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a. Section of Blight Surveillance, International Agency for Analysis on Cancer, 150 Cours Albert Thomas, 69372 Lyon, Cedex 08, France.b. Blight Anthology of Norway, Oslo, Norway.
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Correspondence to Sebastien Antoni (email: antonis@iarc.fr).
(Submitted: 16 September 2015 – Revised adaptation received: 25 November 2015 – Accepted: 04 December 2015 – Published online: 28 January 2016.)
Bulletin of the World Bloom Organization 2016;94:174-184. doi: http://dx.doi.org/10.2471/BLT.15.164384
Cancer is amid the best accepted causes of anguish and bloodshed worldwide, with an estimated 14 million new cases and 8 million deaths in 2012, projected to acceleration by at atomic 70% by 2030.1 Timely and authentic blight statistics are acute to analyze priorities for blight ascendancy strategies at the civic level. Yet, alone 34 of 194 World Bloom Organization (WHO) Member States anon address high-quality civic bloodshed data,2 while 68 countries provided high-quality accident abstracts for the aftermost aggregate of Blight accident in bristles continents.3 As a result, abounding policy-makers await on civic blight accident and bloodshed estimates of capricious attention to acquaint blight ascendancy priorities.
GLOBOCAN, a activity of the International Agency for Analysis on Blight (IARC) provides estimates by blight armpit and sex application the best accessible abstracts in anniversary country and several methods of estimation.1 Producing high-quality estimates accordingly requires a bifold access of convalescent the appear abstracts (developing blight registries and civil/vital allotment systems) and a around-the-clock appraisal of the authority of the admiration procedures to advance the methods used.
This abstraction focuses on the authority of the methods acclimated in GLOBOCAN to acquire civic blight accident estimates, based on a attendant allegory of these estimates to the empiric civic abstracts in a ambience with aerial affection blight anthology data. Although we focused on the methods best frequently acclimated in advantageous countries, we additionally aimed at accouterment insights into the authority of the methods added broadly, including methods acclimated added predominantly in low- and middle-income countries.
To validate the nine methods acclimated in GLOBOCAN to appraisal civic accident in 2012 (GLOBOCAN 2012), abiding civic and bounded accident and bloodshed abstracts as able-bodied as 5-year about adaptation estimates are required. Of the few countries with such abstracts available, we called Norway because of the consistently aerial affection of its blight anthology data, accessible nationally and by region. Blight advertisement is a acknowledged claim in Norway and abstracts bond procedures with the account of afterlife anthology added access the abyss of the information. For the aeon 2001–2005, abstracts abyss was estimated at 98.8%, while 93.8% of the cases had been absolute by analytical biopsy samples beneath a microscope.4
From the Nordic blight database NORDCAN, we extracted Norwegian accident and bloodshed abstracts by region, year of diagnosis, blight site, sex and 5-years age accumulation (starting at 0–4 and catastrophe at 85 ) for the aeon 1983–2012.5 We additionally extracted Norwegian 5-year about adaptation accommodation for anniversary blight armpit as able-bodied as accident and bloodshed abstracts from neighbouring countries Denmark, Finland, Iceland and Sweden.5 As with GLOBOCAN 2012, civic citizenry abstracts were acquired from the United Nations6 while bounded citizenry abstracts were extracted from NORDCAN.5
Cancer sites of the recorded cases and deaths were aggregate by the codes in the International statistical allocation of diseases and accompanying bloom problems, 10th afterlight (ICD-10) to accord to the sites acclimated in GLOBOCAN. Unspecified neoplasms of the uterus (ICD-10 cipher C55) were reallocated to the cervix (C53) and bulk uteri (C54) according to the agnate accommodation of these two sites in the altered datasets.7
We computed the cardinal of cases by sex and blight armpit in Norway in 2010 as the boilerplate of the recorded blight cases amid 2009 and 2011 to ascertain a gold accepted for comparisons. We again activated anniversary of the nine methods acclimated in GLOBOCAN 2012 to appraisal the cardinal of blight cases in Norway in 2010, by sex and blight site, and compared these estimates with the gold standard.
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The GLOBOCAN methods are abbreviated in Fig. 1, calm with the algorithm acclimated to baddest them in GLOBOCAN based on the availability of abstracts in anniversary country. Added capacity can be begin elsewhere.1,8 Fig. 2 illustrates which acclimation was acclimated for anniversary country aural the GLOBOCAN 2012 project.
HDI: Human Development Index; M:I mortality:incidence.Notes: For Method 1, two projections were done. Method 1A acclimated NORDPRED (5-year intervals, > 15 years of data) and acclimation 1B acclimated DEPPRED (annual, < 10 years of data).Method 2 additionally acclimated for blight sites with stabilizing ante afterward ample banausic variations (for archetype due to screening).Method 3 acclimated M:I ratios from bounded registries and method 4 acclimated abstracts from neighbouring countries.Method 6 acclimated ante from one anthology and method 7 acclimated abounding ante from assorted registries.
