers, some may be missed, and such individuals will wrongly appear to be long-term survivors, and survival will be overestimated. Interval-specific relative survival that levels off above one indicates that the survival among the cancer patients is better than expected, which could be due to the presence of immortals., Methods: We included colon cancer cases diagnosed in 1995-1999 within the 19 jurisdictions in seven countries participating in ICBP SURVMARK-2, with follow-up information available until end-2015. Interval-specific relative survival was estimated for each year following diagnosis, by country and age group at diagnosis., Results: The interval-specific relative survival levels off at 1 for all countries and age groups, with two exceptions: for the age group diagnosed at age 75 years and above in Ireland, and, to a lesser extent, in New Zealand., Conclusion: Overall, a subset of immortals are not apparent in the early years within the ICBP SURVMARK-2 study, except for possibly in Ireland. We suggest this approach as one strategy of exploring the existence of immortals, and to be part of routine checks of cancer registry data., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Background: Breast cancer (BC) is the most common cancer in sub-Saharan Africa (SSA). However, little is known about the actual therapy received by women with BC and their survival outcome at the population level in SSA. This study aims to describe the cancer-directed therapy received by patients with BC at the population level in SSA, compare these results with the NCCN Harmonized Guidelines for SSA (NCCN Harmonized Guidelines), and evaluate the impact on survival., Methods: Random samples of patients with BC (≥40 patients per registry), diagnosed from 2009 through 2015, were drawn from 11 urban population-based cancer registries from 10 countries (Benin, Congo, Cote d'Ivoire, Ethiopia, Kenya, Mali, Mozambique, Namibia, Uganda, and Zimbabwe). Active methods were used to update the therapy and outcome data of diagnosed patients ("traced patients"). Excess hazards of death by therapy use were modeled in a relative survival context., Results: A total of 809 patients were included. Additional information was traced for 517 patients (63.8%), and this proportion varied by registry. One in 5 traced patients met the minimum diagnostic criteria (cancer stage and hormone receptor status known) for use of the NCCN Harmonized Guidelines. The hormone receptor status was unknown for 72.5% of patients. Of the traced patients with stage I-III BC (n=320), 50.9% received inadequate or no cancer-directed therapy. Access to therapy differed by registry area. Initiation of adequate therapy and early-stage diagnosis were the most important determinants of survival., Conclusions: Downstaging BC and improving access to diagnostics and care are necessary steps to increase guideline adherence and improve survival for women in SSA. It will also be important to strengthen health systems and facilities for data management in SSA to facilitate patient follow-up and disease surveillance.

International comparison of liver cancer survival has been hampered due to varying standards and degrees for morphological verification and differences in coding practices. This article aims to compare liver cancer survival across the International Cancer Benchmarking Partnership's (ICBP) jurisdictions whilst trying to ensure that the estimates are comparable through a range of sensitivity analyses. Liver cancer incidence data from 21 jurisdictions in 7 countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom) were obtained from population-based registries for 1995-2014. Cases were categorised based on histological classification, age-groups, basis of diagnosis and calendar period. Age-standardised incidence rate (ASR) per 100 000 and net survival at 1 and 3 years after diagnosis were estimated. Liver cancer incidence rates increased over time across all ICBP jurisdictions, particularly for hepatocellular carcinoma (HCC) with the largest relative increase in the United Kingdom, increasing from 1.3 to 4.4 per 100 000 person-years between 1995 and 2014. Australia had the highest age-standardised 1-year and 3-year net survival for all liver cancers combined (48.7% and 28.1%, respectively) in the most recent calendar period, which was still true for morphologically verified tumours when making restrictions to ensure consistent coding and classification. Survival from liver cancers is poor in all countries. The incidence of HCC is increasing alongside the proportion of nonmicroscopically verified cases over time. Survival estimates for all liver tumours combined should be interpreted in this context. Care is needed to ensure that international comparisons are performed on appropriately comparable patients, with careful consideration of coding practice variations., (© 2021 UICC.)

