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Aragones N.,Carlos III Institute of Health | Aragones N.,Consortium for Biomedical Research in Epidemiology and Public Health | Izarzugaza M.I.,Basque Country Cancer Registry | Izarzugaza M.I.,Consortium for Biomedical Research in Epidemiology and Public Health | And 13 more authors.
Annals of Oncology | Year: 2010

Background: During recent decades, an increase in the incidence of certain oesophago-gastric cancer subtypes has been reported in some countries. This study sought to analyse oesophageal and gastric cancer incidence trends in Spain by sex, site and morphology for the period 1980-2004. Patients and methods: Oesophageal and gastric cancer cases were drawn from 13 Spanish population-based cancer registries. Time trends in sex- and age-standardised cancer incidence rates were analysed by subsite and histology over the study period, using change-point Poisson models. Results: Age-standardised oesophageal cancer incidence rates failed to register a significant trend over the study period. Overall, gastric cancer decreased from 27.21 and 13.44 cases per 100 000 person-years in 1980-84 to 20.21 and 8.68 in 2000-04, among men and women, respectively. Whereas oesophageal adenocarcinomas increased by ~5% per annum in both sexes, gastric cardia cancer increased during the study period in males only, though this increase was less pronounced. Among men, oesophageal squamous cell cancer and non-cardia cancer rates declined steadily from the mid-1980s onwards. Over the same period, there was a marked decrease in the incidence of oesophago-gastric cancer presenting with unspecified subsite or morphology. Conclusions: Changes in the prevalence of the main risk factors for these tumours might only partly explain oesophageal and gastric cancer rate trends by subtype. Reclassification, however, would appear to account for most of the divergence in oesophageal and gastric cancer trends by subtype over the study period. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Costa B.,Jordi Gol Primary Care Research Institute | Barrio F.,Jordi Gol Primary Care Research Institute | Pinol J.L.,Jordi Gol Primary Care Research Institute | Cabre J.J.,Jordi Gol Primary Care Research Institute | And 5 more authors.
BMC Medicine | Year: 2013

Background: To investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria.Methods: A cross-sectional primary-care study was conducted as the first part of an active real-life lifestyle intervention to prevent type 2 diabetes within a high-risk Spanish Mediterranean population. Individuals without diabetes aged 45-75 years (n = 3,120) were screened using the FINDRISC. Where feasible, a subsequent 2-hour oral glucose tolerance test and HbA1c test were also carried out (n = 1,712). The performance of the risk score was calculated by applying the area under the curve (AUC) for the receiver operating characteristic, using three sets of criteria (2-hour glucose, fasting glucose, HbA1c) and three diagnostic categories (normal, pre-diabetes, diabetes).Results: Defining diabetes by a single HbA1c measurement resulted in a significantly lower diabetes prevalence (3.6%) compared with diabetes defined by 2-hour plasma glucose (9.2%), but was not significantly lower than that obtained using fasting plasma glucose (3.1%). The FINDRISC at a cut-off of 14 had a reasonably high ability to predict diabetes using the diagnostic criteria of 2-hour or fasting glucose (AUC = 0.71) or all glucose abnormalities (AUC = 0.67 and 0.69, respectively). When HbA1c was used as the primary diagnostic criterion, the AUC for diabetes detection dropped to 0.67 (5.6% reduction in comparison with either 2-hour or fasting glucose) and fell to 0.55 for detection of all glucose abnormalities (17.9% and 20.3% reduction, respectively), with a relevant decrease in sensitivity of the risk score.Conclusions: A shift from glucose-based diagnosis to HbA1c-based diagnosis substantially reduces the ability of the FINDRISC to screen for glucose abnormalities when applied in this real-life primary-care preventive strategy. © 2013 Costa et al; licensee BioMed Central Ltd.

Roman R.,Institute Municipal Dinvestigacio Medica Parc Of Salut Mar | Roman R.,Consortium for Biomedical Research in Epidemiology and Public Health | Sala M.,Institute Municipal Dinvestigacio Medica Parc Of Salut Mar | Sala M.,Consortium for Biomedical Research in Epidemiology and Public Health | And 13 more authors.
Breast Cancer Research and Treatment | Year: 2011