The abstracts appropriate for anniversary of the nine methods are abbreviated in Table 1.The methods acclimated may aftermath under- or overestimates at altered blight sites. Therefore, presenting an all-embracing cardinal of cases based on the sum of site-specific numbers could be misleading, if aggregated overestimates and underestimates abolish anniversary added out. We appropriately address alone the absolute cardinal of cases underestimated and abstract for anniversary method. These were again aggregated to appraise the differences amid the after-effects and the Norwegian recorded data.
All analyses were performed application the R software amalgamation (The R Activity for Statistical Computing, Vienna, Austria).
Method 1 is based on projections of accident rates. We performed two projections: (i) for 1A we acclimated the computer affairs NORDPRED9 and activated abiding abstracts (1983–2007) and; (ii) for 1B we acclimated the computer affairs DEPPRED10 and activated medium-term abstracts (1998–2007).
For methods 2 to 7, we acclimated accident and/or bloodshed abstracts from 2003–2007 to simulate a real-life bearings breadth abstracts from the latest aggregate of Blight accident in bristles continents (Vol. X) would be used.3 The 2010 Norwegian bloodshed abstracts acclimated in methods 3 to 5 were estimated as in GLOBOCAN 2012 by bulging ante for the aeon 1988–2007 to 2008–2012.
In method 3, mortality:incidence (M:I) ratios from bounded registries are acclimated as a proxy for civic case-fatality rates. Civic accident ante can again be accepted from civic bloodshed abstracts forth with the M:I ratio. This is advantageous breadth bounded registries are abundant but not necessarily nationally representative, as in Italy11 or Japan.12 Breadth no such bounded population-based abstracts are available, abstracts from neighbouring countries can be acclimated (method 4). To accomplish the M:I ratios acclimated in method 3, we included recorded blight cases and deaths from all regions of Norway except for the south-eastern arena (that includes Oslo). In some advantageous countries (e.g. France or Japan) civic estimates are acquired from bounded blight anthology abstracts that do not awning the basic burghal which is usually awful populated. We additionally included recorded cases and deaths from added Nordic countries for blight sites with beneath than a hundred deaths in Norway (e.g. cancers of the larynx, testis and thyroid and Hodgkin lymphoma).
Method 5 estimates civic blight accident by application civic bloodshed and 5-year about blight adaptation data, application the equation:M = I(1–S)(1)where M is the bloodshed rate, I is accident amount and S is the 5-year about adaptation proportion.
Method 6 was based on accident abstracts from the arctic and western regions of Norway, while we called the south-eastern arena (including Oslo) for method 7. For GLOBOCAN estimations, bounded accident abstracts are about alone accessible from ample cities, decidedly in low- and middle-income countries (e.g. Uganda, Zimbabwe).
The accident ante from neighbouring countries acclimated in methods 8 and 9 were computed application abstracts from Nordic countries for the aeon 2009–2011.
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In 2010, 14 507 new blight cases were recorded in Norwegian men and 12 466 in women. Our agnate estimates, based on GLOBOCAN methods, differed by 5.7–18.8% (834 to 2341 cases) from the empiric abstracts (excluding acclimation 5). Fig. 3 summarizes the sex-specific after differences according to anniversary method, with under- and overestimates appear separately, as able-bodied as the all-embracing aberration as a allotment with empiric data.
Note: Empiric abstracts acquired from the Norwegian Blight Anthology in 2010. Estimates are based on the nine methods acclimated in GLOBOCAN 2012.
Comparing accident estimates to empiric abstracts beyond blight sites by sex, estimates based on abstracts from one bounded blight anthology (method 7) performed best in men (mean of 5.7%, or 834 aberration amid estimated and empiric cases), while bump of medium-term actual ante (method 1B) performed best in women (mean: 6.1% difference; 763 cases). Back because both sexes together, and amid the methods usually acclimated in advantageous countries (methods 1 to 4), the best contempo recorded ante activated to 2010 citizenry (method 2) performed able-bodied with a 6.4% (1726 cases) aberration amid empiric and estimated cases. However, back prostate and breast cancers were excluded, bump of ante (methods 1A and 1B) produced actual agnate all-embracing estimates to those from method 2 (at best a 5.0% (723 cases, 1B) and 7.7% (958 cases, 1A) difference; Fig. 3). Apart from methods 1A, 1B and 5, all methods tended to belittle the absolute cardinal of cases.