Purpose: Doxorubicin is standard therapy for advanced soft-tissue sarcoma (STS) with minimal improvement in efficacy and increased toxicity with addition of other cytotoxic agents. Pembrolizumab monotherapy has demonstrated modest activity and tolerability in previous advanced STS studies. This study combined pembrolizumab with doxorubicin to assess safety and efficacy in frontline and relapsed settings of advanced STS., Patients and Methods: This single-center, single-arm, phase II trial enrolled patients with unresectable or metastatic STS with no prior anthracycline therapy. Patients received pembrolizumab 200 mg i.v. and doxorubicin (60 mg/m 2 cycle 1 with subsequent escalation to 75 mg/m 2 as tolerated). The primary endpoint was safety. Secondary endpoints included overall survival (OS), objective response rate (ORR), and progression-free survival (PFS) based on RECIST v1.1 guidelines., Results: Thirty patients were enrolled (53.3% female; median age 61.5 years; 87% previously untreated) with 4 (13.3%) patients continuing treatment. The study met its primary safety endpoint by prespecified Bayesian stopping rules. The majority of grade 3+ treatment-emergent adverse events were hematologic (36.7% 3+ neutropenia). ORR was 36.7% [95% confidence interval (CI), 19.9-56.1%], with documented disease control in 80.0% (95% CI, 61.4-92.3%) of patients. Ten (33.3%) patients achieved partial response, 1 (3.3%) patient achieved complete response, and 13 (43.3%) patients had stable disease. Median PFS and OS were 5.7 months (6-month PFS rate: 44%) and 17 months (12-month OS rate: 62%), respectively. Programmed cell death ligand-1 (PD-L1) expression was associated with improved ORR, but not OS or PFS., Conclusions: Combination pembrolizumab and doxorubicin has manageable toxicity and preliminary promising activity in treatment of patients with anthracycline-naive advanced STS., (©2021 American Association for Cancer Research.)

Background: Although prostate cancer (PCa) is the most commonly diagnosed cancer in men of sub-Saharan Africa (SSA), little is known about its management and survival. The objective of the current study was to describe the presentation, patterns of diagnosis, treatment, and survival of patients with PCa in 10 countries of SSA., Methods: In this observational registry study with data collection from 2010 to 2018, the authors drew a random sample of 738 patients with PCa who were registered in 11 population-based cancer registries. They described proportions of patients receiving recommended care and presented survival estimates. Multivariable Cox regression was used to calculate hazard ratios comparing the survival of patients with and without cancer-directed therapies (CDTs)., Results: The study included 693 patients, and tumor characteristics and treatment information were available for 365 patients, 37.3% of whom had metastatic disease. Only 11.2% had a complete diagnostic workup for risk stratification. Among the nonmetastatic patients, 17.5% received curative-intent therapy, and 27.5% received no CDT. Among the metastatic patients, 59.6% received androgen deprivation therapy. The 3- and 5-year age-standardized relative survival for 491 patients with survival time information was 58.8% (95% confidence interval [CI], 48.5%-67.7%) and 56.9% (95% CI, 39.8%-70.9%), respectively. In a multivariable analysis, survival was considerably poorer among patients without CDT versus those with therapy., Conclusions: This study shows that a large proportion of patients with PCa in SSA are not staged or are insufficiently staged and undertreated, and this results in unfavorable survival. These findings reemphasize the need for improving diagnostic workup and access to care in SSA in order to mitigate the heavy burden of the disease in the region., (© 2021 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

New Zealand apple exports must meet strict phytosanitary measures to eliminate codling moth (Cydia pomonella Linnaeus) (Lepidoptera: Tortricidae) larval infestation. This study was part of a program attempting the localized eradication of codling moth within an isolated cluster of seven orchards (391 ha). A conventional management program of insecticide sprays and pheromone mating disruption was supplemented with weekly releases of sterile moths for 1-6 yr. Our objective was to compare the recapture rate of sterile moths following their release by four methods, and the efficiency of each system. The methods were the following: a fixed-wing unmanned plane flying ~40-45 m high at 70 km/h, an unmanned hexacopter travelling 20 m high at 25 km/h, and manually from the ground via bicycles or motor vehicles. The different release methods were used in different years or weeks. Sterile male moths were recaptured in grids of pheromone traps positioned throughout each orchard. The highest recapture rate followed delivery by hexacopter, then bicycle, vehicle, and plane. There was a 17-fold difference in catches between releases by hexacopter and plane, and sixfold between vehicle and plane in the same season. Bicycle delivery had a 3.5-fold higher recapture rate than the plane in different years. The wind-borne horizontal drift of moths was investigated as a possible explanation for the disparity of recaptures between the two aircraft delivery systems. The methods in ascending order of time per hectare for delivery were the following: plane and vehicle, hexacopter, then bicycle. The advantages and disadvantages of each moth delivery method are discussed., (© The Author(s) 2021. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Tropical fruit flies are considered among the most economically important invasive species detected in temperate areas of the United States and the European Union. Detections often trigger quarantine and eradication programs that are conducted without a holistic understanding of the threat posed. Weather-driven physiologically-based demographic models are used to estimate the geographic range, relative abundance, and threat posed by four tropical tephritid fruit flies (Mediterranean fruit fly, melon fly, oriental fruit fly, and Mexican fruit fly) in North and Central America, and the European-Mediterranean region under extant and climate change weather (RCP8.5 and A1B scenarios). Most temperate areas under tropical fruit fly propagule pressure have not been suitable for establishment, but suitability is predicted to increase in some areas with climate change. To meet this ongoing challenge, investments are needed to collect sound biological data to develop mechanistic models to predict the geographic range and relative abundance of these and other invasive species, and to put eradication policies on a scientific basis., (© 2021. The Author(s).)

