Cancer mortality in the oldest old: a global overview.
ABSTRACT: BACKGROUND:As a higher proportion of adults live beyond 85 years, their cancer burden is expected to increase. While trends among the oldest old are established for major epithelial cancers (breast, prostate, lung, and colorectal cancers), they are less studied for minor cancers. This study describes age trends of cancer mortality, with emphasis on individuals aged 85+ years. RESULTS:Overall cancer mortality peaked at 85 years old and decreased or stabilized for all countries except the USA, France, and Japan, in which mortality continued to increase after age 85 years. For most countries, cancers of the oesophagus, stomach, liver, and larynx have a similar flat trend patterns across all ages. Bladder and kidney cancers as well as non-Hodgkin lymphoma, multiple myeloma, and leukemia showed a decreasing pattern after 85 years for UK, Germany, Italy and Poland. Lung cancer peaked at 80 years, although the age-specific peak among women did not follow the same pattern among all countries. Breast and prostate cancers increased after 85 years. CONCLUSION:Mortality stabilized or decreased after age 85, particularly for non-hormonal cancers. Whether this reflects a true biological levelling of mortality rates, or lower validity of cancer registration among the oldest old, remains open to discussion. METHODS:Completed death data were obtained from the World Health Organization (WHO) for eight countries (2000 to 2014). Age-specific mortality rates were calculated for each 5-year age group above age 64. Joinpoint regression models were used to identify significant changes in mortality trends by age.
Project description:The world's population is aging rapidly. This study reports the burden of cancer in the "oldest old" (aged ≥85 years) in Finland, 1953-2017, and estimates age-specific cancer rates in the older population (65-99 years) for 1988-2017. The Finnish Cancer Registry provided data on all cancer diagnoses, cancer deaths, and other deaths in cancer patients in Finland for 1953-2017. Between 1953-1957 and 2013-2017, the proportion of incident cancers in those aged ≥85 years increased from 1.5% to 9.6% (597 to 15,360 new cases), and in 2013-2017, more new cancers were diagnosed at ages ≥85 years than ages <50 years. Cancer incidence and excess mortality attributable to cancer peaked at ages 85-94 years and declined subsequently, whereas cancer-specific mortality continued to increase or plateaued. Due to demographic changes, the number of new cancers in the oldest old has increased substantially in Finland, and currently nearly 1 in 10 cancers are diagnosed in this age group. The increasing cancer burden in the oldest old poses a major challenge for health care and needs to be addressed in designing clinical research and reporting of cancer registries. In older populations with competing risks of death, we propose excess cancer mortality as a measure of cancer-related mortality.
Project description:BACKGROUND: Coronary heart disease (CHD) causes an estimated 7 million deaths worldwide each year. In the last few decades, mortality from CHD has been decreasing in many countries. The aim of this study was to analyze the trends of mortality from CHD and myocardial infarction (MI) in the population of Belgrade during the period 1990-2010. METHODS: Mortality data for CHD and MI were obtained from the Municipal Institute of Statistics in Belgrade and used to calculate age- and sex-specific and age-adjusted mortality rates. Joinpoint regression analysis was used to estimate annual percent changes (APCs) in mortality and to identify points in time where significant changes in trend occur. RESULTS: Trends in CHD mortality rates showed significant decline in men during the period studied (APC -0.5%, no joinpoints detected), but no significant change among women (APC +0.4%, no joinpoints detected). While we observed significant declines in CHD mortality in men aged 35-44, 55-64 and 65-74 and women aged 55-64, there was a significant increase in mortality in men aged ?85 and women aged 75-84 and ?85. Trends in MI mortality rates showed similar patterns in both genders, with a significant decline from the mid-1990s. Significant decline in MI mortality was observed in almost all age groups, except the two oldest (75-84 and ?85) in women population. CONCLUSIONS: Given that CHD and MI mortality trends showed different patterns during the period studied, especially in women, our results imply that further observation of trend is needed.