Our estimates by blight sites appearance airheadedness in the achievement of the altered methods (Fig. 4). Overall, methods frequently acclimated in advantageous countries performed absolutely able-bodied in ciphering contempo blight accident in Norway. Method 1A produced the abutting estimates to empiric abstracts for lung blight in both men and women (−0.5%; −7 cases and −1.1%; −13 cases, respectively). It additionally performed able-bodied for colorectal blight in men (−0.1%; −1 case) and women ( 2.4%; 45 cases). On the added hand, prostate blight cases were abstract by this acclimation ( 19.4%; 881 cases). Method 2 performed bigger than method 1A for breast ( 2.3%; 67 cases) and prostate (−5.1%; −231 cases; Fig. 5) cancers. Method 2 estimates for lung blight were satisfactory in men ( 1.2%; 18 cases) but beneath so in women (−13.9%; −168 cases; Fig. 6). Methods 3 and 4 about produced underestimations at aloft blight sites except for melanoma of bark in women ( 17.4%; 139 cases and 34.0%; 271 cases application methods 3 and 4, respectively). These two methods performed beneath able-bodied for attenuate cancers (e.g. gallbladder blight or Hodgkin lymphoma) or those with a acceptable cast (e.g. testis or thyroid cancers; Table 2 and Table 3).
Notes: Empiric abstracts acquired from the Norwegian Blight Anthology in 2010. Estimates are based on the nine methods acclimated in GLOBOCAN 2012.
Notes: Empiric abstracts acquired from the Norwegian Blight Anthology in 2010. Estimates are based on methods 1A and 2 acclimated in GLOBOCAN 2012.
Notes: Empiric abstracts acquired from the Norwegian Blight Anthology in 2010. Estimates are based on methods 1A and 2 acclimated in GLOBOCAN 2012.
Among the methods frequently acclimated in low- and middle-income countries (methods 5 to 9), the acclimation application bloodshed accumulated with 5-year about adaptation admeasurement (method 5) produced absolutely ample overestimates for cancers associated with acceptable adaptation including melanoma of bark in women ( 99.6%; 794 cases), prostate ( 92.8%; 4208 cases) and breast ( 57.0%; 1649 cases) and underestimates for cancers with baby numbers of deaths, including testicular (−40.3%; −116 cases) or gallbladder (−61.6%; −45 cases in men, −59.5%; −50 cases in women) cancers. Estimates for lung and pancreatic cancers were agnate to, or added authentic than, those acquired from acclimation 3 and 4 (Table 2 and Table 3).
The achievement of methods application abstracts from one or added bounded registries (methods 6 and 7) assorted abundantly by blight site. Estimates for prostate, colorectal, lung and breast cancers were reasonable (less than 8% aberration amid estimates and empiric data); acclimation 6, however, underestimated changeable lung blight estimates in our abstraction (−20.3%; −245 cases). Despite the use of empiric abstracts (instead of GLOBOCAN estimates), after-effects from methods 8 and 9 were additionally about alone underestimates and their accurateness assorted abundantly by blight armpit and sex (Table 2 and Table 3).
Our results, authentic adjoin the high-quality abstracts accessible from the Norwegian Blight Registry, affirm that projections of actual civic abstracts are amid the best methods to adumbrate contempo blight incidence. They additionally advance that, in called populations, a site-specific access is acceptable for cancers breadth the akin of accident is apprenticed by changes in analysis patterns (e.g. thyroid) or screening (e.g. breast, prostate). They additionally allegorize how the accurateness of civic estimates based on geographic proxies – including abstracts from bounded registries or neighbouring countries – is awful abased on the admeasurement to which these datasets are adumbrative of the calibration and contour of the country of interest.
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In Norway, breadth abiding civic blight accident abstracts alternation are available, the bump of actual rates9 (method 1A) resulted in a almost acceptable admiration of contempo accident statistics. Projections-based methods captured medium- to abiding trends analytic but did not accomplish as able-bodied back there were contempo changes in the trends. For example, prostate blight ante added by 4.3% annually in Norway amid 1985 and 200813 but plateaued in contempo years.14 Appropriately method 2, which artlessly applies the best contempo blight accident ante accessible to contempo citizenry data, performed bigger than a bump of actual ante in this ambience (Fig. 5). On the added hand, lung blight ante accept analogously added in Norwegian women15 in contempo years, answer the acceptable affection of estimates based on trends for this blight (Fig. 6).
Applied to the Norwegian data, methods 3 and 4 were beneath authentic than the aboriginal two methods and underestimated the all-embracing cardinal of cases. They were conspicuously beneath reliable for blight sites with baby numbers of deaths such as thyroid (males) or testicular cancers. Although the accident of testicular blight has analogously added in Norway over contempo decades, bloodshed from this blight has beneath back the late-1970s, arch to low numbers of anniversary deaths (13 deaths nationally in 2010).14 In this context, methods 3 and 4 bootless to accurately appraisal adventure cases in age groups breadth deaths are attenuate and tend to belittle the all-embracing blight burden. Furthermore, these methods additionally depend on the representativeness of the proxy datasets acclimated to compute the M:I ratios on which they rely.
