Cyprus Cancer Registry Health Monitoring Unit

Nicosia, Cyprus

Cyprus Cancer Registry Health Monitoring Unit

Nicosia, Cyprus
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Papathoma P.,National and Kapodistrian University of Athens | Thomopoulos T.P.,National and Kapodistrian University of Athens | Karalexi M.A.,National and Kapodistrian University of Athens | Ryzhov A.,National Institute of Cancer | And 37 more authors.
European Journal of Cancer | Year: 2015

Aim: Following completion of the first 5-year nationwide childhood (0-14. years) registration in Greece, central nervous system (CNS) tumour incidence rates are compared with those of 12 registries operating in 10 Southern-Eastern European countries. Methods: All CNS tumours, as defined by the International Classification of Childhood Cancer (ICCC-3) and registered in any period between 1983 and 2014 were collected from the collaborating cancer registries. Data were evaluated using standard International Agency for Research on Cancer (IARC) criteria. Crude and age-adjusted incidence rates (AIR) by age/gender/diagnostic subgroup were calculated, whereas time trends were assessed through Poisson and Joinpoint regression models. Results: 6062 CNS tumours were retrieved with non-malignant CNS tumours recorded in eight registries; therefore, the analyses were performed on 5191 malignant tumours. Proportion of death certificate only cases was low and morphologic verification overall high; yet five registries presented >10% unspecified neoplasms. The male/female ratio was 1.3 and incidence decreased gradually with age, apart from Turkey and Ukraine. Overall AIR for malignant tumours was 23/106 children, with the highest rates noted in Croatia and Serbia. A statistically significant AIR increase was noted in Bulgaria, whereas significant decreases were noted in Belarus, Croatia, Cyprus and Serbia. Although astrocytomas were overall the most common subgroup (30%) followed by embryonal tumours (26%), the latter was the predominant subgroup in six registries. Conclusion: Childhood cancer registration is expanding in Southern-Eastern Europe. The heterogeneity in registration practices and incidence patterns of CNS tumours necessitates further investigation aiming to provide clues in aetiology and direct investments into surveillance and early tumour detection. © 2015 Elsevier Ltd.


Karalexi M.A.,National and Kapodistrian University of Athens | Baka M.,Pan & Agl Kyriakou Childrens Hospital | Ryzhov A.,National Institute of Cancer | Zborovskaya A.,Belarusian Research Center for Pediatric Oncology | And 20 more authors.
European Journal of Cancer | Year: 2016

Aim To assess trends in survival and geographic disparities among children (0–14 years) with chronic myeloid leukaemia (CML) before and after the introduction of molecular therapy, namely tyrosine kinase inhibitors (TKIs) in Southern-Eastern European (SEE) countries and the USA. Methods We calculated survival among children with CML, acute lymphoblastic (ALL) and acute myeloid leukaemia (AML) in 14 SEE (1990–2014) cancer registries and the U.S. Surveillance, Epidemiology and End Results Program (SEER, 1990–2012). We used Kaplan–Meier curves and multivariate Cox regression models to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Results Among 369 CML cases, substantial improvements were noted in 2-year survival during the post-TKI (range: 81–89%) compared to pre-TKI period (49–66%; HR: 0.37, 95% CI: 0.23–0.60). Risk of death was three times higher for <5-year-old children versus those aged 10–14 years (HR: 3.03, 95% CI: 1.85–4.94) and 56% higher for those living in SEE versus SEER (HR: 1.56, 95% CI: 1.01–2.42). Regardless of geographic area and period of TKI administration, however, age seems to be a significant determinant of CML prognosis (pre-TKI period, HR0–4y: 2.71, 95% CI: 1.53–4.79; post-TKI period, HR0–4y: 3.38, 95% CI: 1.29–8.85). Noticeably, post-TKI survival in CML overall approximates that for ALL, whereas therapeutic advancements for AML remain modest. Conclusion Registry data show that introduction of molecular therapies coincides with revolutionised therapeutic outcomes in childhood CML entailing dramatically improved survival which is now similar to that in ALL. Given that age disparities in survival remain substantial, offering optimal therapy to entire populations is an urgent priority. © 2016 Elsevier Ltd


Karalexi M.A.,National and Kapodistrian University of Athens | Papathoma P.,National and Kapodistrian University of Athens | Thomopoulos T.P.,National and Kapodistrian University of Athens | Ryzhov A.,National Institute of Cancer | And 31 more authors.
European Journal of Cancer | Year: 2015

