Cancer Registry of Norway

Findings from family-based analyses, such as sibling comparisons, are often reported using only odds ratios or hazard ratios. We demonstrate how this can be improved upon by applying the marginalized between-within framework.We provide an overview of sibling comparison methods and the marginalized between-within framework, which enables estimation of absolute risks and clinically relevant metrics while accounting for shared familial confounding. We illustrate the approach using Swedish registry data to examine the association between maternal smoking and infant mortality, estimating absolute quantities (e.g., cumulative risks), average treatment effects, attributable fractions, and numbers needed to harm (or treat).The marginalized between-within model decomposes effects into within- and between-family components while applying a global baseline across all families. Although it typically yields similar relative estimates to conditional logistic or stratified Cox regression, the model's specification of a baseline enables the estimation of absolute measures. In the applied example, absolute measures provided more interpretable and policy-relevant insights than relative estimates alone. Code for implementation in Stata and R is provided.The marginalized between-within framework may strengthen the interpretability of family-based analysis by enabling absolute and policy-relevant estimates for both binary and time-to-event outcomes, moving beyond the limitations of solely relying on relative effect measures.

A positive surgical margin (PSM) after radical prostatectomy (RP) is considered an adverse surgical feature, but the clinical implications have been debated. Further motive to aim for negative margins (NSM) may be patient anxiety due to PSM, but studies on psychological consequences are lacking. We explored associations between psychological factors and PSM on a consecutive group of men after RP. Men with suspected prostate cancer were invited to a study on psychological factors. Patient reported outcome measurement questionnaires were collected before diagnosis, and at 6, 12 and 24 months from those who underwent RP. Multivariable mixed models and post hoc pairwise comparisons were used to explore associations between PSM and psychological outcomes. In total, 387 men had RP and 94 (24%) had PSM. General psychological outcomes were not associated with margin status. At 12 months, men with PSM considered their personal risk of recurrence 6% (30% vs. 24%) points higher and had clinical fear of recurrence (FoR) 14% (47% vs. 33%) more often than men with NSM. In adjusted and stratified analyses, men with pathological (p-)T2-stage and NSM had less FoR than the rest of the sample. In pT3-disease, PSM had no additional impact on FoR. A limitation was the small size of the pT2 group with PSM and the lack of information on how patients were informed. After RP, PSM was associated with higher FoR, particularly in men with pT2-cancer. Improved counselling and further research into causes and mitigation of FoR, is warranted.

Background and purposeAs more interventional clinical trials in Precision Cancer Medicine (PCM) are introduced, molecular descriptions of tumours have led to multiple subtypes, even within common tumour types. Therefore, the main limitation of these trials is the small number of eligible patients to assess the clinical benefit. The PRIME-ROSE project addresses this limitation by pooling data from multiple European Drug Rediscovery Protocol (DRUP)-like clinical trials, such that slowly accruing cohorts are accelerated. To achieve this task, a well-documented commonly approved procedure for data merging needs to be established.Patient/material and methodsData sharing is achievable when there is an organisation that includes people from different disciplines who can navigate institutional and country-specific information and governance requirements. Furthermore, alignment of all the study procedures are needed before data are shared. Next, the process of merging data requires harmonisation and standardisation. Implementation of the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) facilitates future data aggregation.ResultsBy aggregating data from European DRUP-like clinical trials, cohorts are completed that were unable to do so in stand-alone studies. Since initiation, the PRIME-ROSE project monitors over 300 cohorts across more than 20 treatments encompassing over 1,000 patients. At least 20 cohorts have progressed after interim analysis.InterpretationData sharing across European trials is feasible and enhances the advancements of PCM studies. The methodologies developed in the PRIME-ROSE project provide a foundation for future data integration efforts in PCM clinical trials, underscoring the viability of conducting robust trials in a global context.

IntroductionEsophageal and gastric cancers account for nearly 1.5 million new cases and 1.1 million deaths annually worldwide. In western countries, the incidence of esophageal cancer is rising while that of gastric cancer has decreased, although the pattern varies between the morphological types and subsites. We aim to describe the burden of esophageal and gastric cancers in Norway by providing national trends in incidence and mortality, separately for esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC), and for gastric ACs by gastric subsites.MethodsWe extracted information about all esophageal (ICD10 C15) and gastric cancer (ICD10 C16) patients diagnosed 1993‒2022 from the Cancer Registry of Norway. Age-standardized (European standard population) rates and performed joinpoint regression analyses were calculated to examine trends in incidence and mortality over time, for esophageal cancer SCC and AC and by subsite for gastric AC (cardia: ICD10 C16.0 and non-cardia: ICD10 C16.1–9). We used annual percent change (APC) and weighted average APC (AAPC), stratified by sex, age group, and stage at diagnosis.ResultsDuring 1993–2022, 6,433 esophageal cancers (2,616 SCC, 3,817 AC) and 14,453 gastric AC were diagnosed, and 4,683 esophageal and 10,421 gastric AC deaths occurred. The incidence and mortality of esophageal ACs increased whereas the rates for esophageal SCC declined in men and were stable in women. The highest AC incidence and mortality increases were seen in men (incidence AAPC = 2.8) and ages ≥70 years (incidence AAPC = 5.9). In contrast, the incidence and mortality of gastric cancer decreased over time, most pronounced for non-cardia gastric AC (incidence AAPC men =−5.3, women =−3.9).ConclusionThe incidence and mortality of esophageal AC has increased in Norway during the last decades, most pronounced in men, ages ≥70 years. The rates of SCCs decreased, although trends differed between sex and age groups. The incidence and mortality of gastric AC decreased in all age-groups for both sexes, especially for non-cardia gastric cancer.

