Cancer
survival in Karunagappally, India, 1991-1997
Abstract
The Rural Cancer Registry of
Karunagappally was established in 1990 to study cancer occurrence due to high
natural background radiation in the coastal area of Kerala state. Cancer
registration was done by active methods. The registry contributed data on
survival for 22 cancer sites or types registered during 1991–1997. Follow-up
has been carried out predominantly by active methods, with median follow-up
time ranging between 3–57 months for various cancers. The proportion of
histologically verified diagnosis for different cancers ranged between 39–100%;
death certificates only (DCOs) comprised 0–25%; 75–100% of total registered
cases were included for survival analysis. The 5-year age-standardized relative
survival rates for common cancers were lung (6%), breast (45%), cervix (55%),
mouth (42%), oesophagus (14%) and tongue (31%). Five-year relative survival by
age group showed no distinct pattern or trend for most cancers. A majority of
cases are diagnosed with a regional spread of disease among cancers of the
tongue (48%), oral cavity (66%), hypopharynx (54%), larynx (46%), cervix (61%)
and breast (53%); survival decreases with increasing extent of disease.
Rural Cancer Registry
The Rural Cancer Registry of Karunagappally was
established in 1990 as a special purpose registry by the Regional Cancer Centre
of Trivandrum, with funding support from the Department of Atomic Energy,
Government of India to study cancer occurrence in relation to the high natural
background radiation present in the coastal area of Kerala state, which has
monazite-rich sands that emit gamma radiation. The registry covers an area of
212 km2 and caters to a mixed rural (96%) and urban (4%) population of 0.4
million with a sex ratio of 1025 females to 1000 males. It has been
contributing data to the quinquennial IARC publication Cancer Incidence in
Five Continents since Vol VII[1]. The
method of cancer registration is entirely done by active methods. There are no
dedicated cancer hospitals or laboratories for tissue diagnosis within the
registry area. Over 50 sources of registration, comprising hospitals in the
government and private sectors, nursing homes, pathology laboratories, imaging
centres and hospices, are visited for data collection. In addition, the
enumerators undertake field visits to trace new cancer cases. The average
annual age-standardized incidence rate is 112 per 100 000 among males and 81
per 100 000 among females with a lifetime cumulative risk of one in 8 for males
and one in 11 for females of developing cancer in 1991–2001. The top-ranking
cancers among males are lung, followed by oral cavity and oesophagus. Among
females, the order is breast, cervix and oral cavity [2].
The
registry has contributed data on survival from 22 cancer sites or types for
this second volume of the IARC publication on Cancer Survival in Africa,
Asia, the Caribbean and Central America.
Data
quality indices
The proportion of cases with a
histological confirmation of cancer diagnosis in this series is 71%, varying
between 39–100%. The proportion of cases registered as death certificates
only (DCOs) is 11%, ranging between 0–25%. The exclusion of cases from the
survival analysis was the greatest in cancer of the brain and nervous system
(25%); it was none for many cancers. Thus, 75–100% of the total cases
registered are included in the estimation of the survival probability.
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Follow-up has been carried out
predominantly by active methods. These included abstraction of cancer mortality
information from the vital statistics division records. The abstracted data are
first matched with the incident cancer database. The follow-up information for
the unmatched incident cases is then obtained through repeated scrutiny of
records in the respective sources of registration, postal/telephone enquiries
and house visits. Further, the monthly cancer follow-up clinics held by
oncologists from the Regional Cancer Centre in the field office and the pain
and palliative care clinics held bi-weekly have helped to obtain maximal
follow-up information.
The closing date of follow-up was 31st December 1999. The median follow-up (in months) ranged between 3 for myeloid leukaemia to 59 for non melanoma skin cancer. Complete follow-up at five years from the incidence date ranged from 91% (prostate cancer) to 100%. The losses to follow-up occurred in the first year of follow-up for a majority of cancers.
The closing date of follow-up was 31st December 1999. The median follow-up (in months) ranged between 3 for myeloid leukaemia to 59 for non melanoma skin cancer. Complete follow-up at five years from the incidence date ranged from 91% (prostate cancer) to 100%. The losses to follow-up occurred in the first year of follow-up for a majority of cancers.
Survival statistics
All ages and both sexes together
The
5-year relative survival is the highest for thyroid cancer (88%) and the lowest
for cancer of the liver (3%) among the cancers studied. The survival figures
for other head and neck cancers are oral cavity (41%), larynx (35%), tongue
(32%) and hypopharynx (15%). Survival rates from gastrointestinal cancers were rectum
(33%) and oesophagus, stomach and pancreas (3%). The survival figures for
Non-Hodgkin lymphoma was 30%, lymphoid leukaemia was 37% and myeloid leukaemia
8%.
The 5-year age-standardized relative survival (ASRS) probability for all ages together is less than or very similar to the corresponding unadjusted one for most cancers. The 5-year ASRS (0–74 years of age) is observed to be higher than the corresponding ASRS (all ages) for the majority.
The 5-year age-standardized relative survival (ASRS) probability for all ages together is less than or very similar to the corresponding unadjusted one for most cancers. The 5-year ASRS (0–74 years of age) is observed to be higher than the corresponding ASRS (all ages) for the majority.