Aim: Childhood central nervous system (CNS) tumour registration and control programs in Southern and Eastern Europe remain thin, despite the lethal nature of the disease. Mortality/survival data were assembled to estimate the burden of malignant CNS tumours, as well as the potential role of sociodemographic survival determinants across 14 cancer registries of this region. Methods: Average age-adjusted mortality rates were calculated, whereas time trends were quantified through Poisson and Joinpoint regressions. Kaplan-Meier curves were derived for the maximum and the more recent (10 and 5. year) registration periods. Multivariate Cox regression models were used to assess demographic and disease-related determinants. Results: Variations in mortality (8-16 per million) and survival (5-year: 35-69%) were substantial among the participating registries; in most registries mortality trend was stable, whereas Bulgaria, having the highest starting rate, experienced decreasing annual mortality (-2.4%, p = 0.001). A steep decrease in survival rates was evident before the second year of follow-up. After controlling for diagnostic subgroup, age, gender and diagnostic year, Greece seemed to present higher survival compared with the other contributing registries, although the follow-up period was short. Irrespective of country, however, rural residence was found to impose substantial adverse repercussions on survival (hazard ratio (HR): 1.2, 95% confidence interval (CI): 1.1-1.4). Conclusion: Cross-country mortality and survival variations possibly reflect suboptimal levels of health care delivery and cancer control in some regions of Southern and Eastern Europe, notwithstanding questionable death certification patterns or follow-up procedures. Continuous childhood cancer registration and linkage with clinical data are prerequisite for the reduction of survival inequalities across Europe. © 2015 Elsevier Ltd.


Georgakis M.K.,National and Kapodistrian University of Athens | Karalexi M.A.,National and Kapodistrian University of Athens | Antunes L.,Portuguese Oncology Institute of Porto | Bastos J.,Portuguese Oncology Institute of Coimbra | And 21 more authors.
Cancer Causes and Control | Year: 2016

Purpose: To describe epidemiologic patterns of childhood (0–14 years) lymphomas in the Southern and Eastern European (SEE) region in comparison with the Surveillance, Epidemiology and End Results (SEER), USA, and explore tentative discrepancies. Methods: Childhood lymphomas were retrieved from 14 SEE registries (n = 4,702) and SEER (n = 4,416), diagnosed during 1990–2014; incidence rates were estimated and time trends were evaluated. Results: Overall age-adjusted incidence rate was higher in SEE (16.9/106) compared to SEER (13.6/106), because of a higher incidence of Hodgkin (HL, 7.5/106 vs. 5.1/106) and Burkitt lymphoma (BL, 3.1 vs. 2.3/106), whereas the incidence of non-Hodgkin lymphoma (NHL) was overall identical (5.9/106 vs. 5.8/106), albeit variable among SEE. Incidence increased with age, except for BL which peaked at 4 years; HL in SEE also showed an early male-specific peak at 4 years. The male preponderance was more pronounced for BL and attenuated with increasing age for HL. Increasing trends were noted in SEER for total lymphomas and NHL, and was marginal for HL, as contrasted to the decreasing HL and NHL trends generally observed in SEE registries, with the exception of increasing HL incidence in Portugal; of note, BL incidence trend followed a male-specific increasing trend in SEE. Conclusions: Registry-based data reveal variable patterns and time trends of childhood lymphomas in SEE and SEER during the last decades, possibly reflecting diverse levels of socioeconomic development of the populations in the respective areas; optimization of registration process may allow further exploration of molecular characteristics of disease subtypes. © 2016 Springer International Publishing Switzerland


Barbaric J.,Agency for Quality and Accreditation in Health Care and Social Welfare | Sekerija M.,Croatian Institute of Public Health | Coza D.,Oncological Institute Ion Chiricuta | Dimitrova N.,National Oncology Hospital | And 11 more authors.
European Journal of Cancer | Year: 2016

Introduction Most countries in South-Eastern Europe (SEE) have lower incidence, but higher mortality rates of malignant melanoma (MM) of the skin compared to North-Western Europe (NWE). We explored trends in MM incidence and mortality in SEE countries by sex and age and compared them with the trends in NWE. Methods We obtained data on incident cases and deaths from MM (ICD-10 code C43) from 11 population-based cancer registries in Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Malta, Romania, Serbia, Slovakia, Slovenia and Turkey. We calculated age-specific rates for 25-49 ('young'), 50-69 ('middle aged') and 70+ years ('older') and estimated the average annual percent of change in incidence and mortality trends 2000-2010 according to age group and sex, using joinpoint regression analysis. Findings The incidence rates of MM across the region were uniformly increasing. Significant increases in mortality rates were observed in middle aged men in Serbia and Bulgaria, middle aged women in Slovenia, older men in the Czech Republic, Serbia and Turkey, and older women in Slovenia and Serbia. Interpretation While MM incidence rates were still increasing across SEE, mortality trends diverged and were less favourable than in NWE. Empowering cancer registration and improving the quality of incidence and mortality data will be essential for monitoring progress in MM control. In the context of prevention of melanoma, disparities in early detection appear to be widening the gap between SEE and NWE, while the provision of care to patients with advanced disease is likely to prove a challenge for regional healthcare budgets. © 2015 Elsevier Ltd. All rights reserved.