Cancer stage at diagnosis is important information for management and treatment of individual patients as well as in epidemiological studies to evaluate effectiveness of health care system in managing cancer patients. Population-based studies to examine international disparities on cancer survival by stage, however, has been challenging due to the lack of international standardization on recording stage information and variation in stage completeness across regions and countries. The International Cancer Benchmarking Partnership (ICBP) previously assessed the availability and comparability of staging information for colorectal, lung, female breast and ovarian cancers. Stage conversion algorithms were developed to aggregate and map all stage information into a single staging system to allow international comparison by stage at diagnosis. In this article, we developed stage conversion algorithms for three additional cancers, namely oesophageal, gastric and pancreatic cancers. We examined all stage information available, evaluated stage completeness, applied each stage conversion algorithm, and assessed the magnitude of misclassification using data from six Canadian cancer registries (Alberta, Manitoba, Newfoundland, Nova Scotia, Prince Edward Island and Saskatchewan). In addition, we discussed five recommendations for registries to improve international cancer survival comparison by stage: (a) improve collection and completeness of staging data; (b) promote a comparable definition for stage at diagnosis; (c) promote the use of a common stage classification system; (d) record versions of staging classifications and (e) use multiple data sources for valid staging data., (© 2021 UICC.)

We examined trends in childhood cancer incidence in sub-Saharan Africa using data from two population-based cancer registries in Harare (Zimbabwe) and Kyadondo (Uganda) with cases classified according to the International Classification of Childhood Cancer and explored reasons for observed variations and changes. Over the whole 25-year period (1991-2015) studied, there were only small, and nonsignificant overall trends in incidence. Nevertheless, within the period, peaks in incidence occurred from 1996 to 2001 in Harare (Zimbabwe) and from 2003 to 2006 in Kyadondo (Uganda). Kaposi sarcoma and non-Hodgkin lymphoma accounted for the majority of the cases during these periods. These fluctuations in incidence rates in both registries can be linked to similar trends in the prevalence of HIV, and the availability of antiretroviral therapy. In addition, we noted that, in Harare, incidence rates dropped from 2003 to 2004 and 2007 to 2008, correlating with declines in national gross domestic product. The results indicate that the registration of childhood cancer cases in resource-poor settings is linked to the availability of diagnostic services mediated by economic developments. The findings highlight the need for specialised diagnostic and treatment programmes for childhood cancer patients as well as positive effects of HIV programmes on certain childhood cancers., (© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Classical biological control is a pest control tool involving the release of imported natural enemies. The Sterile Insect Technique (SIT) comprises releasing sexually sterile insects of a pest into the wild population for suppression or eradication. Both these approaches are environmentally friendly and their combination can result in a synergistic impact on pest populations and improve eradication. However, stringent regulation surrounding the introduction of biological control agents limits their use in eradication owing to the perceived risk of effects on non-target organisms. We investigated the irradiation biology of the egg parasitoid Trissolcus basalis to ascertain whether sterile parasitoids could mitigate the risk of potential sustained non-target impacts. Mated female T. basalis were gamma-irradiated at doses between 120 and 150 Gy and exposed to egg masses of their host Nezara viridula throughout their lifespans. This resulted in host mortality, despite a substantial reduction in developing parasitoid offspring, which followed a negative dose-response. There was no emergence of parasitoid offspring at 140 Gy and above. Irradiation did not affect oviposition behaviour but caused an increase in longevity. Consequently, sterile parasitoids could possibly alleviate concerns regarding the irreversibility of biological control release, which promotes further investigation of their potential role in eradication.

