Karim-Kos, H.E.

Progress against cancer in the Netherlands since the late 1980s : population-based studies of incidence, prognosis and mortality (Doctoral Thesis)

2012-11-21T00:00:00Z

In the second part of the 20th century, cancer became an important health problem worldwide. Life expectancy increased for many western populations from about 70 years in the 1950s to more than 80 years in 2010. Thereby the life span to develop cancer increased, as age is the most important risk indicator of cancer. The Danish Cancer Registry, the oldest nationwide cancer registry, showed that cancer incidence almost doubled in the last 70 years. In the Netherlands, cancer incidence increased with 50% since the 1970s. Fortunately, mortality from cancer started to decrease from the 1980s.

Incidence and survival trends of uncommon corpus uteri malignancies in the Netherlands, 1989-2008 (Article)

2012-05-01T00:00:00Z

Introduction: Corpus uteri cancer is the most common malignancy of the female reproductive tract in industrialized countries, and its incidence is increasing. Although most of these tumors are of the common endometrial type, there are also many uncommon tumors of the corpus uteri. We examined the incidence and survival of patients with uncommon epithelial tumors, carcinosarcomas, and sarcomas of the corpus uteri diagnosed since 1989. Methods: All common and uncommon malignancies of the corpus uteri registered in the nationwide population-based Netherlands Cancer Registry (NCR) during 1989-2008 were included (n = 30,960). The histological subtypes were described according to the Blaustein classification system. Age-standardized incidence for 1989-2008 was calculated per 1,000,000 person-years (p-y), and relative survival was calculated according to the type of uncommon tumor. Results: The incidence of corpus uteri malignancies increased from 159 to 177 per 1,000,000 p-y, mainly owing to the rise in endometrioid adenocarcinomas from 106 to 144 per 1,000,000 p-y. In contrast, the incidence of uncommon epithelial endometrial carcinomas (UEECs) decreased from 30 to 13 per 1,000,000 p-y, although carcinosarcomas increased slightly from 5.1 to 6.9 per 1,000,000 p-y. Furthermore, a remarkable shift in incidence of endometrial stromal cell sarcomas (ESS) was observed from high-grade ESSs to low-grade ESSs after 2003. Five-year relative survival for patients with UEEC decreased from 72% to 54% and for patients with serous adenocarcinoma from 73% to 51%. Coinciding with an increase in the incidence of common adenocarcinoma of the corpus uteri, there was a decline in uncommon adenocarcinomas and more or less a stable incidence of sarcomas and carcinosarcomas. Conclusion: The decrease in UEEC tumors consisted largely of fewer serous carcinomas, possibly and likely reflecting a more precise histopathological classification of villoglandular tumors. Unfortunately, relative survival for patients with UEEC, sarcomas, and carcinosarcomas did not improve over the study period, indicating a need for more research on treatment strategies for this group of patients. Copyright

Diverging trends in incidence and mortality, and improved survival of non-Hodgkin's lymphoma, in the Netherlands, 1989-2007 (Article)

2012-01-01T00:00:00Z

Background: We studied progress in the fight against non-Hodgkin's lymphoma (NHL) in the Netherlands by describing the changes in incidence, treatment, relative survival, and mortality during 1989-2007. Patients and methods: We included all adult patients with NHL [i.e. all mature B-, T-, and natural killer (NK) cell neoplasms, with the exception of plasma cell neoplasms], newly diagnosed in the period 1989-2007 and recorded in the Netherlands Cancer Registry (n = 55 069). Regular mortality data were derived from Statistics Netherlands. Follow-up was completed up to 1 January 2009. Annual percentages of change in incidence, mortality, and relative survival were calculated. Results: The incidence of indolent B-cell and T- and NK-cell neoplasms rose significantly (estimated annual percentage change = 1.2% and 1.3%, respectively); incidence of aggressive B-cell neoplasms remained stable. Mortality due to NHL remained stable between 1989 and 2003, and has decreased since 2003. Five-year relative survival rates rose from 67% to 75%, and from 43% to 52%, respectively, for indolent and aggressive mature B-cell neoplasms, but 5-year survival remained stable at 48% for T- and NK-cell neoplasms. Conclusions: In the Netherlands, incidence of indolent mature B-cell and mature T- and NK-cell neoplasms has increased since 1989 but remained stable for aggressive neoplasms. Survival increased for all mature B-cell neoplasms, preceding a declining mortality and increased prevalence of NHL (17 597 on 1 January 2008).