Papathoma P.,National and Kapodistrian University of Athens | Thomopoulos T.P.,National and Kapodistrian University of Athens | Karalexi M.A.,National and Kapodistrian University of Athens | Ryzhov A.,National Institute of Cancer | And 37 more authors.
European Journal of Cancer | Year: 2015

Aim: Following completion of the first 5-year nationwide childhood (0-14 years) registration in Greece, central nervous system (CNS) tumour incidence rates are compared with those of 12 registries operating in 10 Southern-Eastern European countries. Methods: All CNS tumours, as defined by the International Classification of Childhood Cancer (ICCC-3) and registered in any period between 1983 and 2014 were collected from the collaborating cancer registries. Data were evaluated using standard International Agency for Research on Cancer (IARC) criteria. Crude and age-adjusted incidence rates (AIR) by age/gender/diagnostic subgroup were calculated, whereas time trends were assessed through Poisson and Joinpoint regression models. Results: 6062 CNS tumours were retrieved with non-malignant CNS tumours recorded in eight registries; therefore, the analyses were performed on 5191 malignant tumours. Proportion of death certificate only cases was low and morphologic verification overall high; yet five registries presented >10% unspecified neoplasms. The male/female ratio was 1.3 and incidence decreased gradually with age, apart from Turkey and Ukraine. Overall AIR for malignant tumours was 23/106 children, with the highest rates noted in Croatia and Serbia. A statistically significant AIR increase was noted in Bulgaria, whereas significant decreases were noted in Belarus, Croatia, Cyprus and Serbia. Although astrocytomas were overall the most common subgroup (30%) followed by embryonal tumours (26%), the latter was the predominant subgroup in six registries. Conclusion: Childhood cancer registration is expanding in Southern-Eastern Europe. The heterogeneity in registration practices and incidence patterns of CNS tumours necessitates further investigation aiming to provide clues in aetiology and direct investments into surveillance and early tumour detection. © 2015 Elsevier Ltd. All rights reserved.


Znaor A.,Croatian National Institute of Public Health | Van Den Hurk C.,Comprehensive Cancer Center South | Primic-Zakelj M.,Oncology Institute | Coza D.,Oncological Institute Ion Chiricuta | And 8 more authors.
European Journal of Cancer | Year: 2013

Introduction: Cancer registration coverage and cancer control programmes in South Eastern (SE) Europe, embracing about six new EU member states, remain thin, despite a relatively high incidence and mortality burden from avoidable cancers, particularly in males. We assembled the most recent cancer registry data to estimate the burden of the 17 most common cancers in the region, from Slovenia to Cyprus and Malta. Methods: Data were made available for analysis from Bulgaria, Croatia, Cyprus, Malta, Romania (Cluj County), Serbia, Slovenia and Turkey (Antalya and Izmir provinces). We analysed incidence and mortality of the 17 most common cancers (counts and age-standardised rates, for the most recent year available and for the period 1999-2008). We used Joinpoint regression to quantify recent trends. Findings: For much of SE Europe, there were no marked declines in overall cancer mortality rates during 1999-2008. In men, lung cancer incidence and mortality rates were high compared to other European countries (age-standardised rates (ASRW) of incidence being 50-60/100,000 in most of the countries), and still increasing in Bulgaria, Serbia and Turkey. Prostate cancer incidence rapidly increased throughout the region by 3-12% annually, largely without any clear declines in mortality. Colorectal cancer incidence increased throughout the region, as did mortality especially in Croatia, Serbia and Bulgaria (average annual percentage change (AAPC) 1.5-2%). In women, breast cancer mortality significantly declined in Slovenia, Croatia and Malta (Average Annual Percentage of Change [AAPC] -2%, -1% and -5%, respectively), but not elsewhere. Cervical cancer incidence rates remained very high in Romania, Serbia and Bulgaria (ASRW > 20/100,000). Interpretation: Our data confirmed the North West to South East Europe gradient of increasing incidence and mortality rates of tobacco-related cancers, as well as increasing mortality rates of screen-detectable cancers. The lack of decline in overall cancer mortality also indicates suboptimal levels of cancer control in the region. © 2013 Elsevier Ltd. All rights reserved.