Project description:<h4>Backgrounds</h4>Cancer is one of the main causes of death worldwide, seriously threatening human health and life expectancy. We aimed to analyze the cancer incidence and mortality rates during 2016 in Zhejiang Province, Southeast China.<h4>Methods</h4>Data were collected from 14 population-based cancer registries across Zhejiang Province of China. Cancer incidence and mortality rates stratified by sex and region were analyzed. The crude rate, age-standardized rate, age-specific and region-specific rate, and cumulative rate were calculated. The proportions of 10 common cancers in different groups and the incidence and mortality rates of the top five cancers in different age groups were also calculated. The Chinese national census of 2000 and the world Segi population was used for calculating the age-standardized incidence and mortality rates.<h4>Results</h4>The 14 cancer registries covered a population of 14,250,844 individuals, accounting for 29.13% of the population of Zhejiang Province. The total reported cancer cases and deaths were 55,835 and 27,013, respectively. The proportion of morphological verification (MV%) was 78.95% of the population, and percentage of incident cases identified through death certificates only (DCO%) was 1.23% with a mortality-to-incidence ratio (M/I ratio) of 0.48. The crude incidence rate in Zhejiang cancer registration areas was 391.80/105; the age-standardized incidence rate of the Chinese standard population (ASIRC) and the age-standardized incidence rate of the world standard population (ASIRW) were 229.76/105 and 220.96/105, respectively. The incidence rate in men was higher than that in women. The incidence rate increased rapidly after 45 years of age and peaked in individuals aged 80 to 84 years. The top 10 incidence rates of cancers were lung cancer, female breast cancer, thyroid cancer, colorectal cancer, stomach cancer, liver cancer, prostate cancer, cervical cancer, esophageal cancer, and pancreatic cancer (from highest to lowest). The crude mortality rate in Zhejiang cancer registration areas was 189.55/105; the age-standardized mortality rate of the Chinese standard population (ASMRC) and the age-standardized mortality rate of the world standard population (ASMRW) were 94.46/105 and 93.42/105, respectively. The mortality rate in men was higher than that in women, and the male population in rural areas was higher than that in urban areas. The cancer mortality rate increased rapidly after 50 years of age and peaked in individuals aged 85+ years. The top 10 mortality rates of cancers were lung cancer, liver cancer, stomach cancer, colorectal cancer, pancreatic cancer, esophageal cancer, female breast cancer, prostate cancer, lymphoma, and leukemia (from highest to lowest).<h4>Conclusions</h4>Lung cancer, female breast cancer, thyroid cancer, colorectal cancer, prostate cancer, liver cancer, and stomach cancer were the most common cancers in Zhejiang Province. Effective prevention and control measures should be established after considering the different characteristics of cancers in urban and rural areas.
Project description:Cancer is one of the leading causes of death worldwide and its incidence is expected to increase in the future. In Panama, cancer is also one of the leading causes of death. In 1964, a nationwide cancer registry was started and it was restructured and improved in 2012. The aim of this study is to utilize Joinpoint regression analysis to study the trends of the incidence and mortality of cancer in Panama in the last decade. Cancer mortality was estimated from the Panamanian National Institute of Census and Statistics Registry for the period 2001 to 2011. Cancer incidence was estimated from the Panamanian National Cancer Registry for the period 2000 to 2009. The Joinpoint Regression Analysis program, version 4.0.4, was used to calculate trends by age-adjusted incidence and mortality rates for selected cancers. Overall, the trend of age-adjusted cancer mortality in Panama has declined over the last 10 years (-1.12% per year). The cancers for which there was a significant increase in the trend of mortality were female breast cancer and ovarian cancer; while the highest increases in incidence were shown for breast cancer, liver cancer, and prostate cancer. Significant decrease in the trend of mortality was evidenced for the following: prostate cancer, lung and bronchus cancer, and cervical cancer; with respect to incidence, only oral and pharynx cancer in both sexes had a significant decrease. Some cancers showed no significant trends in incidence or mortality. This study reveals contrasting trends in cancer incidence and mortality in Panama in the last decade. Although Panama is considered an upper middle income nation, this study demonstrates that some cancer mortality trends, like the ones seen in cervical and lung cancer, behave similarly to the ones seen in high income countries. In contrast, other types, like breast cancer, follow a pattern seen in countries undergoing a transition to a developed economy with its associated lifestyle, nutrition, and body weight changes.
