Cancer Epidemiology[JOURNAL]
Sun
200 papers
Normalized breast cancer survival outcomes in U.S. tumor registries.
Nierenberg TC, Crowell KA, Thomas SM … +3 more , Chan K, Greenup RA, Plichta JK
Cancer Epidemiol · 2026 Apr · PMID 41689992 · Publisher ↗
BACKGROUND: This study normalized the National Cancer Database (NCDB) and Surveillance, Epidemiology, End Results Program (SEER) populations to mirror the USCS population and examined survival outcomes in breast cancer f...
BACKGROUND: This study normalized the National Cancer Database (NCDB) and Surveillance, Epidemiology, End Results Program (SEER) populations to mirror the USCS population and examined survival outcomes in breast cancer following normalization. METHODS: Patients diagnosed with stage I-IV breast cancer (2010-2018) were selected from the NCDB and SEER. Rates obtained from the USCS were used to normalize the NCDB and SEER cohorts, using patient weighted frequencies for variables (age, sex, race/ethnicity, etc). Overall survival was estimated using the Kaplan-Meier method before and after normalization. RESULTS: The USCS included 2473,739 patients, the NCDB 1441,556, and SEER 504,938. There were minimal differences between the cohorts based on age or sex. There were notable differences in the racial/ethnic composition (Hispanic: USCS 8.3 %, NCDB 5.9 %, SEER 11.7 %; p < 0.001). There were minimal differences in tumor biomarkers, but significant differences in extent of disease (local: USCS 66.1 %, NCDB 80.2 %, SEER 68.4 %; distant: USCS 6 %, NCDB 3.9 %, SEER 3.9 %; p < 0.001). Variables that were similar without weighting (age, sex, tumor biomarkers), had similar OS after weighting. However, when the NCDB and SEER were weighted by stage, HR status and race/ethnicity combined, slight changes were seen in 5-year OS (NCDB regional: unweighted 76.8 % vs weighted 77.0 %, SEER regional: unweighted 79.7 % vs weighted 78.5 %; p < 0.001). CONCLUSIONS: US tumor registries provide data for a large sampling of breast cancer patients. Despite significant differences in case coverage based on race/ethnicity and stage, OS remained similar following normalization to the USCS, suggesting that analyses using these data sets may be generalizable to the population.
Haematological cancer in pregnancy in New South Wales, Australia: A population-based retrospective cohort study.
Bagade T, Safi N, Hamad N … +3 more , Anazodo A, Remond M, Sullivan E
Cancer Epidemiol · 2026 Apr · PMID 41687364 · Publisher ↗
BACKGROUND: Pregnancy-associated haematological cancers (PAHC) are rare but may have profound impacts on maternal and neonatal outcomes. We aimed to describe the incidence, survival rates, and perinatal outcomes associat...
BACKGROUND: Pregnancy-associated haematological cancers (PAHC) are rare but may have profound impacts on maternal and neonatal outcomes. We aimed to describe the incidence, survival rates, and perinatal outcomes associated with PAHC in New South Wales (NSW), Australia. METHODS: Utilising seven datasets, we performed a population-based retrospective cohort study, linking data for all women who gave birth in NSW from 1994 to 2013, and tracked mortality outcomes up to 2018. Women and their babies were stratified into three groups: gestational haematological cancer (HC), postpartum HC group, and pregnant women not diagnosed with cancer. Descriptive statistics, incidence, mortality rate, survival probability, and a composite severe maternal morbidity outcome indicator (MMOI) and composite neonatal adverse outcome indicator (NAOI) were calculated and compared between groups. We also conducted a sub-group analysis of women with lymphoma and leukaemia. FINDINGS: Of the 1786,302 pregnancies included in the cohort, 224 women were diagnosed with PAHC. The overall incidence of PAHC was 12.5/100,000 women giving birth, which increased by 4 % yearly over the study period. The overall mortality rate was 15.5/1000 and 20/1000 women-years in the gestational HC and postpartum HC groups, respectively. Gestational HCs were associated with higher odds of MMOI (AOR 17.39 (95 % CI: 9.88-30.59) and NAOI (AOR 4.69 (95 % CI: 2.43-9.03) compared to postpartum HC and pregnant women not diagnosed with cancer. INTERPRETATION: Over the two-decade study period, we observed a significant increase in the incidence of PAHCs, with an associated higher maternal and neonatal mortality and morbidity for women with gestational HCs. Our results emphasise the critical importance of decision-making and clinical practice regarding the continuation of pregnancy and cancer management for women diagnosed with PAHCs.
Exploring associations between travel burden, clinical features, and outcomes from head and neck cancer in Scotland, UK.
Turner M, Kent S, Hanley S … +1 more , Murchie P
Cancer Epidemiol · 2026 Apr · PMID 41687363 · Publisher ↗
BACKGROUND: Geographic inequalities in cancer outcomes are reported internationally, but little is known about associations between geography and head and neck cancer (HNC) in Scotland. We explored how travelling times t...