Extent of disease
A
majority of cases have been diagnosed with a regional spread of disease among
cancers of the tongue (48%), oral cavity (66%), hypopharynx (54%), larynx
(46%), cervix (61%) and breast (53%). For ovarian cancer, there are more cases
in the distant metastasis category (54%) than others. The extent of disease was
unknown in 7–17%. The 5-year absolute survival by extent of disease followed
the expected pattern: highest for localized disease followed by regional and
distant metastasis among known categories of extent of disease for most
cancers.
Cancer survival Harare, Zimbabwe, 1993-1997
Abstract
The Zimbabwe national cancer
registry was established in 1985 as a population-based cancer registry covering
Harare city. Cancer is not a notifiable disease, and registration of cases is
done by active methods. The registry contributed data on randomly drawn
sub-samples of Harare resident cases among 17 common cancer sites or types registered
during 1993–1997 from black and white populations. Follow-up was carried out
predominantly by active methods with median follow-up ranging from 1–54 months
for different cancers. The proportion with histologically verified diagnosis
for various cancers ranged from 20–100%; death certificate only cases (DCOs)
comprised 0–34%; 58–97% of total registered cases were included for survival
analysis. Complete follow-up at five years ranged from 94–100%. Five-year
age-standardized relative survival rates of selected cancers among both races
combined were cervix (42%), breast (68%), Kaposi sarcoma (4%), liver (3%),
oesophagus (12%), stomach (20%) and lung (14%). Survival was markedly higher
among white than black populations for most cancers with adequate cases.
Five-year relative survival by age group was fluctuating, with no definite
pattern or trend.
Zimbabwe national cancer registry
The Zimbabwe national cancer registry was established
in 1985 as a population-based cancer registry at the Parirenyatwa Hospital,
Medical School of the University of Zimbabwe, Harare, under the support of the
Ministry of Health and Child Welfare, IARC and other organizations. It
contributed data to the quinquennial IARC publication Cancer Incidence in
Five Continents in volumes VII (for African (black) and European (white)
populations) and VIII (for black population only)[1].
Cancer is not a notifiable disease, and registration of cases is done by active
methods. The principal sources of data are the medical records in the cancer
departments, hospitals, pathology laboratories in the public and private
sectors and specific clinical research studies. The registry covers the city of
Harare and caters to a population of about 1.5 million in 1997 with a sex ratio
of 943 females to 1000 males. The average annual age-standardized incidence
rate (ASR) of all cancers except non-melanoma skin among the black population
was 223 per 100 000 among males and 219 per 100 000 among females in 1993–1997;
the corresponding figures for the white population in 1990–1992 were 291 per
100 000 males and 298 per 100 000 females[1,2,3].
The registry has contributed data on survival from the
17 cancer sites or types in this volume of the IARC publication on Cancer
Survival in Africa, Asia, the Caribbean and Central America. For this
study, only sub-samples of Harare resident cases among 17 common cancers are
included. For most cancers, it was intended that a minimum of 150 cases be
randomly selected. For cervix and breast cancers and Kaposi sarcoma, the number
intended is 300. For breast cancer, it is equally distributed among minority
(white) and African (black) races. For the rest of cancers, the inclusion of
the minority races (other than white) is only by chance[4].
Data quality indices
The
proportion of cases with histological confirmation of cancer diagnosis in this
series is 65%, varying between 20% for liver cancer and 100% for Hodgkin
lymphoma. The proportion of cases registered on a death certificate only is
10%, ranging from nil to 34%. The exclusion of cases without any follow-up information
or other inconsistencies ranged from 1–8%. Thus, 58–97% in the series among
different cancers are included in the estimation of the survival probability.
Cancer survival in Riyadh, Saudi Arabia, 1994-1996
Abstract
The national cancer registry in
Saudi Arabia has functioned since 1994, collecting population-based incidence
data on malignant and in situ tumours. Cancer registration is carried
out by both passive and active methods. The registry contributed data on
survival from cancer of the breast registered in 1994–1996 from Riyadh
province. Follow-up was carried out predominantly by active methods, and the
median follow-up was 57 months. The proportion of cases with a histological
confirmation of breast cancer diagnosis was almost 100%; there were no cases
registered based on death certificate only (DCO); 93% of total cases registered
were included in the survival analysis. Complete follow-up at five years was
80%. Relative survival rates at one, three and five years were 96%, 83% and
65%, respectively. Five-year age-standardized relative survival was 65%.
Five-year relative survival by age group did not show any pattern and was
fluctuating. Five-year absolute survival by extent of disease was localized
(70%), regional (56%), distant metastasis (57%) and unknown (62%).
National cancer registry
The national cancer registry in Saudi Arabia has
functioned since 1994, collecting population-based incidence data on malignant
and in situ tumours. It is based at Gulf Centre for cancer registration,
King Faisal Specialist Hospital, Riyadh. Cancer registration is carried out by
both passive and active methods. Cancer care services are provided
predominantly by the Ministry of Health, which includes cancer centres with all
diagnostic and treatment facilities and other hospitals with some participation
from private sector. Data are collected from all these sources by scrutiny of
records or linkage with data in computer systems maintained at these places.