The lack of accurate population-based information on childhood cancer stage and survival in low-income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population-based registries in sub-Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non-Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed-up, allowing calculation of 3-year relative survival by cancer type and registry. Stage-specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three-year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%-33%] for BL in Harare to 57% (95% CI = 31%-76%) for retinoblastoma in Kampala. Stage was assigned for 83% of patients (n = 317 of 381), with over half having metastatic or advanced disease at diagnosis (n = 166, 52%). Stage was a strong predictor of survival for each malignancy; for example, 3-year observed survival was 88% (95% CI = 68%-96%) and 13% (4%-29%) for localised and advanced BL, respectively (P < .001). These are the first data on stage distribution and stage-specific survival for childhood cancers in Africa. They demonstrate the feasibility of the Toronto Stage Guidelines in a low-resource setting and highlight the value of population-based cancer registries in aiding our understanding of the poor outcomes experienced by this population., (© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Background: The cancer registry of Bulawayo (Zimbabwe) operated for 15 years in the preindependence period (1963-77), and was restarted in 2011. This allows comparison of incidence of cancers over a period of almost 50 years., Methods: Age-standardized rates, with SEs, were calculated for 1963-1972 and 2011-2015. Detailed results are presented for those cancers for which there was a significant ( P < 0.05) change in the rates between the two periods., Results: There were declines in the rates of those cancers previously known to be common in East and Southern Africa (esophagus, liver, bladder), and the emergence of cancers associated with "westernization" of lifestyles (breast, prostate, large bowel). Cancers related to infection with HIV-AIDS (Kaposi sarcoma, non-Hodgkin lymphoma, eye cancers) have come to comprise a much larger proportion of the total burden, and cancer of the cervix (also AIDS-related) has shown a large increase in incidence-as elsewhere in sub-Saharan Africa (SSA). More surprising is the decline in cancer of the lung-formerly very high, but by 2011-2015, despite little change in the prevalence of smoking, rates were low-close to the average for SSA. This may relate, in part, to a decline in the numbers of miners, and ex-miners, residing in the city., Conclusions: The changes in incidence are largely explained by differences in past exposure to environmental risk factors., Impact: Few datasets from SSA can document temporal changes in the cancer epidemic on the continent. There are some anticipated observations, as well as unexpected findings meriting further investigation., (©2021 American Association for Cancer Research.)

Trends in the incidence of cancer in the population of Kyadondo County, Uganda-which comprises the city of Kampala and a peri-urban hinterland-are presented for a period of 25 years (1991-2015) based on data collected by the Kampala Cancer Registry. Incidence rates have risen overall-age-adjusted rates are some 25% higher in 2011 to 2015 compared with 1991 to 1995. The biggest absolute increases have been in cancers of the prostate, breast and cervix, with rates of some 100% (prostate), 70% (breast) and 45% (cervix) higher in 2010 to 2015 than in 1991 to 1995. There were also increases in the incidence of cancers of the esophagus and colon-rectum (statistically significant in men), while the incidence of liver cancer-the fifth most common in this population-increased until 2007, and subsequently declined. By far the most commonly registered cancer over the 25-year period was Kaposi sarcoma, but the incidence has declined, consistent with the decreasing population-prevalence of HIV. Non-Hodgkin lymphomas, also AIDS-related, increased in incidence until 2006/2007 and then declined-possibly as a result of availability of antiretroviral therapy. The trends reflect the changing lifestyles of this urban African population, as well as the consequences of the epidemic of HIV/AIDS and the availability of treatment with ARVs. At the same time, it highlights the fact that the decreases in cancer of the cervix observed in high and upper-middle income countries are not a consequence of changes in lifestyle, but demand active intervention through screening (and, in the longer term, vaccination)., (© 2020 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of Union for International Cancer Control.)

Population-based data on survival from childhood cancers in sub-Saharan Africa are sparse. We report data on 221 children with cancer diagnosed between 2010 and 2014 in the population of Kampala, Uganda. Survival for eight of nine children with cancer assessed was below the WHO's global target of 60% (the exception was Hodgkin lymphoma: 86% at 3 years). There was significant (P < .05) decline in survival between 1 and 3 years for Wilms tumour and Kaposi sarcoma (30% and 34% at 3 years, respectively). Survival from Burkitt lymphoma, Wilms tumour and Kaposi sarcoma has not changed compared with results from the 2005-2009 study., (© 2020 Wiley Periodicals LLC.)

The codling moth is a serious pest of apples in most regions of the world where this fruit is produced. The sterile insect technique is one strategy used to control this pest and is employed as part of an area-wide integrated pest management program for the codling moth in British Columbia, Canada. Modified fixed wing aircraft are the most common method for the release of sterile insects in large area-wide pest management programs. However, aerial release with a full-size aircraft can be prohibitively expensive. We evaluated the use of small, uncrewed aircraft systems (UASs) for the release of sterile codling moths. Sterile codling moths released from greater altitudes were more broadly distributed and drifted more in strong winds, compared to those released from lower altitudes. Most of the released insects were recaptured in a 50 m wide swath under the release route. Recapture rates for aerially released insects were 40-70% higher compared to those released from the ground. UASs provide a promising alternative to ground release and conventional aircraft for the release of sterile codling moths.