BACKGROUND: Geographic inequalities in cancer outcomes are reported internationally, but little is known about associations between geography and head and neck cancer (HNC) in Scotland. We explored how travelling times to health services influences clinical characteristics, stage at diagnosis, treatment, and one-year mortality for HNC in Scotland. METHODS: We conducted a national, population-based, retrospective cohort study using linked administrative and clinical data covering all individuals diagnosed with HNC in Scotland between 2014 and 2019. We calculated and categorised their travelling times to key healthcare facilities and explored associations with key outcomes - HPV-status, stage at diagnosis, treatment received, and one-year mortality. Multivariable regression models adjusted for key confounders. RESULTS: 6692 patients were included. Patients with the longest travelling time (≥ 60 min or island) were less likely to present with advanced-stage disease (OR 0.73, 95 % CI: 0.54-0.98) and were significantly less likely to die within one year (HR 0.64, 95 % CI: 0.46-0.88). No difference was observed in proportion of HPV-positive cancers across travel time categories. There were also no significant differences in proportions receiving surgery or treated within 31 days of diagnosis. CONCLUSIONS: The association between geography and HNC in Scotland is complex and differs from previous studies in other cancers. Patients with the longest travel time had lower risk of advanced stage at presentation and reduced one-year mortality with no apparent difference in HPV-prevalence or treatment access. In context these findings suggest that travelling time disadvantage is not uniform across cancer types and highlights the need for cancer site-specific approaches to monitoring and reducing inequalities. This large, population-based analysis provides the most comprehensive assessment of HNC and geography in Scotland to date. Findings challenge assumptions of consistent travel time disadvantage and can inform policy on equitable cancer care delivery in the pre-pandemic era.
Temporal trends in breast cancer incidence and mortality in Australia: An Age-Period-Cohort analysis.
Nguyen PD, Page AN, McBride KA … +2 more , Spittal MJ, Munasinghe S
Cancer Epidemiol · 2026 Apr · PMID 41678908 · Publisher ↗
BACKGROUND: Breast cancer is the most diagnosed cancer among Australian women. Recently, incidence rates have risen but mortality rates have decreased. The extent to which these changes are the result of cumulative risk...
BACKGROUND: Breast cancer is the most diagnosed cancer among Australian women. Recently, incidence rates have risen but mortality rates have decreased. The extent to which these changes are the result of cumulative risk factor effects (age-effects), events affecting all women at specific points in time (period effects), or changes in generational risk factors (cohort effects) is unclear. This study investigates whether observed trends in breast cancer incidence and mortality are associated with age, period, or cohort effects. METHODS: Annual Australian breast cancer incidence (1982-2020) and mortality data (1907-2022) were obtained from the Australian Institute of Health and Welfare. Age-Period-Cohort (APC) modelling with a drift in cohort function was used to estimate adjusted age, period and cohort effects. RESULTS: Age effects showed higher incidence and mortality rates with increasing age, peaking at 75-84 years. Cohort effects showed progressively increasing risk among women born after the 1940s, with higher incidence among younger cohorts. Incidence peaks corresponded with introduction of population-based mammography screening, and also changes in population level risk factors. Period effects (adjusting for cohort effects) were modest, demonstrating reductions in incidence over time, while mortality peaked in the 1990s before declining after 2000. CONCLUSION: Increasing age-related breast cancer incidence and mortality reinforce the importance of early prevention. Incidence has shifted due to cohort and period effects with younger generations showing the highest increases in incidence, suggesting generational shifts in breast cancer risk, likely attributable to mammography screening and increased prevalence of modifiable risk factors.
Incidence and survival of head and neck cancers in the United Kingdom 2000-2021.
Miquel-Dominguez A, Tan EH, Burn E … +7 more , Delmestri A, Duarte-Salles T, Golozar A, Man WY, Prieto-Alhambra D, Avilés-Jurado FX, Newby D
Cancer Epidemiol · 2026 Apr · PMID 41678907 · Publisher ↗
BACKGROUND: Understanding the changing burden of head and neck cancers (HNC) is essential to guide public health interventions and inform cancer care strategies. METHODS: We conducted a cohort study using routinely colle...
BACKGROUND: Understanding the changing burden of head and neck cancers (HNC) is essential to guide public health interventions and inform cancer care strategies. METHODS: We conducted a cohort study using routinely collected primary care data Clinical Practice Research Datalink (CPRD) GOLD from the United Kingdom. Adults aged ≥ 18 years with ≥ 1 year of prior history were included. We estimated crude and age-standardised incidence rates (IRs) and one-, five-, and ten-year survival from 2000 to 2021, stratified by age and calendar year. Findings from CPRD GOLD were compared with primary care data from CPRD Aurum (England only). RESULTS: There were 12,455 patients with a diagnosis of HNC from CPRD GOLD (69.2 % male; median age 64 years). Crude incidence in GOLD increased from 9.08 (95 % CI: 7.88-10.42) per 100,000 person-years in 2000-15.59 (14.07-17.23) in 2021, with similar trends observed in CPRD Aurum. Age-standardised incidence trends were attenuated overall but remained elevated for oropharyngeal and tongue cancers. Five-year survival improved modestly, from 53.8 % (95 % CI: 51.4-56.3 %) in 2000-2004-58.7 % (56.5-60.9 %) in 2015-2019. CONCLUSIONS: Incidence increases for HNC were attenuated after age standardisation, suggesting a contribution of demographic ageing, although elevations persisted for specific subsites. Small improvements in long term survival highlights more research is needed to improve earlier diagnosis which will lead to better patient outcomes.
Associations of maternal education with suggested childhood cancer risk factors: Findings from the Childhood Cancer and Leukemia International Consortium (CLIC).
Dolatkhah R, Erdmann F, Bouaoun L … +22 more , Mueller BA, Petridou ET, Schraw JM, Kane E, Marcotte EL, Force LM, Dockerty JD, Moissonnier M, Olsson A, Roman E, Clavel J, Metayer C, Magnani C, Mora AM, Rashed WM, Chow EJ, Bonaventure A, Kang AY, Miligi L, Scheurer ME, Spector LG, Schüz J
Cancer Epidemiol · 2026 Apr · PMID 41666504 · Publisher ↗
BACKGROUND: Causes of childhood cancer remain poorly understood. Using data from the case-control studies of the Childhood Cancer and Leukemia International Consortium (CLIC), we explored how maternal education as a key...