Progress against cancer in the Netherlands since the late 1980s: An epidemiological evaluation (Article)

2011-10-06T00:00:00Z

Progress against cancer through prevention and treatment is often measured by survival statistics only instead of analyzing trends in incidence, survival and mortality simultaneously because of interactive influences. This study combines these parameters of major cancers to provide an overview of the progress achieved in the Netherlands since 1989 and to establish in which areas action is needed. The population-based Netherlands Cancer Registry and Statistics Netherlands provided incidence, 5-year relative survival and mortality of 23 major cancer types. Incidence, survival and mortality changes were calculated as the estimated annual percentage change. Optimal progress was defined as decreasing incidence and/or improving survival accompanied by declining mortality, and deterioration as increasing incidence and/or deteriorating survival accompanied by increasing mortality rates. Optimal progress was observed in 12 of 19 cancer types among males: laryngeal, lung, stomach, gallbladder, colon, rectal, bladder, prostate and thyroid cancer, leukemia, Hodgkin and non-Hodgkin lymphoma. Among females, optimal progress was observed in 12 of 21 cancers: stomach, gallbladder, colon, rectal, breast, cervical, uterus, ovarian and thyroid cancer, leukemia, Hodgkin and non-Hodgkin lymphoma. Deterioration occurred in three cancer types among males: skin melanoma, esophageal and kidney cancer, and among females six cancer types: skin melanoma, oral cavity, pharyngeal, esophageal, pancreatic and lung cancer. Our conceptual framework limits misinterpretations from separate trends and generates a more balanced discussion on progress.

The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival (Article)

2011-10-01T00:00:00Z

Background: The complement of the cancer mortality to incidence ratio [1-(M/I)] has been suggested as a valid proxy for 5-year relative survival. Whether this suggestion holds true for all types of cancer has not yet been adequately evaluated. Methods: We used publicly available databases of cancer incidence, cancer mortality and relative survival to correlate relative survival estimates and 1-(M/I) estimates from Denmark, Finland, Iceland, Norway, Sweden, the USA and the Netherlands. We visually examined for which tumour sites 5-year relative survival cannot simply be predicted by the 1-(M/I) and evaluated similarities between countries. Results: Country-specific linear regression analyses show that there is no systematic bias in predicting 5-year relative survival by 1-(M/I) in five countries. There is a small but significant systematic underestimation of survival from prognostically poor tumour sites in two countries. Furthermore, the 1-(M/I) overestimates survival from oral cavity and liver cancer with >10 in at least two of the seven countries. By contrast, the proxy underestimates survival from soft tissue, bone, breast, prostate and oesophageal cancer, multiple myeloma and leukaemia with >10 in at least two of the seven countries. Conclusion: The 1-(M/I) is a good approximation of the 5-year relative survival for most but not all tumour sites.

Trends in cervical cancer in the Netherlands until 2007: Has the bottom been reached? (Article)

2011-05-01T00:00:00Z

We explored trends in incidence and mortality of cervical cancer by age, stage and morphology, and linked the observed trends to screening activities. Data was retrieved from the Netherlands Cancer Registry during 1989-2007 (incidence) and Statistics Netherlands during 1970-2007 (mortality). Trends were evaluated by calculating the estimated annual percentage change (EAPC). Joinpoint regression analysis was used to detect changes in trends. Cervical intraepithelial neoplasia (CIN) detection rates were calculated by data from "the nationwide network and registry of histo- and cytopathology" during 1990-2006. Total age-adjusted incidence rate (European standardized rate (ESR)) was 7.9 per 100,000 woman years in 2007. During 1989-1998, incidence rates decreased with an EAPC of -1.3% (95% confidence interval (CI) -2.2 to -0.3), during 1998-2001 with -6.7% (95% CI: -16.4 to 4.1), and increased during 2001-2007 with 2.3% (95% CI: 0.4 to 4.2). Total mortality ESR was 1.9 per 100,000 woman years in 2007. Mortality rates decreased during 1970-1994 annually with -4.1% (95% CI: -4.6% to -3.7%), and with -2.6% (95% CI: -3.8% to -1.5%) during 1994-2007. The observed trend in total incidence is similar to the trend in squamous cell carcinomas in age group 35-54 years, suggesting that the observed trends are likely to be associated to changes in the screening program. This is supported by the trend in CINIII detection rates. In conclusion, incidence and mortality overall decreased and leveled off. On top of that there was an extra decrease that was compensated by a following recent increase in incidence, probably resulting from reorganization of the Dutch screening program.

