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Navarro C.,Regional Health Authority | Navarro C.,CIBER ISCIII | Martos C.,Aragon Health science Institute | Ardanaz E.,CIBER ISCIII | And 14 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.


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 12 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.


Larranaga N.,CIBER ISCIII | Galceran J.,Pere Virgili Health Research Institute | Ardanaz E.,CIBER ISCIII | Ardanaz E.,Navarre Public Health Institute | And 12 more authors.
Annals of Oncology | Year: 2010

Background: Although prostate cancer has recently registered increasing incidence and decreasing mortality in Spain, no analysis has yet been made of these two indicators to ascertain the magnitude of and reasons for these trends. Materials and methods: The time trend in invasive prostate cancer incidence from 1975 to 2004 was studied by combining data from 13 Spanish population-based cancer registries. Change-point Poisson regression models were fitted for all men and for two age groups (45-64 and 65+ years). Age-period-cohort models were used to study cohort and period effects. In addition, we studied the time trend in prostate cancer mortality in Spain for the period 1980-2007. Results: Incidence increased annually by 1.3% from 1975 to 1990 and by 7.3% thereafter. Until 1990, the percentage increase was low and indeed similar for both age groups. While the subsequent increase in the two age groups was greater, this was particularly marked among the youngest men, with a decrease being observed in age groups >85 years in the last quinquennium. Mortality increased by an annual figure of 0.7% until 1998, after which it decreased by 3.6% per annum until 2007. Conclusions: Despite the dramatic rise in incidence from 1990 onwards, mainly due to opportunistic screening, prostate cancer mortality was only observed to decline slowly from 1998. If prostate-specific antigen screening remains at a similar level in Spain, overdiagnosis may well become an important chronic side-effect and health problem. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Lopez-Abente G.,Carlos III Institute of Health | Lopez-Abente G.,CIBER ISCIII | Ardanaz E.,CIBER ISCIII | Ardanaz E.,Navarre Public Health Institute | And 11 more authors.
Annals of Oncology | Year: 2010

Background: Some years ago, Spain registered a much lower colorectal cancer (CRC) incidence and mortality rate than did other European countries but the rates have since converged. This study sought to compare time trends for CRC incidence and mortality, identify change-points in these trends and thereby update available information in Spain. Methods: Incidence data were drawn from all population-based cancer registries in Spain which participated in the European Network of Cancer Registries and had been collecting data for at least 10 consecutive years during the period 1975-2004. Colorectal cancer corresponded to codes 153, 154 and 159.0 of the International Classification of Diseases ninth revision (ICD-9) and codes C18-C21 and C26.0 of the ICD-10. In all, the 13 registries included in this study cover ~26% of the total Spanish population. We evaluated the time trends in incidence and mortality using transition change-point and age-period-cohort models. Results: Our results revealed an important increase in CRC incidence in Spain, which held constant across the entire study period but became slightly attenuated in both sexes around 1995, when a change-point was detected. The annual increase in incidence, which had been 4.3% per annum in men up to this point, declined to 2.5% thereafter. In women, the increase in incidence, albeit also of considerable magnitude, was more moderate. The incidence trend contrasted sharply with that for mortality, inasmuch as the latter changed in 1997-98, after which point mortality rates in both sexes began to decline. Conclusions: The divergence between incidence (upward trend) and mortality rates (downward trend from the mid-1990s onwards) would suggest that possible explanations may lie in improved accessibility to endoscopy increased early detection with a corresponding shift to an earlier disease stage and improvements in therapy. This trend is having important consequences insofar as disease prevalence and burden of care are concerned. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Izarzugaza M.I.,Basque Country Cancer Registry | Ardanaz E.,Navarre Public Health Institute | Ardanaz E.,CIBER ISCIII | Chirlaque M.D.,Murcia Cancer Registry | And 11 more authors.
Annals of Oncology | Year: 2010

The association between tobacco use and lung cancer and other tumours has been confirmed by a large number of studies. In Spain, the prevalence of smoking has been declining since 1978. This study describes lung, bladder and laryngeal cancer mortality and incidence rates and their trends in Spain. Mortality data were furnished by the National Statistics Institute (2001-07) and incidence data by population-based cancer registries (1975-2004). Changes in rates were calculated using Poisson regression models, which enable trend changes to be estimated. In the case of lung cancer, mortality rates decreased among men [annual percentage change (APC) -1.3%] though not among women (APC 3.5%), whereas incidence rates increased in both sexes, overall and adjusted for registry, by 0.75% among men and 3.2% among women. Bladder cancer mortality rates decreased among men (APC -1.2%) and women (APC -0.8%), yet incidence rates increased across the sexes. While laryngeal cancer mortality rates decreased among men (APC -5.5%) and women (APC -0.03%) alike, incidence rates decreased (-1.28%) among men but not among women (3.95%). A decrease in male versus female mortality due to tobacco-related tumours is evident in Spain. Incidence rates are beginning to reflect the progressive cessation of smoking that has been observed among men rather than women. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Chirlaque M.D.,Murcia Cancer Registry | Chirlaque M.D.,CIBER ISCIII | Salmeron D.,Murcia Cancer Registry | Salmeron D.,CIBER ISCIII | And 10 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.