Project description:<h4>Importance</h4>Gastric cancer is one of the most common cancers, with a high mortality-to-incidence ratio. It is uncertain whether developed nations may encounter an increasing burden of gastric cancer in young adults, as occurs for other cancers.<h4>Objectives</h4>To evaluate the incidence and mortality of gastric cancer and compare the global incidence trends between younger (<40 years) and older (≥40 years) populations.<h4>Design, setting, and participants</h4>This population-based cohort study analyzed data from global and national cancer registries, including data from 1980 to 2018, with at least 15 calendar years of incidence and mortality data. Data on age-standardized incidence and mortality rates of gastric cancer among 48 countries were retrieved from the Surveillance, Epidemiology, and End Results Program, the National Cancer Institute, the Nordic Cancer Registries, and the World Health Organization Mortality Database. The 10-year incidence trend of gastric cancer was assessed by age and sex. The 2018 GLOBOCAN database was used for reporting the global incidence and mortality of gastric cancer, the most recent data available at the time of analysis. Analyses were performed between January 10, 2020, and March 20, 2020.<h4>Main outcomes and measures</h4>The average annual percent change (AAPC) of the incidence and mortality trends as evaluated by joinpoint regression analysis.<h4>Results</h4>A total of 1 033 701 new cases of gastric cancer and 782 685 related deaths were reported in 2018. Overall, the incidence of gastric cancer decreased in 29 countries, and mortality decreased in 41 countries. The age-standardized incidence of gastric cancer decreased from a range of 2.6 to 59.1 in 1980 to a range of 2.5 to 56.8 in 2018 per 100 000 persons. The overall age-standardized mortality rate changed from a range of 1.3 to 25.8 in 1980 to a range of 1.5 to 18.5 in 2018 per 100 000 persons, but increasing mortality was observed in Thailand (female: AAPC, 5.30; 95% CI, 4.38-6.23; P < .001; male: AAPC, 3.92; 95% CI, 2.14-5.74; P < .001). The incidence of gastric cancer decreased in most regions among individuals 40 years or older and increased in populations younger than 40 years in several countries, including Sweden (male: AAPC, 13.92; 95% CI, 7.16-21.11; P = .001), Ecuador (female: AAPC, 6.05; 95% CI, 1.40-10.92; P = .02), and the UK (male: AAPC, 4.27; 95% CI, 0.15-8.55; P = .04; female: AAPC, 3.60; 95% CI, 3.59-3.61; P < .001).<h4>Conclusions and relevance</h4>In this population-based cohort study, an increasing incidence of gastric cancer was observed in younger individuals in some countries, highlighting the need for more preventive strategies in younger populations. Future research should explore the reasons for these epidemiologic trends.
Project description:<h4>Background</h4>Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends.<h4>Methods</h4>Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries.<h4>Results</h4>Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia.<h4>Conclusions</h4>Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all children with cancer worldwide.<h4>Lay summary</h4>Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, particularly in high-income countries. This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind.
Project description:<h4>Objectives</h4>The prostate specific antigen test is widely used as the main method of screening prostate cancer in Korea. Additionally, the use of ultrasound sonography may lead to overdiagnosis of kidney cancer as well as thyroid cancer. This study aimed to highlight epidemiological evidences regarding overdiagnosis of prostate and kidney cancers in Korean.<h4>Methods</h4>The annual trends of national incidence and mortality of prostate and kidney cancers provided by the Korean Statistical Information Service were evaluated.<h4>Results</h4>The rate of increase in the incidence of prostate and kidney cancer was 6 and 5 times higher than that of mortality between 2000 and 2011, respectively. Additionally, the age group showing the highest incidence in prostate cancer shifted from 85 years and older to 75-79 years.<h4>Conclusions</h4>This evidence suggests that prostate and kidney cancers are overdiagnosed in Korea. Further research in this area, using national cancer registry databases, should be encouraged to prevent overdiagnosis.