Cervical cancer is the leading cause of cancer death in African women. We sought to estimate population-based survival and evaluate excess hazards for mortality in African women with cervical cancer, examining the effects of country-level Human Development Index (HDI), age and stage at diagnosis. We selected a random sample of 2760 incident cervical cancer cases, diagnosed in 2005 to 2015 from 13 population-based cancer registries in 11 countries (Benin, Cote d'Ivoire, Ethiopia, Kenya, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda and Zimbabwe) through the African Cancer Registry Network. Of these, 2735 were included for survival analyses. The 1-, 3- and 5-year observed and relative survival were estimated by registry, stage and country-level HDI. We used flexible Poisson regression models to estimate the excess hazards for death adjusting for age, stage and HDI. Among patients with known stage, 65.8% were diagnosed with Stage III-IV disease. The 5-year relative survival for Stage I-II cervical cancer in high HDI registry areas was 67.5% (42.1-83.6) while it was much lower (42.2% [30.6-53.2]) for low HDI registry areas. Independent predictors of mortality were Stage III-IV disease, medium to low country-level HDI and age >65 years at cervical cancer diagnosis. The average relative survival from cervix cancer in the 11 countries was 69.8%, 44.5% and 33.1% at 1, 3 and 5 years, respectively. Factors contributing to the HDI (such as education and a country's financial resources) are critical for cervical cancer control in SSA and there is need to strengthen health systems with timely and appropriate prevention and treatment programmes., (© 2020 UICC.)

Codling moth was introduced into New Zealand, and remains a critical pest for the apple industry. Apples exported to some markets require strict phytosanitary measures to eliminate the risk of larval infestation. Mating disruption and insecticide applications are the principal means of suppression in New Zealand. We tested the potential for the sterile insect technique (SIT) to supplement these measures to achieve local eradication or suppression of this pest. SIT was trialed in an isolated group of six integrated fruit production (IFP) orchards and one organic orchard (total 391 ha), using sterilized insects imported from Canada, with release by unmanned aerial vehicle and from the ground. Eradication was not achieved across the region, but a very high level of codling moth suppression was achieved at individual orchards after the introduction of sterile moths in combination with mating disruption and larvicides. After six years of releases, catches of wild codling moths at three IFP orchards (224 ha) were 90-99% lower than in 2013-2014, the year before releases began. Catches at three other IFP orchards (129 ha) decreased by 67-97% from the year before releases began (2015-2016), from lower initial levels. At a certified organic orchard with a higher initial population under only organic larvicides and mating disruption, by 2019-2020, there was an 81% reduction in wild moths capture from 2016-2017, the year before releases began.

Breast cancer (BC) is the leading cause of cancer in sub-Saharan Africa (SSA) with rapidly increasing incidence rates reported in Uganda and Zimbabwe. However, the magnitude of these rising trends in premenopausal and postmenopausal women is unknown in most African countries. We used data from the African Cancer Registry Network on incident breast cancers in women from 11 population-based cancer registries in 10 countries representing each of the four SSA regions. We explored incidence changes among women before and after age 50 by calendar period and, where possible, generational effects in this unique sub-Saharan African cohort. Temporal trends revealed increasing incidence rates in all registries during the study period, except in Nairobi where rates stabilised during 2010 to 2014 after rapidly increasing from 2003 to 2010 (APC = 8.5 95%, CI: 3.0-14.2). The cumulative risk varied between and within regions, with the highest risks observed in Nairobi-Kenya, Mauritius and the Seychelles. There were similar or more rapidly increasing incidence rates in women aged 50+ compared to women <50 years in all registries except The Gambia. Birth cohort analyses revealed increases in the incidence rates in successive generations of women aged 45 and over in Harare-Zimbabwe and Kampala-Uganda. In conclusion, the incidence of BC is increasing rapidly in many parts of Africa; however, the magnitude of these changes differs. These results highlight the need for urgent actions across the cancer continuum from in-depth risk factor studies to provision of adequate therapy as well as the necessity of supporting the maintenance of good quality population-based cancer registration in Africa., (© 2020 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Background: Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs., Methods: We obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas., Results: The responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10-386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres., Conclusions: We conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.