BACKGROUND: Causes of childhood cancer remain poorly understood. Using data from the case-control studies of the Childhood Cancer and Leukemia International Consortium (CLIC), we explored how maternal education as a key socioeconomic status (SES) indicator, varies across studies/countries and contributes to understanding of potential environmental and lifestyle risk factors. METHODS: Control group data from cancer-free children matched by diagnosis date of cases from 16 studies were included, using both interview-based and health registry sources. Maternal education, the primary SES measure used in previous analyses with pooled CLIC data, was categorized as low, medium, or high according to the International Standard Classification of Education. Multinomial logistic regression assessed associations between maternal education and perinatal/lifestyle factors, calculating crude and adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for high vs. low education. RESULTS: Maternal education levels varied across studies and over time, with the highest proportions of highly educated mothers in the U.S. and lowest in Costa Rica, Italy, and Egypt. Higher maternal education was generally positively associated with higher birthweight, breastfeeding, daycare attendance, and maternal prenatal alcohol consumption. Higher maternal education was generally inversely associated with lower birthweight, younger maternal age, paternal occupational pesticide exposure, maternal prenatal smoking, and having more siblings. The direction of associations for older maternal age and for caesarean delivery differed substantially across regions. Exclusion of mothers < 21 years at birth of the index child had little effect on the results. CONCLUSION: This multi-country analysis supports the use of maternal education for adjustment as a proxy for SES, showing largely consistent associations with various behaviors and exposures. While the direction of associations was generally consistent, the strengths varied sometimes considerably by geographical region. These findings support the inclusion of maternal education as a covariate in analyses of childhood cancer risk when pooling CLIC studies.
Spatial distribution of timely treatment for cervical cancer: Socioeconomic inequalities and disparities in healthcare service availability in Brazil.
Silva LGSD, Silva PVS, Chaves MFD … +6 more , Oliveira NPD, Barbosa IR, Cruz-Ku G, Torres-Roman JS, Condeço Melhorado AM, Bezerra de Souza DL
Cancer Epidemiol · 2026 Apr · PMID 41666503 · Publisher ↗
INTRODUCTION: Cervical cancer is one of the leading causes of cancer-related death among women in countries with lower socioeconomic levels. In Brazil, it represents the third most common type of cancer and the fourth le...
INTRODUCTION: Cervical cancer is one of the leading causes of cancer-related death among women in countries with lower socioeconomic levels. In Brazil, it represents the third most common type of cancer and the fourth leading cause of death, excluding non-melanoma skin cancers. Delays in initiating oncologic treatment have remained frequent even after the implementation of Law No. 12,732, which mandates treatment initiation within 60 days of diagnosis. OBJECTIVE: To analyze the spatial distribution of the proportion of cervical cancer cases that started treatment within 60 days after diagnosis and to assess its spatial correlation with contextual socioeconomic indicators and healthcare service availability in Brazil. METHODS: Ecological study included the 133 Intermediate Regions of Urban Articulation during the post-enactment period of Law No. 12,732 (2013-2019). The dependent variable-the proportion of cases initiating treatment within 60 days-was obtained from the Integrated Cancer Hospital Registry. Socioeconomic variables were extracted from the Atlas of Human Development in Brazil, while data on medical density and health service availability were obtained from the National Registry of Health Establishments and the Outpatient Information System of the Brazilian Unified Health System. Spatial clustering was evaluated using Global Moran's I and the Local Indicator of Spatial Association. Multivariate analysis employed spatial regression models with global effects. RESULTS: The proportion of cervical cancer cases that initiated treatment within 60 days was 40.4 % (95 % CI: 39.9 %-40.9 %). A positive spatial correlation was observed between timely treatment and cytopathological test density (p = 0.00523), while a negative correlation was found with the population aging rate (p < 0.001). CONCLUSION: Regions with lower population aging rates and greater availability of cytopathological exams were associated with higher compliance with the "60-day law." These findings highlight the influence of socioeconomic context and healthcare service distribution on timely access to cervical cancer treatment.
Estimates of cancer incidence to 2025 in Italy: Numbers and rates.
Fabiano S, Perotti V, Contiero P … +8 more , Tittarelli A, Pesce MT, Guzzinati S, Stracci F, Serraino D, Mazzucco W, Dal Maso L, AIRTUM Working Group
Cancer Epidemiol · 2026 Apr · PMID 41666502 · Publisher ↗
OBJECTIVES: We forecasted the incidence of malignant tumours in Italy in 2025, using the most representative estimates of incidence rates and recent trends in cancer incidence available. A comparison with estimates for 2...
