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Cancer epidemiology and Cancer registry

Cancer epidemiology and Cancer registry. C. Sauvaget MD, PhD Scientist, Screening Group (SCR). Definition of Epidemiology. Study of the distribution and determinants of diseases in human populations Epidemiological studies have been categorized into 2 major groups:

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Cancer epidemiology and Cancer registry

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  1. Cancer epidemiology and Cancer registry C. Sauvaget MD, PhDScientist, Screening Group (SCR)

  2. Definition of Epidemiology • Study of the distribution and determinants of diseases in human populations • Epidemiological studies have been categorized into 2 major groups: • Focus on distribution: descriptive epidemiology – burden, pattern • Focus on determinants: analytical epidemiology – causes, risk factors • Application: prevention, control

  3. Descriptive Epidemiology • Can be conducted with or without the knowledge of exposure • Pure descriptive epidemiology—no exposure data • Present rates by calendar year, cohort year of birth stratified by age, gender, race, disease subtype, geographic regions • Analytical ecological study-with exposure data • Correlation or regression at aggregate level

  4. Example of ecological study Estimated daily consumption of fat per caput in 1964-66 and age-adjusted breast cancer incidence rates in women aged 35-64 years in 1972-77 in 24 countries (reproduced, by permission of Oxford University Press, from Armstrong & Mann, 1988-5). Dos Santos I. Cancer epidemiology, 1999, IARC publications

  5. Role of Descriptive Epidemiology-1a • Can provide tremendous insights into the aetiology – • Different racial groups living in same area with wide differences in disease rate -- possibility of genetic susceptibility • Testicular cancer (Whites: 6/100,000; Blacks: 0.7/100,000) • Same racial group living in different areas with similar disease rate -- possibility of genetic susceptibility • Testicular cancer (Blacks: 0.6-1.0/100,000)

  6. Role of Descriptive Epidemiology-1b • Can provide tremendous insights into the aetiology • Same racial group living in different areas with wide differences in disease rate — possibility of environmental exposures • Different occupational groups have major differences in disease rate — importance of occupational exposures • Different religious groups having different rates —importance of lifestyle factors Chinese Han, and other minorities

  7. Example of environmental factor Age-adjusted incidence rates of female breast cancer for USA residents (1972-85) by birthplace and age at migration, and for Jordan (1973-81) (reproduced, by permission of Churchill Livingston, from Shimizu et al., 1991) Dos Santos I. Cancer epidemiology, 1999, IARC publications

  8. Example of occupational factor Men occupation class and risk of incident cancer (1990-2002, n= 14 853) Melchior et al. Cancer causes and control 2005;16:515-524

  9. Role of Descriptive Epidemiology-2 • Disease incidence trends over time • Point to an altered influence of risk factors in the population: • Increase exposure to UVR due to: »Increase outdoor activities »Change in cloth patterns »Increase use of suntan lamps »Increase depletion of ozone layer • Increase in skin cancer

  10. Annual Age-std mortality rate from lung cancer Number of cigarettes per adult Time trend of cigarettes sales and lung cancer mortality Kubik et al. Cancer 1995

  11. Annual age-adjusted incidence rates of cancers at selected primary sites in Finland: actual rates from 1953 to 1979 and predictions up to the year 2000 based on a statistical model which included age, period and cohort effects (reproduced with permission from Läärä, 1982) Dos Santos I. Cancer epidemiology, 1999, IARC publications

  12. Screening coverage rate Incidence of invasive cervical cancer Percentage Incidence rate/1000 000 National call-recall introduced  Age-standardised incidence of invasive cervical cancer and screening coverage rate: England, 1975-2002 Sources: Cancer Research UK; Quinn et al., 1999; Willoughby et al., 2006

  13. Proportion of cancers attribution to various risk factors * HBV, HCV, HPV, EBV, Helicobacter Pylori, HIV, schistosomiasis… Doll and Peto. JNCI 1981,66:1191-1308