The registry covers an area of 3 855 000 km2 and caters to a mixed
urban and rural estimated population of about 20.7 million in 1998 with a sex
ratio of 1264 males to 1000 females; the corresponding Saudi population is 15.1
million with 1020 males to 1000 females. The average annual age-standardized
incidence rate among Saudis was 65 per 100 000 among males and 68 per 100 000
among females, with a lifetime cumulative risk of one in 13 of developing
cancer for both sexes in the period 1997–1998. The top-ranking cancers among
males are liver, followed by non-Hodgkin lymphoma and leukaemia. Among females,
the order is breast, thyroid and leukaemia[1].
Cancer survival in Bhopal, India, 1991-1995
Abstract
The Bhopal population-based cancer
Registry was established in 1986 under the national cancer registry programme
to investigate the after-effect of a gas leak in 1984. Cancer registration is
done entirely by active methods. The registry is contributing data on survival
for 16 cancer sites or types registered during 1991–1995. Follow-up of cases
was done by active methods with median follow-up time ranging between 8–44
months for different cancers. The proportion with histologically verified
diagnosis for various cancers ranged between 61–100%; death certificates only
(DCOs) comprised 0–2%; 50–92% of total registered cases were included for
survival analysis. The 5-year
age-standardized relative survival rates for common cancers were mouth (34%),
cervix (31%), breast (25%), tongue (12%), oesophagus (3%) and lung (1%).
The 5-year relative survival by age group showed that survival was the highest
in the younger age group (45 years and below) for a majority of cancers. A
decreasing survival with increasing clinical extent of disease was noted for
most cancers studied.
Bhopal Cancer Registry
The Bhopal Population-Based Cancer Registry is the only
one of its kind in the central part of India. It was established in 1986 as a
special purpose registry at the Gandhi Medical College, Bhopal, under the
National Cancer Registry Programme, to investigate the after-effect of the gas
leak in 1984. Data from the registry have been regularly published by the
Indian Council of Medical Research[1].
The method of cancer registration is entirely done by active methods. The
registry staff visits the various medical institutions in and around Bhopal
city for data collection by direct interview of cases and/or from medical
records[2].
The registry covers an area of 285 km2 and caters to an entirely urban
population of about 1.4 million in 2001 with a sex ratio of 893 females to 1000
males. The average annual age-standardized incidence rate is 114 per 100 000
among males and 104 per 100 000 among females with a lifetime cumulative risk
of one in 10 of developing cancer for both sexes in the period 1999–2001. The
leading site of cancer among males is the lung followed by oral cavity and
oesophagus. The ranking among females is breast followed by cervix and oral
cavity[1].
Cancer survival in Chiang Mai, Thailand, 1993-1997
Abstract
The Chiang Mai tumour registry was
established in 1978 as a hospital-based cancer registry, and population-based
cancer registration started in 1986, with retrospective data collection on
cancer incidence and mortality since 1983. Registration of cases is done by
active method. Data on survival for 36
cancer sites or types registered during 1993–97 are reported here.
Follow-up has been carried out predominantly by active methods, with median
follow-up ranging between 1–39 months for different cancers. The proportion of
histologically verified diagnosis for various cancers ranged between 28–100%;
death certificate only (DCOs) cases comprised 0–56%; 33–92% of total registered
cases were included for survival analysis. Complete follow-up at five years
ranged from 59–100% for different cancers. The 5-year age-standardized relative survival rates was the highest for
Hodgkin lymphoma (70%) followed by thyroid (65%), cervix (57%), breast (56%)
and corpus uteri (49%). The 5-year relative survival by age group showed
either an inverse relationship or was fluctuating. An overwhelmingly high
proportion of cases were diagnosed with a regional spread of disease, ranging
between 44–82% for different cancers and survival decreased with increasing
extent of disease for all cancers studied.
Cancer survival in Singapore, 1993-1997
The Singapore cancer registry is a
national registry established in 1968. Cancer registration is done by passive
methods. The registry contributed survival data on 45 cancer sites or types
registered during 1993–1997. Data on 34 cancers registered during 1968–1997
were utilized for survival trend by period and cohort approaches. Follow-up was
done by passive methods, with median follow-up ranging between 2–72 months for
different cancers. The proportion with histologically verified diagnosis for
various cancers ranged between 27–100%; death certificates only (DCOs)
comprised 0–7%; 76–100% of total registered cases were included for the
survival analysis. The top-ranking cancers on 5-year age-standardized relative
survival rates were non-melanoma skin (96%), thyroid (90%), testis (88%),
corpus uteri (77%), breast (74%), Hodgkin lymphoma (73%) and penis (70%).
Five-year relative survival by age group showed either a decreasing trend with
increasing age groups or was fluctuating. Localized stage of disease ranged
between 18–65% for various cancers and survival decreased with increasing
extent of disease. Period survival closely predicted survival experience of
cancers diagnosed in that period, and an increasing trend in period survival
over different periods indicated an improved prognosis for cancers diagnosed in
those calendar periods.
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