OBJECTIVES: We forecasted the incidence of malignant tumours in Italy in 2025, using the most representative estimates of incidence rates and recent trends in cancer incidence available. A comparison with estimates for 2025 obtained using different assumptions and data sets is also presented. METHODS: 34 cancer registries (81 % of the Italian population) were used to estimate incidence rate trends in 2013-2017, by cancer types, sex, and age. The stratified incidence rates were projected until 2025 by applying trends in the same strata, using a linear regression model with the calendar year as an independent variable. RESULTS: We estimated 362,100 new cancer cases in Italy in 2025 (182,300 in men, 179,800 in women). Prostate is the most frequent cancer site in men (31,200 cases; age-standardised incidence rates-ASR=92.3 per 100,000), followed by lung (27,100, ASR=80.9), bladder, and colon-rectum (23,000 cases each; ASR=69.0). 55,900 women were estimated to be diagnosed with breast cancer (ASR=159.0 per 100,000), 18,900 with colorectal (ASR=47.0) and 16,400 with lung cancers (ASR=41.0). CONCLUSIONS: Our estimates were slightly lower than those based on other assumptions and/or different datasets (i.e., ECIS/GLOBOCAN ones). More effective anti-smoking campaigns are needed to halt the predicted increase in smoking-related cancers among women.
Cancer survival in Italian patients diagnosed between 2008 and 2017.
Capocaccia R, Fusco M, Zarcone M … +54 more , Fruscione S, Pesce MT, Stracci F, Mazzucco W, AIRTUM Working Group, Graziano G, Mazzola S, Minichino A, Sessa A, Tumino R, Colanino AZ, Candela G, Loperto I, Vitale F, Abbate R, Clemente SV, Vincenzi R, Piras D, Porcheddu A, Gasparotti C, Maifredi G, Pinna P, Zollo E, Ciullo V, Baracco S, Napolioni V, Manasse S, Eugenia S, Usticano A, Caldarella A, Turi A, Santelli E, Galasso R, Riccio LD, Martinelli L, Mantovani W, Serraino D, Maso LD, Ferrante M, Migliore E, Leite S, Villa M, Casella C, Russo AG, Negrino L, D'orsi G, Manzoni F, Bruni R, Castelli M, Gambino M, Cavallo R, Fametti AC, Ghisleni S, Sampietro G
Cancer Epidemiol · 2026 Apr · PMID 41653505 · Publisher ↗
As national cancer survival estimates in Italy date back to 2011, we provided updated figures using population-based cancer registries. Analyses by age and sex included 1.418.044 cancers diagnosed between 2013 and 2017 f...
As national cancer survival estimates in Italy date back to 2011, we provided updated figures using population-based cancer registries. Analyses by age and sex included 1.418.044 cancers diagnosed between 2013 and 2017 from 34 registries covering 48 million residents. The 2008-2017 period, with 20 registries covering 24 million residents, was used for trends and regional comparisons. Net survival was estimated by Pohar-Perme method with life tables by year, sex, residence and calculated using the international standard distribution. Five-year age-standardized net survival for all cancers combined was 66.7 % in females and 62.2 % in males. Females had better survival than males for most cancers, notably acute lymphatic leukaemia (+9 % points (pp)), upper respiratory/digestive (+9 pp), lung (+6 pp), CNS (+5 pp), and stomach (+4 pp). Males had a higher survival for bladder (+4 pp), kidney (+2 pp), and urinary cancers (+5 pp). Best outcomes (>75 %) were documented for prostate, testicular, breast, endometrial, thyroid, melanoma, Hodgkin lymphoma, bladder, and chronic lymphatic leukaemia. Poorest prognosis (<30 %) was for CNS, liver, lung, pancreas, and acute myeloid leukaemias. Survival was age-dependent, highest in younger and lowest in older patients, with > 40 % points gaps in some haematological cancers. From 2008-2017, net survival arose from 65.7 % to 70.7 % in men and from 69.9 % to 74.1 % in women. Improvements were seen for pancreas, lung, and acute leukaemias, mainly in women, while decreases affected bladder, cervical, chronic lymphatic leukaemia in men. Geographical disparities persisted, with higher survival in Northern-Central Italy (64.0 % for men and 68.3 % for women) than in Southern-Islands (58.1 % for men and 63.7 %, for women). Our findings confirmed a better prognosis for younger patients and females than male patients. Survival has continued to improve over time, even at a higher improving rate in the considered period than the past.
Corrigendum to "Early-onset cancer incidence in the United States by race/ethnicity between 2011 and 2020" [Cancer Epidemiol. 92 (2024) 102632].
Gupta A, Akinyemiju T
Cancer Epidemiol · 2026 Apr · PMID 41643236 · Publisher ↗
Abstract loading — click title to view on PubMed.
All-cause mortality by race and socioeconomic status among women treated for breast cancer in metropolitan Detroit.
Sivapalan S, Chuba PJ, Szpunar SM … +4 more , Berdi K, Dul CL, Falk JS, Aref A
Cancer Epidemiol · 2026 Apr · PMID 41637848 · Publisher ↗
BACKGROUND: Black women with breast cancer in the United States experience significantly higher mortality than White women, despite similar incidence rates. Both biological and socioeconomic factors contribute to this di...