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.


News Article | February 16, 2017
Site: www.eurekalert.org

The consumption of butter, which is rich in saturated fatty acids and trans fats, has been related to a high risk of suffering from this disease Recently, dietary guidelines for the general population have shifted towards a plant-based diet (rich in legumes, whole-grain cereals, fruits, vegetables and nuts) and low in animal-based foods (like red meat and pastries). Increasing evidence is suggesting that plant-based diets are beneficial for health and they also have less impact on the environment. Researchers at the Unit of Human Nutrition of the Universitat Rovira i Virgili (Tarragona-Spain), in collaboration with other centers from the PREDIMED Study and Harvard University, have evaluated the associations between total and subtypes of fat intake and the risk of type 2 diabetes. In addition, they have evaluated the relationship between food sources rich in saturated fatty acids and the incidence of type 2 diabetes. The research's main findings showed that those participants who consumed higher amounts of saturated fatty acids and animal fat had a twofold higher risk of developing type 2 diabetes than those participants with a lower intake of saturated and animal fat. The consumption of 12 grams per day of butter was associated with a twofold higher risk of diabetes after 4.5 years of follow-up, whereas the intake of whole-fat yogurt was associated with a lower risk. The present study analyzed data from 3,349 participants in the PREDIMED Study who were free of diabetes at baseline but at high cardiovascular risk. After 4.5 years of follow-up, 266 participants developed diabetes. This study will be published in the scientific journal The American Journal of Clinical Nutrition in February 2017 and was led by doctors Marta Guasch-Ferré;, researcher at Harvard T.H. Chan School of Public Health, Nerea Becerra-Tomás, researcher at the URV's Unit of Human Nutrition, and Jordi Salas-Salvadó;, who is head of the URV's Unit of Human Nutrition, Clinical Director of Nutrition at the Internal Medicine Service of the Sant Joan University Hospital in Reus, principal investigator at the CIBERObn, and member of the Pere Virgili Health Research Institute (IISPV). According to the researchers, these findings emphasize the healthy benefits of a Mediterranean diet for preventing chronic diseases, particularly type 2 diabetes, and the importance of substituting saturated and animal fats (especially red and processed meat) for those found in vegetable sources such as olive oil and nuts.


Roman R.,Mar Teaching Hospital | Roman R.,Consortium for Biomedical Research in Epidemiology and Public Health | Sala M.,Mar Teaching Hospital | 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.


PubMed | Pere Virgili Health Research Institute, Public Health & Planning Directorate, Direccion General de Programas Asistenciales, Autonomous University of Barcelona and 8 more.
Type: Journal Article | Journal: PloS one | Year: 2013

Breast cancer incidence has decreased in the last decade, while the incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world. The phenomenon has been attributed to the widespread adaption of screening mammography. The aim of the study was to evaluate the temporal trends in the rates of screen detected invasive cancers and DCIS, and to compare the observed trends with respect to hormone replacement therapy (HRT) use along the same study period.Retrospective cohort study of 1,564,080 women aged 45-69 years who underwent 4,705,681 screening mammograms from 1992 to 2006. Age-adjusted rates of screen detected invasive cancer, DCIS, and HRT use were calculated for first and subsequent screenings. Poisson regression was used to evaluate the existence of a change-point in trend, and to estimate the adjusted trends in screen detected invasive breast cancer and DCIS over the study period.The rates of screen detected invasive cancer per 100.000 screened women were 394.0 at first screening, and 229.9 at subsequent screen. The rates of screen detected DCIS per 100.000 screened women were 66.8 at first screen and 43.9 at subsequent screens. No evidence of a change point in trend in the rates of DCIS and invasive cancers over the study period were found. Screen detected DCIS increased at a steady 2.5% per year (95% CI: 1.3; 3.8), while invasive cancers were stable.Despite the observed decrease in breast cancer incidence in the population, the rates of screen detected invasive cancer remained stable during the study period. The proportion of DCIS among screen detected breast malignancies increased from 13% to 17% throughout the study period. The rates of screen detected invasive cancer and DCIS were independent of the decreasing trend in HRT use observed among screened women after 2002.

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