This project investigated how kairomone lures, camera traps, and counting software could together contribute to pest management. Images of cumulative daily catch of New Zealand Flower Thrips (NZFT) attracted to a ripe peach lactone (6-pentyl-2H-pyran-2-one; 6-PAP) were automatically loaded to the internet and compared with scanned bases checked weekly using in-house software and manual counting. Camera traps were able to provide thrips counts equivalent to delta traps, but daily and remotely. An 11-fold greater NZFT count occurred within 24 h in passive traps after polyethylene sachets loaded with 250 mg of 6-PAP were placed in trees. Intensive trapping, by placing 1, 2, 4, and 8 traps per tree (500 mg/trap), resulted in a maximum 32-fold increase in thrips per tree. While 6-PAP has proved to be a useful tool for monitoring NZFT numbers, our results suggest that it is not likely to be suitable for mass trapping. Future research should investigate NZFT behavior to better understand population movement on an area-wide basis. Camera traps can be a valuable tool for recording insect flight activity remotely, but the number of traps required for statistically reliable estimates may be prohibitive.

Nezara viridula Linnaeus (Hemiptera: Pentatomidae) is a polyphagous pest of a wide range of economically important crops. Because the control of this species and other pentatomids relies primarily on insecticide application, investigation into the Sterile Insect Technique (SIT) is warranted. We aimed to investigate the irradiation biology of N. viridula for the potential application of SIT against this pest. Male and female N. viridula were gamma-irradiated at doses between 4 and 28 Gy and mated with both irradiated and nonirradiated conspecifics. Sterility of the resulting eggs followed a dose-response in each case. Irradiated males crossed with untreated females showed higher F 1 egg sterility than crosses where the female was irradiated. The greatest F 1 egg sterility was observed when both parents were irradiated. There was no obvious dose-response for the longevity of irradiated males, and for the fecundity of nonirradiated females mated with irradiated males. The fecundity of irradiated females appeared to decrease with irradiation dose. These results can be applied to a potential future application of SIT against N. viridula , but predominantly supports the ongoing development of SIT for Halyomorpha halys Stål (Hemiptera: Pentatomidae) and hemipteran pests in general.

Background: Differences in registration practices across population-based cancer registries may contribute to international variation in survival estimates. In particular, there are variations in recorded date of incidence (DOI) as cancer registries have access to different sources of information and use different rules to determine an official DOI. This study investigates the impact of different DOI rules on cancer survival estimates., Materials and Methods: Detailed data on dates of pathological confirmation and hospital admittance were collected from three registries participating in the ICBP SURVMARK-2 project (England, Northern Ireland and Norway). Multiple dates of incidence were determined for each cancer patient diagnosed during 2010-2014 by applying three sets of rules that prioritize either: a) histological date, b) hospital admittance date or c) the earliest date recorded. For each set of rules and registry, 1- and 5-year net survival were estimated for eight cancer sites (oesophagus, stomach, colon, rectum, liver, pancreas, lung and ovary)., Results: The mean difference between different DOIs within a country and cancer site ranged from 0.1-23 days. The variation in 1- and 5-year net survival using different DOIs were generally small for all registries and cancer sites. Only for liver and pancreatic cancer in Norway and ovarian cancer in England, were larger 1-year survival differences, of 2-3 % found., Conclusion: In the ongoing discussion of the comparability of survival estimates across registry populations, the use of different DOI definitions can be considered to have a very limited impact., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Cervical cancer is the second most common cancer and the leading cause of cancer death in women in sub-Saharan Africa (SSA)., Methods: Trends in the incidence of cervical cancer are examined for a period of 10-25 years in 10 population-based cancer registries across eight SSA countries (Gambia, Kenya, Malawi, Mauritius, Seychelles, South Africa, Uganda and Zimbabwe). A total of 21,990 cases of cervical cancer were included in the analyses., Results: Incidence rates had increased in all registries for some or all of the periods studied, except for Mauritius with a constant annual 2.5% decline. Eastern Cape and Blantyre (Malawi) registries showed significant increases over time, with the most rapid being in Blantyre (7.9% annually). In Kampala (Uganda), a significant increase was noted (2.2%) until 2006, followed by a non-significant decline. In Eldoret, a decrease (1998-2002) was followed by a significant increase (9.5%) from 2002 to 2016., Conclusion: Overall, cervical cancer incidence has been increasing in SSA. The current high-level advocacy to reduce the burden of cervical cancer in SSA needs to be translated into support for prevention (vaccination against human papillomavirus and population-wide screening), with careful monitoring of results through population-based registries.