BACKGROUND: Black women with breast cancer in the United States experience significantly higher mortality than White women, despite similar incidence rates. Both biological and socioeconomic factors contribute to this disparity. The Area Deprivation Index (ADI), a composite measure of socioeconomic disadvantage, may provide insight into neighborhood-level influences on survival. We aimed to examine the relative influences of race, ADI, and established clinical risk factors with overall survival among women with breast cancer in Metropolitan Detroit. METHODS: We conducted a retrospective cohort study of 3350 women diagnosed with stage 0-IV breast cancer between 2005 and 2015 at Ascension (now Henry Ford) hospitals in Metropolitan Detroit. Data were extracted from the METRIQ® cancer registry. Variables included race, age, stage, receptor-defined subtype, marital status, insurance, and ADI derived from 9-digit ZIP codes. Kaplan-Meier and Cox proportional hazards models were used to evaluate associations with overall survival. RESULTS: The cohort was 75.5 % White, 19.6 % Black, and 4.9 % Asian/Other. Mean age at diagnosis was 61.4 years. Survival differed significantly by race, with mean survival of 105.3 months for White versus 96.1 months for Black (p < 0.001). ADI strongly predicted outcomes: women in the most deprived quartile had 26 % lower 10-year survival compared to the least deprived quartile (94.1 vs. 108.2 months, p < 0.001). Survival was also associated with age, hormone receptor positivity, tumor subtype, nodal status, and AJCC pathologic stage (p < 0.001), as well as with HER2 positivity by immunohistochemistry (p < 0.001). Mean survival for cases having luminal A, luminal B, and Her2 enriched histologies were statistically significantly longer at 102.9 ± 1.1 months (95 % CI 100.9-105.0), 103.2 ± 3.4 months (CI 95.6-109.8) and 104.5 ± 4.8 months (CI 95.1-113.9) respectively compared to TNBC at 87.9 ± 3.1 months (CI 81.8-94.0) (p < 0.001). In multivariable Cox regression adjusting for age, stage, and subtype, ADI remained a significant predictor while race dropped from the model. CONCLUSIONS: Breast cancer survival disparities in Metropolitan Detroit are driven predominantly by socioeconomic deprivation as measured by ADI. Although Black women presented at younger ages and with more aggressive subtypes, neighborhood level disadvantage accounted for the largest impact on survival. These findings highlight the need for interventions targeting socioeconomic and environmental determinants of health to reduce racial disparities in breast cancer outcomes.
Determinants of colonoscopy adherence after positive colorectal cancer screening: Insights from individual and municipality-level data in Flanders.
Ha TL, Tran TN, Hoeck S … +1 more , Van Hal G
Cancer Epidemiol · 2026 Apr · PMID 41621157 · Publisher ↗
BACKGROUND: Timely follow-up colonoscopy after a positive fecal immunochemical test (FIT) is essential for the effectiveness of colorectal cancer (CRC) screening programs (CRC-SP). However, a substantial proportion of in...
BACKGROUND: Timely follow-up colonoscopy after a positive fecal immunochemical test (FIT) is essential for the effectiveness of colorectal cancer (CRC) screening programs (CRC-SP). However, a substantial proportion of individuals fail to complete diagnostic follow-up. This study aimed to identify individual- and municipality-level factors associated with nonadherence to follow-up colonoscopy in the Flemish CRC-SP. METHODS: Individual-level data from the Flemish Centre for Cancer Detection (CCD), including 26,539 individuals with a positive FIT result in 2019, were linked with publicly available municipality-level indicators to assess demographic, socioeconomic, and healthcare-related characteristics. The outcome was nonadherence to follow-up colonoscopy within one year after a positive FIT result. A multivariable logistic regression model was developed using a structured approach: univariable screening (p < 0.15), multicollinearity assessment, and variable selection using least absolute shrinkage and selection operator (LASSO) regression. A random intercept for province was incorporated to account for potential clustering. RESULTS: A total of 5021 individuals (18.9 %) did not complete a follow-up colonoscopy within one year after a positive FIT result. In the final multivariable model, older age (65-69: OR = 1.12, 95 % CI: 1.03-1.21, p = 0.006; 70-74: OR = 1.29, 95 % CI: 1.20-1.40, p < 0.001), male gender (OR = 1.14, 95 % CI: 1.07-1.22, p < 0.001), and higher proportions of individuals living alone (OR = 1.02, 95 % CI: 1.00-1.03, p = 0.009) was associated with increased odds of nonadherence. In contrast, having a global medical dossier (GMD) were associated with better adherence (OR = 0.97, 95 % CI = 0.96-0.98, p < 0.001). Variance at the provincial level was negligible. CONCLUSIONS: This study provides evidence to support targeted implementation strategies within the Flemish CRC-SP. Strengthening primary care involvement and addressing social determinants of health may improve follow-up colonoscopy rates and enhance the equity and effectiveness of the screening program.
Trends in use of poly (ADP-ribose) polymerase inhibitor (PARPi) in ovarian cancer.
Dottino JA, Baumann KE, Esselen KM … +4 more , Costa R, Argetsinger S, Ross-Degnan D, Wagner AK
Cancer Epidemiol · 2026 Apr · PMID 41576586 · Publisher ↗
BACKGROUND: To assess population-level trends in use of poly (ADP-ribose) polymerase inhibitors (PARPis) among ovarian cancer patients in the years following initial FDA approvals. METHODS: A national, commercial and Med...
BACKGROUND: To assess population-level trends in use of poly (ADP-ribose) polymerase inhibitors (PARPis) among ovarian cancer patients in the years following initial FDA approvals. METHODS: A national, commercial and Medicare Advantage insurance claims database was used to identify patients with ovarian cancer from 2015 to 2021. Year of ovarian cancer diagnosis was categorized by initial period of PARPi approval for treatment indication (2015-2016) and expanded period of PARPi approval for treatment and maintenance indications (2017-2021). Clinical and demographic characteristics were assessed. The primary outcome was proportion of patients with PARPi dispensings. Time from first observed ovarian cancer diagnosis to first observed PARPi dispensing was calculated. RESULTS: Of 23,165 patients with ovarian cancer, most were 65 years or older (62.8 %) and had Medicare Advantage insurance (66.2 %). More patients diagnosed in the expanded compared to the initial approval period received PARPi (9.8 % vs. 6.6 %, p < 0.0001) and within less time from diagnosis to PARPi initiation (HR: 2.31, 95 % CI 2.06, 2.59). Age over 65 was associated with lower likelihood of PARPi receipt (OR: 0.85, 95 % CI 0.74, 0.98). In the initial approval period, patients residing in non-white zip codes were more likely to receive a PARPi (OR: 1.61, 95 % CI 1.19, 2.18) and frail patients were less likely to receive a PARPi (OR: 0.41, 95 % CI 0.22, 0.78). CONCLUSION: Since 2015, PARPi use increased among ovarian cancer patients, and time from diagnosis to PARPi receipt decreased, reflecting expanded PARPi indications over time. Monitoring demographic and clinical characteristics of PARPi recipients may help assess population-level use of novel therapeutics.