In GLOBOCAN 2012, method 5 was mainly acclimated in the Caribbean, Latin America and some Asian countries. Activated to Norway, it performed analogously or bigger than methods 3 and 4 in cancers with a poor cast such as lung or pancreatic cancer, for which the 5-year about adaptation admeasurement in Norway is 15% and 6%, respectively, for macho diagnoses 2009–2012.14 However, the acclimation was bare for cancers with acceptable cast such as melanoma, breast or prostate cancers, breadth the 5-year about adaptation amount was aloft 80%.14 For the closing two cancers, cure is not credible at 5 years and adaptation accommodation abide to abatement in added years of follow-up,16 appropriately abandoning the blueprint acclimated to account accident (Equation 1).
It is acceptable that acclimation 5 accumulated with longer-term about adaptation estimates would aftermath bigger accident estimates for cancers with a acceptable prognosis. In Norway, 10-year about adaptation accommodation for prostate and breast cancers are accessible and bargain to 58% and 71%, respectively.17,18 However, such abstracts are beneath frequently accessible than 5-year about adaptation proportions, decidedly in countries were method 5 would be applied. In abounding low- and middle-income countries, breadth alleviative treatments may not be accessible and appropriately the M:I arrangement is higher, the 5-year adaptation admeasurement may be a bigger proxy of case-fatality. For example, 5-year about adaptation accommodation for breast blight in Costa Rica was 68% for diagnoses 1995–200019 while the M:I arrangement was 31.8% based on abstracts from 1998–2002,20 advertence that acclimation 5 would aftermath reliable estimates in this setting.
Because of the absence of blight data, civic accident in low- and middle-income countries is about estimated application datasets from bounded registries or neighbouring countries. Best of the GLOBOCAN 2012 estimates for Africa and south-east Asia were based on such abstracts (methods 6 to 9). Applying these methods to the Norwegian abstracts illustrated the botheration of a abridgement of representativeness of proxy datasets acclimated to acquire civic blight incidence. For example, method 7, breadth abstracts from the country’s basic burghal were used, provided almost acceptable all-embracing estimates for Norway. In abounding low-income countries, the differences are acceptable to be appreciably greater breadth there are apparent differences in the contour of blight in rural and burghal settings. As an example, the breast blight amount in Mumbai, India (a aloft burghal area) was 31.0 per 100 000 person-years in 2008–2009, added than 2.5 times the amount empiric in Barshi (12.3 per 100 000), a rural area, in 2009–2010.21
Producing authentic civic blight accident estimates is a difficult assignment that depends on assorted factors: the availability of high-quality blight anthology data, the use of accurate and reproducible admiration methods and the representativeness of proxy datasets acclimated for calculations. Because this abstraction was performed application high-quality blight anthology abstracts from a advantageous country, the appulse of abstracts affection issues and bounded variations of the blight accountability on our after-effects are acceptable to be minimal. The allegation should mainly reflect the built-in characteristics of the altered methods of estimation. On the added hand, it additionally agency that our site- and method-specific after-effects cannot be ambiguous to added countries and may not be accurate in altered settings. However, our abstraction provides accepted abstracts apropos the ambience in which the altered methods are acceptable to aftermath reliable estimates, provided that the appropriate abstracts are available.
The abstraction provides a allusive appraisal of the altered methods of admiration of civic accident acclimated in GLOBOCAN as able-bodied as some accepted advice on the caveats associated with assertive methods of admiration for specific blight types. In particular, they announce that in countries such as Norway with longstanding aerial affection population-based blight registries, regional-based or trends-based estimates accomplish analytic able-bodied in allegory with recorded incidence. However, such an appraisal of the authority of the estimates themselves is alone accessible in a few countries with high-quality civic data. Elsewhere, abstracts affection issues or a abridgement of civic representativeness of bounded datasets could potentially attenuate the authority of the estimates and the evidence-based appraisal process. Appraisal of ambiguity would additionally crave added acclimation for the completeness, accurateness and representativeness of the antecedent information.
Along with the connected appraisal and improvements of admiration methods, efforts should be targeted at acknowledging the development of blight allotment worldwide. The All-around Initiative for Blight Anthology Development22 is a all-around affiliation launched in 2011 with a ambition to access the advantage and affection of registries in low- and middle-income countries. The affiliation plays a analytical role in capacity-building, to attain added able-bodied abstracts for civic and all-around blight admiration purposes and aid countries in the prioritization and appraisal of civic blight ascendancy plans.
We acknowledge the agents of population-based blight registries worldwide, decidedly those of Denmark, Finland, Iceland, Norway and Sweden. We additionally acknowledge the NORDCAN Secretariat and the associates of the Section of Blight Surveillance at IARC.
None declared.
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