Trends of cutaneous melanoma in the Netherlands: increasing incidence rates among all Breslow thickness categories and rising mortality rates since 1989 (Article)

2011-04-01T00:00:00Z

Abstract: Background: It has been debated that the epidemic of melanoma is largely due to overdiagnosis, since increases in incidence were mainly among thin melanomas and mortality rates remained stable. Our objective was to examine this controversy in the Netherlands. Patients and Methods: Information on newly diagnosed melanoma patients was obtained from the Netherlands Cancer Registry (NCR). European Standardised Rates (ESR) and Estimated Annual Percentage Change (EAPC) were calculated for the period 1989-2008.Cohort-based, period-based and multivariate survival analyses were performed. Results: The incidence rate of melanoma increased with 4.1% (95% CI: 3.6-4.5) annually. Incidence rates of both thin melanomas (. 1mm) and thick melanomas (> 4 mm) increased since 1989. Mortality rates increased mainly in older patients (>65 years). Ten-year relative survival of males improved significantly from 70% in 1989-1993 to 77% in 2004-2008 (p < 0.001) and for females the 10-year relative survival increased from 85% to 88% (p < 0.01). Recently diagnosed patients had a better prognosis even after adjusting for all known prognostic factors. Conclusion: Since incidence of melanomas among all Breslow thickness categories increased as well as the mortality rates, the melanoma epidemic in the Netherlands seems to be real and not only due to overdiagnosis.

Trends of cutaneous melanoma in the Netherlands: increasing incidence rates among all Breslow thickness categories and rising mortality rates since 1989 (Article)

2011-01-01T00:00:00Z

Improved survival of colon cancer due to improved treatment and detection: A nationwide population-based study in The Netherlands 1989-2006 (Article)

2010-11-01T00:00:00Z

Background: We described changes in treatment of colon cancer over time and the impact on survival in The Netherlands in the period 1989-2006. Patients and methods: All 103 744 patients with invasive colon cancer during 1989-2006 in The Netherlands were included. Data were extracted from The Netherlands Cancer Registry. Trends in treatment over time were analysed and multivariable relative survival analysis was carried out. Results: The administration of adjuvant chemotherapy in stage III patients <75 years increased from 19% in 1989-1993 to 79% in 2004-2006 and from 1% to 19% in stage III patients ≥75 years. Among stage IV patients, resection rates of the primary tumour decreased from 72% to 63%, while chemotherapy administration increased from 23% to 64% in those <75 years. Survival increased from 52% to 58% in males and from 55% to 58% among females. Stage III patients with adjuvant chemotherapy exhibited a relative excess risk of 0.4 (95% confidence interval 0.4-0.4) compared with those without. Among stage IV patients, resection of primary tumour, palliative chemotherapy, and metastasectomy were important prognostic factors. Conclusions: There were substantial improvements in management and survival of colon cancer from 1989 to 2006. Stage III disease patients with colon cancer experienced the largest improvement in survival, most likely related to the increased administration of adjuvant chemotherapy.

Prostate cancer: Trends in incidence, survival and mortality in the Netherlands, 1989-2006 (Article)

2010-07-01T00:00:00Z

Background: Prostate cancer occurrence and stage distribution changed dramatically during the end of the 20th century. This study aimed to quantify and explain trends in incidence, stage distribution, survival and mortality in the Netherlands between 1989 and 2006. Methods: Population-based data from the nationwide Netherlands Cancer Registry and Causes of Death Registry were used. Annual incidence and mortality rates were calculated and age-adjusted to the European Standard Population. Trends in rates were evaluated by age, clinical stage and differentiation grade. Results: 120,965 men were newly diagnosed with prostate cancer between 1989 and 2006. Age-adjusted incidence rates increased from 63 to 104 per 100,000 person-years in this period. Two periods of increasing incidence rates could be distinguished with increases predominantly in cT2-tumours between 1989 and 1995 and predominantly in cT1c-tumours since 2001. cT4/N+/M+-tumour incidence rates decreased from 23 in 1993 to 18 in 2006. The trend towards earlier detection was accompanied by a lower mean age at diagnosis (from 74 in 1989 to 70 in 2006), increased frequency of treatment with curative intent and improved 5-year relative survival. Mortality rates decreased from 34 in 1996 to 26 in 2007. Conclusions: The increase of prostate cancer incidence in the early 1990s was probably caused by increased prostate cancer awareness combined with diagnostic improvements (transrectal ultrasound, (thin) needle biopsies), but not PSA testing. The subsequent peak since 2001 is probably attributable to PSA testing. The decline in prostate cancer mortality from 1996 onwards may be the consequence of increased detection of cT2-tumours between 1989 and 1995. Unfortunately, data on the use of PSA tests and other prostate cancer diagnostics to support these conclusions are lacking.