Incidence trends and survival of cervical cancer: A population-based study on Thai Cancer registry database.
Nguanboonmak A, Pakkaranang B, Yanaranop M … +1 more , Tantiyavarong P
Cancer Epidemiol · 2026 Apr · PMID 41576585 · Publisher ↗
BACKGROUND: Cervical cancer remains common among Thai women, but nationwide evidence on incidence and survival is limited. This study analyzed trends over the past decade. METHODS: We conducted a nationwide, retrospectiv...
BACKGROUND: Cervical cancer remains common among Thai women, but nationwide evidence on incidence and survival is limited. This study analyzed trends over the past decade. METHODS: We conducted a nationwide, retrospective cohort study using data from the Thai national population-based cancer registry. The study included women diagnosed with cervical cancer between 2012 and 2022. Age-standardized incidence rates (ASR) were calculated using the WHO standard population. Relative survival was estimated using the Ederer II method, based on national life tables. RESULTS: A total of 47,220 newly diagnosed cervical cancer cases were included. The ASR ranged from 7.69 to 11.18 per 100,000 women. Incidence increased from 2012 to 2015 (slope = +0.43), then declined until 2021 (slope = -0.36), with a slight resurgence in 2022. Younger women (aged 30-39 years) exhibited a steadily increasing incidence trend. The overall 5-year relative survival rate was 75 % (95 % CI, 74-75 %), and survival rates at 1, 3, and 5 years declined progressively throughout the study period. CONCLUSION: While cervical cancer incidence in Thailand declined overall from 2012 to 2022, rates increased among younger women. Relative survival also declined over time. These findings underscore the need to re-evaluate national screening strategies, particularly for younger populations, and to strengthen timely access to diagnosis and treatment.
The International Classification of Diseases for Oncology, 4th Edition (ICD-O-4): An overview.
Znaor A, Rous B, Levy GG … +8 more , Watanabe R, Jakob R, Krpelanova E, Wijesinghe HD, Puspanathan P, Cree IA, Bray F, Lokuhetty D
Cancer Epidemiol · 2026 Apr · PMID 41576584 · Publisher ↗
BACKGROUND: The International Classification of Diseases for Oncology (ICD-O) was specifically developed for coding tumours according to their site of origin (topography), microscopic appearance or histology, behaviour a...
BACKGROUND: The International Classification of Diseases for Oncology (ICD-O) was specifically developed for coding tumours according to their site of origin (topography), microscopic appearance or histology, behaviour and grade (morphology), and is optimal for use in cancer registries. The fourth edition of the ICD-O (ICD-O-4) aims to provide an improved structure of unique codes to existent and newly defined tumour entities and has been harmonised with the International Classification of Diseases 11th Edition (ICD-11). METHODS: Based on an International Association of Cancer Registries (IACR) survey of cancer registries, over 90 % of the respondents (250 of 276) agreed to an update of ICD-O-3.2 morphology by the addition of a fifth digit to the existing four-digit histology code. Following the 5th Edition of the WHO Classification of Tumours (WCT), a beta version of ICD-O-4 was developed and disseminated for open consultation by the International Agency on Research for Cancer (IARC) on the WCT website. RESULTS: Following closure of the consultation period, the ICD-O-4 codes were finalized. The main changes in comparison to ICD-O-3.2 include the addition of a 5th alphanumeric digit to the histology code, changes in the first four digits of histology codes, changes of behaviour codes (e.g. pituitary adenoma code changed from /1 to /3), a new topography code for gastroesophageal junction (C16.7), detailed codes for extrahepatic bile ducts (C24.2, C24.3) and cystic duct (C24.4), change of the code for anal skin cancer from skin to anus (C44.5 to C21.3) and an optional additional digit in the topography code. CONCLUSION: ICD-O-4 is compiled in consultation with pathologists, epidemiologists, public health researchers as well as the cancer registry community. The five-digit histology codes enable a hierarchical and detailed coding of tumours, while the new topography and behaviour codes reflect the evidence base on tumour aetiology, stage and behaviour.
Survival of all cancer sites combined: Partitioning of temporal changes into cancer, non-cancer and case-mix.
Lambert PC, Nilssen Y, Myklebust TÅ … +3 more , Aagnes B, Møller B, Rutherford MJ
Cancer Epidemiol · 2026 Apr · PMID 41576583 · Publisher ↗
Quantifying cancer survival is a crucial component of cancer surveillance and control. Survival for all cancers combined is an overall summary to explore differences between population groups and over time. Net survival...