False-positive results may influence adherence to mammography screening. The effectiveness of breast cancer screening is closely related to adequate adherence among the target population. The objective of this study was to evaluate how false-positives and women's characteristics affect the likelihood of reattendance at routine breast cancer screening in a sequence of routine screening invitations. We performed a retrospective cohort study of 1,371,218 women aged 45-69 years, eligible for the next routine screening, who underwent 4,545,346 screening mammograms from 1990 to 2006. We estimated the likelihood of attendance at seven sequential screening mammograms. Multilevel discrete time hazard models were used to estimate the effect of false-positive results on reattendance, and the odds ratios (OR) of non-attendance for the women's personal characteristics studied. The overall reattendance rate at the second screening was 81.7% while at the seventh screening was 95.6%. At the second screening invitation reattendance among women with and without a false-positive mammogram was 79.3 vs. 85.3%, respectively. At the fourth and seventh screenings, these percentages were 86.3 vs. 89.9% and 94.6 vs. 96.0%, respectively. The study variables associated with a higher risk of failing to participate in subsequent screenings were oldest age (OR = 8.48; 95% CI: 8.31-8.65), not attending their first screening invitation (OR = 1.12; 95% CI: 1.11-1.14), and previous invasive procedures (OR = 1.09; 95% CI: 1.07-1.10). The risk of non-attendance was lower in women with a familial history of breast cancer (OR = 0.97; 95% CI: 0.96-0.99), and those using hormone replacement therapy (OR = 0.96; 95% CI: 0.94-0.97). In conclusion, reattendance was lower in women with false-positive mammograms than in those with negative results, although this difference decreased with the number of completed screening participations, suggesting that abnormal results in earlier screenings more strongly influence behavior. These findings may be useful in providing women with accurate information and in improving the effectiveness of screening programs. © Springer Science+Business Media, LLC. 2011.

Chirlaque M.D.,Murcia Cancer Registry | Chirlaque M.D.,CIBER ISCIII | Salmeron D.,Murcia Cancer Registry | Salmeron D.,CIBER ISCIII | And 11 more authors.
Annals of Oncology | Year: 2010

Background: This study provides estimates of population-based relative survival in Spain for nine major cancers and reports results on cancer survival by region, gender and age group. Patients and methods: Our analysis covered eight Spanish regions, namely, Basque Country, Navarre, Girona, Tarragona, Castelló n, Albacete, Murcia and Granada, and included patients with cancer of the colon, rectum, lung, breast, ovary, prostate, testis, melanoma of skin and Hodgkin's lymphoma. Cases diagnosed during the period 1995-99 were followed up until 31 December 2004. For individual records, the maximum likelihood approach was used to estimate 5-year relative survival (5y-RS), with crude and adjusted 5y-RS being calculated. A statistical test was applied to explain significant geographical variations. Results: In the regions studied, the highest 5y-RS ratio was detected for lung cancer (adjusted 5y-RS of 12.4% in Navarre versus 6.1% in Granada) and the lowest for breast cancer (91.3% in Castelló n versus 81.2% in Albacete). 5y-RS for the respective cancer types was as follows: colon and rectal, 54.7% and 50.2%, respectively; ovarian, 43% overall, though much lower in the oldest age groups; prostate, 76%, rising to close to 80% in the 45-74 age group, with rates ranging from highest in Girona to lowest in Albacete; testicular, 95%, the type with the best prognosis; and Hodgkin's lymphoma, 85%, rising to 92% among young adults. In the case of melanoma of skin, the sex-related difference in 5y-RS was >10% for women. Conclusions: Although regional differences were identified for most tumours, these were more marked in lung cancer. Women showed better prognosis. Breast and prostate cancer registered lower survival among young than among middle-aged adults. The worst prognosis was for lung cancer and the best for cutaneous melanoma, with breast, prostate and Hodgkin's lymphoma displaying favourable and colon, rectum and ovary unfavourable prognoses. Identifying regional, gender- and age-related differences affords valuable knowledge for improving cancer care. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Navarro C.,Regional Health Authority | Navarro C.,CIBER ISCIII | Martos C.,Aragon Health science Institute | Ardanaz E.,CIBER ISCIII | And 15 more authors.
Annals of Oncology | Year: 2010

Population-based cancer registries (PBCRs) are a key element for cancer control. They measure cancer incidence and trends, provide indicators for planning and evaluating cancer control activities, and undertake research. The first two PBCRs in Spain were established in Zaragoza in 1960 and Navarre in 1970, but it was from 1980 to 1995 when most of the existing registries went into operation. Today, 26.5% of the Spanish population is served by a cancer registry. All registries' quality-control indicators meet the inclusion criteria for comparability and quality of data required by the International Agency for Research on Cancer, and indeed some fulfil most of the excellence criteria for gold standard certification. After their initiation into recording accurate and complete information targeted at ascertaining cancer incidence in their catchment areas, PBCRs are progressively broadening their scope and becoming increasingly involved in collecting and analysing additional data on patient care, diagnosis, disease stage, treatment and follow-up. Spanish registries have become actively engaged in research projects, domestic and international, at a rate that has risen remarkably in the past decade. The creation of a network of Spanish cancer registries is being considered, with the aim of its becoming a key player in developing standards for cancer registration, providing training and technical assistance, undertaking quality audits and promoting the use of cancer surveillance data to reduce the burden of cancer in Spain. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

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