PubMed | National Oncology Hospital, Institute of Public Health of Serbia, Oncological Institute Ion Chiricuta, Institute of Oncology and 15 more.
Type: | Journal: Hematological oncology | Year: 2016

Childhood (0-14years) lymphomas, nowadays, present a highly curable malignancy compared with other types of cancer. We used readily available cancer registration data to assess mortality and survival disparities among children residing in Southern-Eastern European (SEE) countries and those in the United States. Average age-standardized mortality rates and time trends of Hodgkin (HL) and non-Hodgkin (NHL; including Burkitt [BL]) lymphomas in 14 SEE cancer registries (1990-2014) and the Surveillance, Epidemiology, and End Results Program (SEER, United States; 1990-2012) were calculated. Survival patterns in a total of 8918 cases distinguishing also BL were assessed through Kaplan-Meier curves and multivariate Cox regression models. Variable, rather decreasing, mortality trends were noted among SEE. Rates were overall higher than that in SEER (1.02/10


PubMed | Institute of Public Health of Serbia, Institute of Oncology, G Gennimatas General Hospital, National and Kapodistrian University of Athens and 19 more.
Type: Journal Article | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2015

Childhood central nervous system (CNS) tumour registration and control programs in Southern and Eastern Europe remain thin, despite the lethal nature of the disease. Mortality/survival data were assembled to estimate the burden of malignant CNS tumours, as well as the potential role of sociodemographic survival determinants across 14 cancer registries of this region.Average age-adjusted mortality rates were calculated, whereas time trends were quantified through Poisson and Joinpoint regressions. Kaplan-Meier curves were derived for the maximum and the more recent (10 and 5 year) registration periods. Multivariate Cox regression models were used to assess demographic and disease-related determinants.Variations in mortality (8-16 per million) and survival (5-year: 35-69%) were substantial among the participating registries; in most registries mortality trend was stable, whereas Bulgaria, having the highest starting rate, experienced decreasing annual mortality (-2.4%, p=0.001). A steep decrease in survival rates was evident before the second year of follow-up. After controlling for diagnostic subgroup, age, gender and diagnostic year, Greece seemed to present higher survival compared with the other contributing registries, although the follow-up period was short. Irrespective of country, however, rural residence was found to impose substantial adverse repercussions on survival (hazard ratio (HR): 1.2, 95% confidence interval (CI): 1.1-1.4).Cross-country mortality and survival variations possibly reflect suboptimal levels of health care delivery and cancer control in some regions of Southern and Eastern Europe, notwithstanding questionable death certification patterns or follow-up procedures. Continuous childhood cancer registration and linkage with clinical data are prerequisite for the reduction of survival inequalities across Europe.


PubMed | National Oncology Hospital, Institute of Public Health of Serbia, Oncological Institute Ion Chiricuta, Institute of Oncology and 16 more.
Type: | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2016

To assess trends in survival and geographic disparities among children (0-14 years) with chronic myeloid leukaemia (CML) before and after the introduction of molecular therapy, namely tyrosine kinase inhibitors (TKIs) in Southern-Eastern European (SEE) countries and the USA.We calculated survival among children with CML, acute lymphoblastic (ALL) and acute myeloidleukaemia (AML) in 14 SEE (1990-2014) cancer registries and the U.S.Surveillance, Epidemiology and End Results Program (SEER, 1990-2012). We used Kaplan-Meier curves and multivariate Cox regression models to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).Among 369 CML cases, substantial improvements were noted in 2-year survival during the post-TKI (range: 81-89%) compared to pre-TKI period (49-66%; HR: 0.37, 95% CI: 0.23-0.60). Risk of death was three times higher for <5-year-old children versusthose aged 10-14 years (HR: 3.03, 95% CI: 1.85-4.94) and 56% higher for those living in SEE versusSEER (HR: 1.56, 95% CI: 1.01-2.42). Regardless of geographic area and period of TKI administration, however, age seems to be a significant determinant of CML prognosis (pre-TKI period, HRRegistry data show that introduction of molecular therapies coincides with revolutionised therapeutic outcomes in childhood CML entailing dramatically improved survival which is now similar to that in ALL. Given that age disparities in survival remain substantial, offering optimal therapy to entire populations is an urgent priority.

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