  14. Effect of Hepatitis B vaccination on incidence of liver cancer in Taiwan Chang et al. N Eng J Med 1997

  15. Measures of occurrence of disease • Denominator • Time period • Incidence • Prevalence • Risk

  16. Measures of occurrence of disease • Population at risk: The part of a population which is susceptible to a disease • Incidence: The number of new health events occurring in a defined population during a specified period of time • New cases /population at risk /time • Used to measure current disease activity • Allows comparison between areas with different populations • Ex. 100 subjects are followed for 1 year and 20 developed the disease => the incidence rate is 20 cases /100 person-years of observation • Prevalence: The proportion of individuals in a population at risk with a disease at a single point in time

  17. Relationship between Incidence and Prevalence Incidence • Prevalence is the number of new and existing cases divided by the total population (can be during a period of time or at a given point) • Prevalence = (New cases + existing cases) / Total population • Can be expressed as a percent • Can give a picture of disease burden within a population • Prevalence rate = incidence rate x average duration of disease Duration Prevalence Dead, cured, missed, etc.

  18. Using routine data to measure disease occurrence Dos Santos I. Cancer epidemiology, 1999, IARC publications

  19. Exposure and outcome-1 • Definition • Measurement

  20. * Does alcohol intake increase the risk of lung cancer? Alcohol Lung cancer (exposure) (outcome) * Does hepatitis B vaccination protect against liver cancer? Hepatitis B vaccine liver cancer (exposure) (outcome) Exposure and outcome-1

  21. * Does alcohol intake increase the risk of lung cancer? Alcohol Lung cancer (exposure) (outcome) Smoking (confounder) Exposure and outcome-2

  22. Exposure • Nature • Dose • Time • Source: • Questionnaire • Self-administered • Personal interview • Records • Diaries • Biological measurement

  23. Outcome • Hospital records • Cancer registration • Death registry

  24. Cancer registries http://ci5.iarc.fr/ http://globocan.iarc.fr/

  25. Cancer Registry: Registration Cancer Registry The office or institution which is responsible for the collection, storage, analysis and interpretation of data on persons with cancer. Cancer registration The process of continuing systematic collection of data on the occurrence, characteristics, and outcome of reportable neoplasm with the purpose of helping to assess (prevent) and control the impact of malignant disease in the community.

  26. Cancer Registry1. Population-based Cancer Registry • All cases in a DEFINED population are registered • True (unbiased) profile of cancer in the community • incidence, stage distribution, survival, etc. • Calculation of incidence rates (because population at risk is quantified) • The main interest is for epidemiology and public health

  27. Cancer Registry2. Hospital-based Cancer Registry • Records all cases of cancer treated in a given hospital • The population from which the cases come is not defined • The main interest is clinical care hospital administration

  28. Basic information required and variable definitions

  29. Most valid basis of diagnosis of cancer Microscopic 1. Autopsy with concurrent or previous histology 2. Histology of primary 3. Histology of metastasis 4. Cytology or haematology Non-microscopic 5. Specific biochemical and/or immunological tests 6. Exploratory surgery 7. Clinical investigation (X-ray, US…) 8. Clinical only 9. Death Certificate Only (DCO) ICD-Oncology

  30. Incidence and survival data • Provided by cancer registries thru the International Association of Cancer Registries (IACR) • Mostly regional (except Nordic countries) • Not always recent (generally 5-year delay): request time to be compiled and published. • Detailed information (site, histology, laterality, grade, stage)

  31. Coverage of cancer registration worldwide% of the population covered (around 2000) 40.0 99.0 19.0 7.1 7.9 13.0 82.0 16.5% total

  32. Mortality data Number of deaths from cancer • National level • Provided by the WHO • Recent and available for long time periods (1950 to 2008) • Limited number of cancers • Quality can be poor (under-reporting, incomplete coverage, high percentage of ill-defined causes of deaths)

  33. Mortality data (WHO databank) % of the population covered (around 2005) 98.0 100.0 100 9.0 13.8* 95.0 76.5 33% total *Egypt and South-African Republic

  34. Estimated age-standardised incidence rate per 100,000 Lung: male, all ages 1,095,186 cases in 2008 GLOBOCAN 2008 Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr

  35. Estimated age-standardised incidence rate per 100,000Breast: all ages 1,383,523 cases in 2008 GLOBOCAN 2008 Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr

  36. Less developed countries Population (2008): 640 million population Females 321 million population 3.5 million cases 2.1 million deaths Males 319 million Population 3.7 million cases 2.7 million deaths Lung Breast Stomach Cervix uteri Liver Colorectum Oesophagus Prostate Corpus uteri Ovary Bladder Leukaemia Lip, oral cavity Incidence Mortality (Thousands) GLOBOCAN 2008

  37. Cancer epidemiology studies • Descriptive studies • Observational studies • Experimental studies

  38. Incidence case Prevalence estimate Prevalence at time t1 = 2/10 = 0.20 = 20% Prevalence at time t2 = 3/8 = 0.38 = 38% Dos Santos I. Cancer epidemiology, 1999, IARC publications

  39. Person-years and incidence rate Consider a hypothetical group of nine persons who were followed up from the beginning of 1980 to the end of 1984. Subjects joined the study at different points, as shown in Figure. Three subjects, (2), (6) and (7), developed the disease of interest during the study period and one, (4), was last contacted at the end of 1983. Incidence rate = 3/32 = 0.094 per person-year or 9.4/100,000 P-Yrs Dos Santos I. Cancer epidemiology, 1999, IARC publications

  40. Main types of epidemiological studies Intervention (experimental) studies Clinical trials Filed trials Individual level Aggregated level (community trials) Observational (non-experimental) studies Cohort studies Case-control studies Cross-sectional surveys Routine-data-based studies Individual level Aggregated level (ecological studies)

  41. Randomized Control Trials Intervention outcome+ Research cohort outcome- outcome+ Randomization outcome- No intervention Research direction： What will happen in the future?

  42. Prospective Cohort Study Exposed Disease Cohort No disease Disease No disease Not exposed Present Future Time Research direction： What will happen in the future?

  43. Case-control Study • Interview • Review of medical records • Review of biological exams How many people were exposed? Case How many people were not exposed? How many people were exposed? Control Selection of controls is one of the most difficult problems in epid. How many people were not exposed? past present Time Research direction： What happened in the past?

  44. Cancer Registry Types 1. Population-based cancer registry (PBCR) 2. Hospital-based cancer registry 3.Pathology registry

  45. Cancer Registry3. Pathology Tumor Registry • Collects information from one or more laboratories on histologically diagnosed cancers • The population from which the tumour tissue has come is not defined • The information - has high diagnostic quality - but is difficult to generalize

  46. HOSPITAL CANCER REGISTRYAdditional variables • Contact details • Admission + Discharge dates • Hospital referred from , to • Physicians (treating, following) • Diagnostic procedures • Extent of disease • Treatment details (first, subsequent) • Outcome (recurrence) • Follow - up

  47. The results are presented for 170 countries of the world, plus build-in areas (six WHO regions, more and less developed countries and the world) Data available for 27 major cancers, for men and women, and for 5 age groups: 0-14,15-44,45-54,55-64,65+ Accessible thru the Internet or using a Windows-based PC software http://globocan.iarc.fr/

  48. 11 million New Cases 7 millionDeaths 25 millionLiving with Cancer Cancer – worldwide burden

  49. Incidence Mortality New cancer cases and deaths, World 2002 (10.8 million cases/6.7 million deaths) Males 5.8 million cases 3.8 million deaths Females 5.0 million cases 2.9 million deaths Lung (1.35/1.18) Breast (1.15/0.41) Colon/Rectum (1.0/0.53) Stomach (0.93/0.70) Prostate (0.68/0.22) Liver (0.63/0.60) Cervix uteri (0.49/0.28) Oesophagus (0.41/0.34) Bladder (0.35/0.14) Non-Hodgkin lymphoma (0.30/0.16) Leukaemia (0.28/0.20) Oral cavity (0.27/0.12) Pancreas (0.23/0.22) Kidney (0.21/0.11) Ovary (0.20/0.12) 1000 800 600 400 200 0 200 400 600 800 1000 (Thousands)

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