Marked improvements in survival of patients with rectal cancer in the Netherlands following changes in therapy, 1989-2006 (Article)

2010-05-01T00:00:00Z

Background: Since the 1990s, treatment of patients with rectal cancer has changed in the Netherlands. Aim of this study was to describe these changes in treatment over time and to evaluate their effects on survival. Methods: All patients in the Netherlands Cancer Registry with invasive primary rectal cancer diagnosed during the period 1989-2006 were selected. The Cochran-Armitage trend test was used to analyse trends in treatment over time. Multivariate relative survival analyses were performed to estimate relative excess risk (RER) of dying. Results: In total, 40,888 patients were diagnosed with rectal cancer during the period 1989-2006. The proportion of patients with stages II and III disease receiving preoperative radiotherapy increased from 1% in the period 1989-1992 to 68% in the period 2004-2006 for younger patients (<75 years) and from 1% to 51% for older patients (≥75 years), whereas the use of postoperative radiotherapy decreased. Administration of chemotherapy to patients with stage IV disease increased over time from 21% to 66% for patients younger than 75 years. Both males and females exhibited an increase in five-year relative survival from 53% to 60%. The highest increase in survival was found for patients with stage III disease. In the multivariate analyses survival improved over time for patients with stages II-IV disease. After adjustment for treatment variables, this improvement remained significant for patients with stages III and IV disease. Conclusions: The changes in therapy for rectal cancer have led to a markedly increased survival. Patients with stage III disease experienced the greatest improvement in survival.

Why cancer survival may worsen (Article)

2010-01-07T00:00:00Z

If cancer survival is reported to be worsening over time or inferior compared to other countries, politicians and health-care workers may get blamed because suboptimal care is presumed to be the cause. Yet, a variety of reasons exist for cancer survival statistics to change for the worse, of which deterioration of care is only one. Another explanation is that the improved diagnosis of premalignant lesions causes survival statistics to reflect only the most aggressive cancers-those with the poorest prognosis. In addition, deleterious changes in the distribution of prognostic factors and in the distribution of sociodemographic characteristics may negatively affect survival proportions. In this article, we identify the pitfalls that might be encountered in comparisons of published, population-based survival data from different time periods or populations.

Explanations for worsening cancer survival (Article)

2010-01-01T00:00:00Z

Centralization of Esophageal Cancer Surgery: Does It Improve Clinical Outcome? (Article)

2009-07-01T00:00:00Z

Background: The volume-outcome relationship for complex surgical procedures has been extensively studied. Most studies are based on administrative data and use in-hospital mortality as the sole outcome measure. It is still unknown if concentration of these procedures leads to improvement of clinical outcome. The aim of our study was to audit the process and effect of centralizing oesophageal resections for cancer by using detailed clinical data. Methods: From January 1990 until December 2004, 555 esophagectomies for cancer were performed in 11 hospitals in the region of the Comprehensive Cancer Center West (CCCW); 342 patients were operated on before and 213 patients after the introduction of a centralization project. In this project patients were referred to the hospitals which showed superior outcomes in a regional audit. In this audit patient, tumor, and operative details as well as clinical outcome were compared between hospitals. The outcome of both cohorts, patients operated on before and after the start of the project, were evaluated. Results: Despite the more severe comorbidity of the patient group, outcome improved after centralizing esophageal resections. Along with a reduction in postoperative morbidity and length of stay, mortality fell from 12% to 4% and survival improved significantly (P = 0.001). The hospitals with the highest procedural volume showed the biggest improvement in outcome. Conclusion: Volume is an important determinant of quality of care in esophageal cancer surgery. Referral of patients with esophageal cancer to surgical units with adequate experience and superior outcomes (outcome-based referral) improves quality of care.