Honey bees (Apis mellifera) forage by using their sense of smell and returning to floral odours that they have previously learned to associate with high-quality food rewards. Foraging bees communicate with other bees in the hive about food sources by exchanging chemical and locational information. It is well established that bees transfer non-volatile information regarding taste and quality of nectar via trophallaxis and communicate location information via directional dances. But to our knowledge, volatiles carried by returning forager bees on their bodies has not been explored as another source of chemical information. We investigated the cuticular-adsorbed odours of bees when foraging on three different crops and compared their odours with the crops' flower headspace. We found that cuticular extracts were in majority correlated with the flower headspace where bees were foraging, specific to the crop and field. Our results support the hypothesis that the scent of returning forager bees can be communicated to hivemates and is associated with information about current floral resources. Some of the floral volatiles that we identified in bee extracts had been previously found to be key compounds learned from the crop, thus supporting a mechanism for the selection of decisive compounds.

Behaviours of insects can be manipulated by transmitting vibrational signals to host plants in order to develop pest management techniques. Bactericera cockerelli is an important pest and uses vibrations for mate-finding. In order to design a future control strategy for B. cockerelli , three different bioassays were performed to assess whether vibrational signals could affect relevant behaviours. Single males or pairs were treated with a female playback in test 1 and 2, respectively. In test 3, mixed sex groups received either different disturbance playbacks. The use of a female playback significantly reduced the mating success of males, since they were attracted towards the source of the stimulus. Moreover, test 2 revealed that B. cockerelli females are competitive, since they used their signals to cover the playback and to duet with males, while in test 3, the disturbance playback, consisting of broadband noises significantly reduced male signalling activity. However, none of the treatments of test 3 negatively affected the mating success of males, which tended to mount the other conspecifics present on the same leaf. The role of vibrations in sexual communication and their potential application as control technique for B. cockerelli are discussed as well., Competing Interests: The authors declare no conflicts of interest.

The difficulty to locate mates and overcome predation can hamper species establishment and population maintenance. The effects of sparseness between individuals or the effect of predators on the probability of population growth can be difficult to measure experimentally. For testing hypotheses about population density and predation, we contend that habitat complexity can be simulated using insect mazes of varying mathematical difficulty. To demonstrate the concept, we investigated whether the use of 3D printed mazes of varying complexity could be used to increase spatial separation between sexes of Drosophila simulans , and whether the presence of a generalist predator hampered mate-finding. We then examined how increasing D. simulans population density might overcome the artificially created effects of increasing the distance between mates and having a predator present. As expected, there was an increase in time taken to find a mate and a lower incidence of mating as habitat complexity increased. Increasing the density of flies reduced the searching time and increased mating success, and overcame the effect of the predator in the maze. Printable 3D mazes offer the opportunity to quickly assess the effects of spatial separation on insect population growth in the laboratory, without the need for large enclosed spaces. Mazes could be scaled up for larger insects and can be used for other applications such as learning.

Codling moth, Cydia pomonella (Lepidoptera: Tortricidae), is a phytosanitary pest of New Zealand's export apples. The sterile insect technique supplements other controls in an eradication attempt at an isolated group of orchards in Hawke's Bay, New Zealand. There has been no attempt in New Zealand to characterize potential sources of uncontrolled peri-urban populations, which we predicted to be larger than in managed orchards. We installed 200 pheromone traps across Hastings city, which averaged 0.32 moths/trap/week. We also mapped host trees around the pilot eradication orchards and installed 28 traps in rural Ongaonga, which averaged 0.59 moths/trap/week. In Hastings, traps in host trees caught significantly more males than traps in non-host trees, and spatial interpolation showed evidence of spatial clustering. Traps in orchards operating the most stringent codling moth management averaged half the catch rate of Hastings peri-urban traps. Orchards with less rigorous moth control had a 5-fold higher trap catch rate. We conclude that peri-urban populations are significant and ubiquitous, and that special measures to reduce pest prevalence are needed to achieve area-wide suppression and reduce the risk of immigration into export orchards. Because the location of all host trees in Hastings is not known, it could be more cost-effectively assumed that hosts are ubiquitous across the city and the area treated accordingly.