Project description:Participation and performance trends in ultramarathon running have been investigated for large datasets and long period of times with an increase in participants and an improvement in performance. However, the analysis of ultramarathons across many decades is missing. We analyzed these trends for 96,036 athletes (88,286 men and 7750 women) from 67 countries competing between 1956 and 2019 in '100 km Lauf Biel' in Switzerland, the oldest 100-km ultramarathon in the world. More men than women participated in all years. The number of male participants reached a peak at around 1985 and a decline in participation occurred thereafter. Women started competing in 1962. Men were always faster than women and both women and men reduced their race times over years. After about 1985, both overall women and men and both female and male winners were not able to improve race times. For men, athletes from all age groups below the age of 49 years old reached a peak of participation in the 1980s, and showed a decrease since then. Regarding age groups, the decrease first started in age group 20-29 years, followed by 30-39, 40-49, 50-59, and 60-69 years. For athletes in age groups 70-79 and 80-89 years, no decrease occurred. For women, age group athletes in age groups 40-49, 50-59, and 60-69 years increased their participation, whereas age groups 20-29 and 30-39 peaked in the late 1980s and started to decrease or stabilize, respectively. Switzerland, Germany, and France were the countries with the highest numbers of participants throughout the history of the race. In men, race times increased after about 1990 for most nationalities; only runners from Germany seemed to stabilize their performance. In women, runners from Italy, France, and Austria improved their performance over the years. In summary, the analysis of the oldest 100-km ultramarathon in the world showed a decrease in participation and an impairment in performance in the last 60 years. These changes were due to a decrease in the number of male ultramarathoners in around the 1980s, where mainly the number of age group runners younger than 70 years decreased.
Project description:While the age-standardized mortality rate in Japan is decreasing for all cancers as a whole, this is not the case for some major site-specific cancers. We descriptively compared trends in all-cancer and site-specific cancer mortality in Japan and selected countries. Data on age-standardized cancer mortality rates in six countries (Japan, the USA, the UK, Canada, Australia and the Republic of Korea) in 1980-2016 were obtained from the World Health Organization mortality database. While stomach and liver cancer mortality rates in Japan and Korea were initially much higher than those in non-Asian countries, they have rapidly decreased over the long term. By contrast, colorectal, pancreatic and cervical cancer mortality rates in Japan, which were initially lower than those in other countries, have increased such that they are now similar or higher than the rates in non-Asian countries. For male lung cancer, Japan's initially lower mortality rate is now comparable to that in non-Asian countries as a result of slower decline. Meanwhile, the mortality rate of female breast cancer in Japan and Korea has increased and is nearing the rates observed in non-Asian countries, which by contrast have shown a steady decrease. Thus, while Japan has been successful in reducing the burden of stomach and liver cancers, it is falling behind in reducing the mortality rate of screening-related cancers such as colorectal, female breast and cervical cancers. Control measures for these cancers need to be strengthened.
Project description:<h4>Background</h4>Cancer survival is a key measure of the effectiveness of health-care systems. Persistent regional and international differences in survival represent many avoidable deaths. Differences in survival have prompted or guided cancer control strategies. This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival.<h4>Methods</h4>Data from population-based cancer registries in 12 jurisdictions in six countries were provided for 2·4 million adults diagnosed with primary colorectal, lung, breast (women), or ovarian cancer during 1995-2007, with follow-up to Dec 31, 2007. Data quality control and analyses were done centrally with a common protocol, overseen by external experts. We estimated 1-year and 5-year relative survival, constructing 252 complete life tables to control for background mortality by age, sex, and calendar year. We report age-specific and age-standardised relative survival at 1 and 5 years, and 5-year survival conditional on survival to the first anniversary of diagnosis. We also examined incidence and mortality trends during 1985-2005.<h4>Findings</h4>Relative survival improved during 1995-2007 for all four cancers in all jurisdictions. Survival was persistently higher in Australia, Canada, and Sweden, intermediate in Norway, and lower in Denmark, England, Northern Ireland, and Wales, particularly in the first year after diagnosis and for patients aged 65 years and older. International differences narrowed at all ages for breast cancer, from about 9% to 5% at 1 year and from about 14% to 8% at 5 years, but less or not at all for the other cancers. For colorectal cancer, the international range narrowed only for patients aged 65 years and older, by 2-6% at 1 year and by 2-3% at 5 years.<h4>Interpretation</h4>Up-to-date survival trends show increases but persistent differences between countries. Trends in cancer incidence and mortality are broadly consistent with these trends in survival. Data quality and changes in classification are not likely explanations. The patterns are consistent with later diagnosis or differences in treatment, particularly in Denmark and the UK, and in patients aged 65 years and older.<h4>Funding</h4>Department of Health, England; and Cancer Research UK.