Quantifying cancer survival is a crucial component of cancer surveillance and control. Survival for all cancers combined is an overall summary to explore differences between population groups and over time. Net survival is the usual measure for reporting survival for all cancers combined. Differences in the cancer site distribution between groups can be adjusted for using standardization. We propose using individual weights incorporated into the Pohar Perme estimator of net survival for standardized all cancers combined survival estimates, rather than a weighted average of stratum specific estimates. This removes sparse data problems, where estimates are unobtainable for some strata. Extending to reference adjusted all-cause survival gives an alternative, interpretable measure, enabling partitioning of all-cause survival differences into those due to cancer site/age/sex distribution differences, other cause mortality differences and cancer mortality differences. We illustrate the methods using data on 749 889 individuals diagnosed with cancer in Norway 1986-2021. Using individual weights gives very similar estimates to traditional and model-based standardization and avoids using ad-hoc sparse data methods. Reference adjusted all-cause survival provides measures with simpler interpretation. For example, between 1986 and 1990 and 2016-2021 there was a 25.9 %age point improvement in 5-year all-cause survival. This improvement was partitioned into changes in the site/age/sex distribution (2.0), changes in other cause mortality rates (4.4) with the majority (19.6) due to improvements in cancer survival. Survival of all cancers combined is easily analyzed non-parametrically using individual weights. Reference adjusted all-cause survival gives a more interpretable measure improving understanding of differences over time/between groups.
Cardiovascular disease as a contributing cause of cancer mortality: A population-based analysis of United States death certificate data (1999-2020).
Mehta S, Arora L, Agarwal N … +1 more , Khubchandani A
Cancer Epidemiol · 2026 Apr · PMID 41570439 · Publisher ↗
BACKGROUND: Emerging evidence suggests a complex bidirectional relationship between cardiovascular disease (CVD) and cancer. However, population-level data characterizing the burden of cardiovascular comorbidities at the...
BACKGROUND: Emerging evidence suggests a complex bidirectional relationship between cardiovascular disease (CVD) and cancer. However, population-level data characterizing the burden of cardiovascular comorbidities at the time of cancer-attributable death remains limited. We analyzed the association between the presence of cardiovascular disease on death certificates and cancer mortality patterns across demographic groups using national mortality data from 1999 to 2020. METHODS: Using CDC WONDER multiple cause-of-death data, we analyzed records of adults ≥ 18 years with cancer as the underlying cause of death. CVD comorbidity was defined as any cardiovascular condition (ICD-10 I00-I99) listed as a contributing cause. We calculated age-adjusted mortality rates (AAMR) per 100,000 population and rate ratios, stratified by demographics and cancer types. RESULTS: Among 13,847,293 cancer deaths, 4521,847 (32.6 %) had cardiovascular disease listed as a contributing cause. The overall AAMR for cancer deaths with CVD was 47.75 per 100,000 (95 % CI: 47.66-47.85). Males showed higher rates than females (62.26 vs 37.22 per 100,000, rate ratio 1.67). Non-Hispanic Black populations had the highest burden (57.10 per 100,000), while Asian/Pacific Islander populations had the lowest (30.80 per 100,000). For lung cancer, mortality rates were substantially higher when CVD was present, with rate ratios ranging from 1.70 to 2.43; however, this association is likely attributable to profound unmeasured confounding by shared risk factors such as smoking. CONCLUSIONS: Cardiovascular disease is listed as a contributing factor in nearly one-third of all cancer deaths, with distinct demographic patterns. These findings highlight the significant burden of cardiovascular comorbidities documented on death certificates at the end of life for cancer patients.
Changing patterns in tongue, oral cavity, laryngeal and hypopharyngeal squamous cell carcinomas in New Zealand: Incidence, trends and survival from 2006 to 2022.
Win Myint TT, McIvor N, Douglas R … +3 more , Cavadino A, Tin Tin S, Elwood M
Cancer Epidemiol · 2026 Apr · PMID 41570438 · Publisher ↗
BACKGROUND: Cancers of the oral cavity, larynx, and hypopharynx have traditionally been associated with common risk factors such as tobacco and alcohol use. With changes in smoking and drinking patterns, the incidence of...
BACKGROUND: Cancers of the oral cavity, larynx, and hypopharynx have traditionally been associated with common risk factors such as tobacco and alcohol use. With changes in smoking and drinking patterns, the incidence of these cancers is expected to change. Although the incidence of oral cavity cancer has been reported recently, there is limited evidence available for laryngeal and hypopharyngeal cancers in New Zealand (NZ). Furthermore, while growing evidence suggests increasing incidence of tongue cancer among females and young individuals, this trend has not been investigated in NZ. This study will therefore assess the incidence rates, trends in incidence, and survival of tongue, other oral cavity, laryngeal and hypopharyngeal cancers. METHODS: The study included patients with a primary diagnosis of squamous cell carcinoma (SCC) oral tongue, other oral cavity, larynx and hypopharynx, which were retrieved from the National Cancer Registry from 2006 to 2022. Directly age-standardised incidence rates were calculated, using the World Health Organisation standard population. Time trends were analysed with joinpoint regression to identify annual percentage changes (APCs), and overall and relative survival rates were estimated. RESULTS: The average annual incidence rate per 100,000 population was 1.2 for oral tongue SCC, 1.0 for other oral cavity SCC, 1.1 for laryngeal SCC, and 0.3 for hypopharyngeal SCC. Males consistently showed a higher incidence rate than females for all tumours except oral tongue SCC, where the incidence rates in older-aged females were higher than that of their male counterparts. Incidence rates differed by ethnicity, with Pasifika having higher incidence rates for oral tongue and other oral cavity SCC, and Māori for laryngeal and hypopharyngeal SCC, compared to European. Over the past 17 years, trends in incidence rates of laryngeal SCC declined significantly with 5 % per year overall and across all sexes, age groups and ethnic groups, whereas those of oral tongue, other oral cavity and hypopharyngeal SCC remained stable. Both overall and relative survival rates were highest for oral tongue SCC and lowest for hypopharyngeal SCC. The 5-year relative survival rates were 73 % for oral tongue SCC, 58 % for other oral cavity SCC, 67 % for laryngeal SCC and 42 % for hypopharyngeal SCC. In addition to age effects, survival outcomes varied by ethnicity, with notable disparity observed among Māori for other oral cavity and laryngeal SCC. CONCLUSION: This study confirms a consistent decline in laryngeal SCC incidence rates in New Zealand over the last 17 years. However, no such decline was observed for oral tongue, other oral cavity, and hypopharyngeal SCC. The findings suggest that the risk attributed by common risk factors such as smoking may vary between tumour sites and demographic groups, particularly for oral tongue SCC.