The beginning of the end of the lung cancer epidemic in Dutch women? (Article)

2008-09-15T00:00:00Z

In some European countries, female lung cancer mortality and incidence have started to decrease or flatten out, whereas they are still rising in The Netherlands. We present recent mortality and incidence trends of lung cancer and smoking trends in The Netherlands to show the end of the lung cancer epidemic in Dutch women. Lung cancer mortality and incidence rates by gender were analyzed for 4 age groups (20-44, 45-49, 50-54 and 55-59), and smoking prevalence rates were examined for women using joinpoint regression and birth cohort analysis. Data on mortality were collected for the period 1960-2006, incidence for the period 1989-2003 and smoking prevalence for the period 1988-2007. Because of decreasing lung cancer mortality and incidence rates among males and dramatically increasing rates among females, rates of young males were surpassed by those of females after the mid-1990s. However, although in young women (20-49) mortality increased with 4-5% per year, it flattened out (no significant inor decreases) since 1999. Among older women, mortality rates were still increasing markedly. Mortality rates and smoking prevalence tended to decrease in women born after the 1950s. This is the first report suggesting that the lung cancer epidemic in Dutch women is coming to an end. Although the increase in lung cancer incidence and mortality among Dutch women has been one of the most dramatic in Europe, the recent decrease in young women is expected to be followed by a future leveling off or a slight decrease in overall female lung cancer rates.

Recent trends of cancer in Europe: A combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s (Article)

2008-07-01T00:00:00Z

Introduction: We present a comprehensive overview of most recent European trends in population-based incidence of, mortality from and relative survival for patients with cancer since the mid 1990s. Methods: Data on incidence, mortality and 5-year relative survival from the mid 1990s to early 2000 for the cancers of the oral cavity and pharynx, oesophagus, stomach, colorectum, pancreas, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, testis, kidney, bladder, and Hodgkin's disease were obtained from cancer registries from 21 European countries. Estimated annual percentages change in incidence and mortality were calculated. Survival trends were analyzed by calculating the relative difference in 5-year relative survival between 1990-1994 and 2000-2002 using data from EUROCARE-3 and -4. Results: Trends in incidence were generally favorable in the more prosperous countries from Northern and Western Europe, except for obesity related cancers. Whereas incidence of and mortality from tobacco-related cancers decreased for males in Northern, Western and Southern Europe, they increased for both sexes in Central Europe and for females nearly everywhere in Europe. Survival rates generally improved, mostly due to better access to specialized diagnostics, staging and treatment. Marked effects of organised or opportunistic screening became visible for breast, prostate and melanoma in the wealthier countries. Mortality trends were generally favourable, except for smoking related cancers. Conclusion: Cancer prevention and management in Europe is moving in the right direction. Survival increased and mortality decreased through the combination of earlier detection, better access to care and improved treatment. Still, cancer prevention efforts have much to attain, especially in the domain of female smoking prevalence and the emerging obesity epidemic.

High-volume versus low-volume for esophageal resections for cancer: The essential role of case-mix adjustments based on clinical data (Article)

2008-01-01T00:00:00Z

Background: Most studies addressing the volume-outcome relationship in complex surgical procedures use hospital mortality as the sole outcome measure and are rarely based on detailed clinical data. The lack of reliable information about comorbidities and tumor stages makes the conclusions of these studies debatable. The purpose of this study was to compare outcomes for esophageal resections for cancer in low- versus high-volume hospitals, using an extensive set of variables concerning case-mix and outcome measures, including long-term survival. Methods: Clinical data, from 903 esophageal resections performed between January 1990 and December 1999, were retrieved from the original patients' files. Three hundred and forty-two patients were operated on in 11 low-volume hospitals (<7 resections/year) and 561 in a single high-volume center. Results: Mortality and morbidity rates were significantly lower in the high-volume center, which had an in-hospital mortality of 5 vs 13% (P < .001). On multivariate analysis, hospital volume, but also the presence of comorbidity proved to be strong prognostic factors predicting in-hospital mortality (ORs 3.05 and 2.34). For stage I and II disease, there was a significantly better 5-year survival in the high-volume center. (P = .04). Conclusions: Hospital volume and comorbidity patterns are important determinants of outcome in esophageal cancer surgery. Strong clinical endpoints such as in-hospital mortality and survival can be used as performance indicators, only if they are joined by reliable case-mix information.