Detection of pest infestations in fresh produce traded internationally could offer improved prospects for reducing the movement of unwanted pests. Because immature stages of some pests can be difficult to find visually, other cues such as herbivore-induced volatiles that can potentially be detected at the early stages of infestation are worth investigating. In this study, we artificially infested postharvested apples (Malus × domestica 'Royal Gala') with two economic apple pests, the specialist codling moth (CM, Cydia pomonella Linnaeus, Lepidoptera: Tortricidae) and the generalist Queensland fruit fly (QFF, Bactrocera tryoni, Froggatt, Diptera: Tephritidae) and collected volatile organic compounds (VOCs) over time (days 0, 6, and 14-15). In both infestation experiments, we found a strong and significant interaction between time and treatment. Apples infested with the QFF emitted lower total amounts of VOCs than uninfested apples, whereas apples infested with the CM released similar total amounts of VOCs. Apples infested with CM had increases in several hexyl and butyl esters, which were particularly noticeable after 15 d. In contrast, changes in ethyl esters were characteristics of QFF infestation and could be detected from day 6. Our multilevel and multivariate statistical analysis identified specific volatile biomarkers for each species at each sampling time that can be used to design a new tool for remote detection and surveillance of these invasive pests in harvested apples. Nevertheless, other information such as the cultivar as well as the storage condition needs to be taken into consideration to increase accuracy of future odorant-based sensors for pest identification., (© The Author(s) 2019. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Females of the Queensland fruit fly (QFF), Bactrocera tryoni, are amongst the most damaging pests of horticulture in Australia and neighboring countries. Females can lay eggs into more than a hundred species of fruits and vegetables, resulting in large crop losses. Sexually mature males can be managed sustainably with traps baited with long-lasting synthetic lures, and sexually immature males and females can be attracted and killed by short-lived protein baits applied directly on surfaces, with a low success rate (< 20%). No long-lasting attractants for virgin or mated females exist. With the aim of developing a female attractant for surveillance, we collected and analyzed the odors of four ripe host fruits: orange, cherry guava, banana and feijoa. Virgin and mated female QFF were tested with gas-chromatography coupled with electro-antennographic detection to identify electrophysiologically (EAD)-active compounds. We detected 41 EAD-active compounds, with seven found common for more than one fruit. Overall, mated females responded more often and with higher intensity than virgin females. In particular, five compounds present either in cherry guava or feijoa triggered a significantly higher EAD response from mated females than from virgins. Twenty-six EAD-active compounds were selected and tested individually in a Y-tube olfactometer to measure attraction of both virgin and mated females. Behavioral responses differed significantly amongst the compounds, but not strongly between virgin and mated females. We did not find any correlation between electrophysiological and behavioral responses. Further field testing with behaviorally-active compounds is needed for the development of a new QFF female lure.

Introduction: Mauritius, a small state, is among the few African countries where cancer registration is population based and nationwide. We reported trends in cancer incidence for twenty five years as well as the mortality to incidence ratio (MIR) as main quality indicator of the Mauritius National Cancer Registry (MNCR)., Materials and Methods: We calculated age standardised incidence rates (ASRs) of cancers by sex and by 5 year age group for five successive year periods from 1991 to 2015. The average annual percentage change (AAPC) were determined by sex and cancer sites. MIRs were compared for the period 2001-2004 and 2012-2015., Results: In males, the most common cancer sites (in terms of ASRs per 100,000) were those of the colon-rectum (17.0), prostate (16.5), trachea-bronchus-lung (13.0), stomach (8.4) and lip-oral cavity-pharynx (7.7). The AAPC were +3.9%, +4.2%, +0.5%, -0.1% and -1.3% respectively. In females, the most frequent sites were breast (53.7), colon-rectum (13.2), cervix uteri (11.2), corpus uteri (7.7) and ovary (5.7). The AAPC were +3.4%, +4.4%, -2%, +5.2% and -0.1% respectively. The most significant decrease in MIRs among males were liver (1.9 to 1.0), stomach (1.3 to 0.8) and lung (1.7 to 1.2) cancers while among females, they were pancreas (3.4 to 1.3), liver (1.8 to 1.2) and stomach (1.5 to 0.8) cancers., Conclusion: The most common cancers were those associated with 'westernisation' of lifestyle. Our figures contrast with other Sub-Saharan Africa countries where infection related cancers are most predominant. The MNCR has also improved its data quality over time., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Improvements to current brown marmorated stink bug (BMSB), Halyomorpha halys , surveillance and killing systems are needed to improve detection sensitivity and to reduce pesticide use. Detection of BMSB in New Zealand with traps is reliant on sticky panels with aggregation pheromone, which are low cost but inefficient compared with beating foliage. Trapping for BMSB adults and nymphs was conducted daily with lethal traps consisting of an aggregation pheromone-baited-coat hanger covered with dark-colored long-lasting insecticide-treated mesh, we termed "The Nazgȗl", based on its sinister appearance. A deep tray lined with white plastic was attached centrally at the base for collecting the dead BMSB. The lethal traps killed and caught up to 3.5-fold more nymphs and adult BMSB than identically-baited sticky panels in the 3 weeks of deployment, and provided a snapshot of phenology by instar. We expect that lure-and-kill stations could contribute to the suppression of a delimited population and could be included as part of a semiochemical-based eradication program. Attracting and killing females and nymphs, thus removing future offspring, could contribute to population suppression during an eradication.