Inequalities in survival among children with central nervous system cancers and neuroblastoma: A population-based study.
Afshar N, Qiang D, Cheah S … +1 more , Milne RL
Cancer Epidemiol · 2026 Apr · PMID 41570437 · Publisher ↗
BACKGROUND: Inequalities in adult cancer survival by sex, socio-economic position, and rural-urban residence are well established; however, evidence for childhood cancers, particularly site-specific survival, remains lim...
BACKGROUND: Inequalities in adult cancer survival by sex, socio-economic position, and rural-urban residence are well established; however, evidence for childhood cancers, particularly site-specific survival, remains limited and inconsistent. This study investigated whether these inequalities exist among children diagnosed with central nervous system (CNS) cancers or neuroblastoma. METHODS: We conducted a population-based study using Victorian Cancer Registry data including 1324 children aged 0-14 years when diagnosed with CNS cancers (n = 933) or neuroblastoma (n = 391) in 1982-2021. Follow-up was conducted through linkage with death registries up to the end of 2021. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality in relation to sex, area-level socio-economic disadvantage, and remoteness of residence. RESULTS: There was weak evidence of higher mortality in males than females for both CNS cancers (HR=1.16; 95 % CI: 0.96-1.41) and neuroblastoma (HR=1.29; 95 % CI: 0.92-1.80). Survival was poorer among children living in the most disadvantaged areas (highest quintile): 54 % higher mortality for CNS cancers (HR=1.54; 95 % CI: 1.09-2.18) and 89 % higher for neuroblastoma (HR=1.89; 95 % CI: 0.99-3.61) compared to those in the least disadvantaged areas (lowest quintile). Children with neuroblastoma living outside major cities had higher mortality (HR=1.43; 95 % CI: 1.01-2.02) than those in major cities, which was attenuated (HR=1.32; 95 % CI: 0.92-1.88) after adjustment for socio-economic disadvantage. CONCLUSION: Children with CNS cancers and neuroblastoma living in socio-economically disadvantaged areas experienced poorer survival outcomes. There was weaker evidence for poorer survival in males and those living outside major cities. These findings underscore the need for targeted strategies to address survival inequalities in these childhood cancers.
Sex-specific associations of creatinine and antioxidant biomarkers with lung cancer risk by drinking and smoking behavior: A prospective cohort study.
Shin JW, Sull JW, Minh NT … +1 more , Jee SH
Cancer Epidemiol · 2026 Apr · PMID 41570436 · Publisher ↗
BACKGROUND: This study aimed to evaluate the associations between serum creatinine, a potential antioxidant marker, and major endogenous antioxidant biomarkers with lung cancer risk, stratified by sex, alcohol consumptio...
BACKGROUND: This study aimed to evaluate the associations between serum creatinine, a potential antioxidant marker, and major endogenous antioxidant biomarkers with lung cancer risk, stratified by sex, alcohol consumption, and smoking status. METHODS: We analyzed 133,596 cancer-free adults from the Korean Cancer Prevention Study II (KCPS-II) cohort. During a mean follow-up of 13.5 years, 721 incident lung cancer cases were identified. Serum levels of creatinine, total bilirubin, albumin, and uric acid were measured. Alcohol consumption and smoking status were classified as never, former, current, and ever users, with ever users including both current and former users. Individuals with both alcohol and smoking exposure were additionally analyzed as a high-risk group. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for lung cancer, stratified by alcohol and smoking status. Biomarkers were analyzed by quartiles and linear trends. RESULTS: A 1-SD increase in serum creatinine was inversely associated with lung cancer risk in the overall population, including current drinkers (HR: 0.85, 95 % CI: 0.73-0.98), ever drinkers (HR: 0.85, 95 % CI: 0.75-0.97), former smokers (HR: 0.77, 95 % CI: 0.62-0.96), and ever smokers (HR: 0.81, 95 % CI: 0.70-0.93). In men, similar associations were observed in current drinkers (HR: 0.83, 95 % CI: 0.72-0.97), ever drinkers (HR: 0.86, 95 % CI: 0.75-0.99), former smokers (HR: 0.77, 95 % CI: 0.62-0.96), and ever smokers (HR: 0.80, 95 % CI: 0.70-0.92). High-risk groups exposed to both smoking and alcohol showed consistent inverse associations, with current smokers who were also current drinkers (HR: 0.81, 95 % CI: 0.66-1.00), and ever smokers who were also ever drinkers (HR: 0.78, 95 % CI: 0.67-0.91). No significant association was observed in women. CONCLUSIONS: In men, serum creatinine showed a strong inverse association with lung cancer risk under oxidative stress conditions related to smoking and alcohol consumption.
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