<h3>Objective</h3> To investigate the association between low levels of benzene exposure (average intensity&lt;0.05 parts per million [ppm]) and risk of colorectal cancer (CRC) including its anatomical subsites. <h3>Material and Methods</h3> Among the 25,347 men in the NOPW cohort with offshore work history between 1965 and 1998, we prospectively identified 469 CRC cases 1999–2021 and compared them with 2031 non-cases drawn from the cohort in case-cohort analyses. Work histories were linked to job-exposure matrices for benzene and other occupational exposures. Weighted Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for overall CRC and anatomical subtypes (right- and left-sided colon cancer [RCC and LCC] and rectal), adjusted for age, body mass index, smoking, alcohol intake, red/processed meat intake, and physical activity. <h3>Results</h3> Risks of CRC increased with increasing benzene exposure. For all CRC, the HRs (95% CI) for the most exposed [quartile 4] vs the unexposed were 1.32 (0.96 to 1.81, [0.177–0.879 ppm-years]; p-trend=0.085) for cumulative, 1.52 (1.11 to 2.07, [17–34 years]; p-trend=0.032) for the duration, and 1.56 (1.15 to 2.12, [0.015–0.046 ppm]; p-trend=0.005) for average intensity of benzene exposure. For right-sided colon cancer, the association was most evident for exposure duration (HR=2.25, 1.33 to 3.80, quartile 4 [17–34 years] vs. unexposed; p-trend=0.007). Sensitivity analyses showed consistent associations. <h3>Conclusion</h3> Our results suggest that risks of CRC, and particularly RCC, increased with increasing duration of rollover shift work and benzene exposure in male offshore workers.

With the rapid advancement of quantum computing, research on quantum machine learning (QML) algorithms has grown significantly. Among these, the Quantum Neural Network (QNN) stands out as one of the promising algorithms that integrates the principles of quantum computing with artificial neural networks to process data. Inspired by applications of QNN across fields, we investigate their use in software testing for the Cancer Registry of Norway (CRN), part of the Norwegian Institute of Public Health (NIPH), responsible for cancer statistics among the Norwegian population. CRN develops a complex socio-technical software system, Cancer Registration Support System ( \(\mathtt{CaReSS}\) ), interacting with many entities (e.g., hospitals, medical laboratories, and other patient registries) to achieve its task. For cost-effective testing of \(\mathtt{CaReSS}\) , CRN has employed \(\mathtt{EvoMaster}\) , an AI-based REST API testing tool combined with an integrated classical machine learning model \(\mathtt{EvoClass}\) . Within this context, we propose \(\mathtt{EvoQlass}\) to investigate the feasibility of using, inside \(\mathtt{EvoMaster}\) , a QNN classifier, instead of the existing classical machine learning model. Results indicate that \(\mathtt{EvoQlass}\) can achieve performance comparable to that of \(\mathtt{EvoClass}\) . We further explore the effects of various QNN configurations on performance and offer recommendations for optimal QNN settings for future QNN developers.

Health-related quality of life (HRQoL) of breast cancer survivors has been extensively evaluated. However, HRQoL differences for women diagnosed by organized mammographic screening and women diagnosed due to symptoms have been sparsely described. We aimed to compare self-reported long-term HRQoL and quality adjusted life years (QALYs) between women with screen-detected breast cancer and women with symptomatic breast cancer, adjusting for histopathologic tumor characteristics and treatment. This study was nested within a cohort of women diagnosed with breast cancer by organized mammographic screening or due to symptoms 2006-2017 who responded a questionnaire measuring HRQoL (VAS, 0-100) and EQ-5D-5L 2019-2020. Responses to EQ-5D-5L were transformed into health utility values using a tariff based on preferences elicited in a national survey. Multivariable linear regression models were used to compare VAS-scores adjusting for tumor characteristics and treatment. QALYs were estimated by summing up the health utility values between the third and the fifth year since breast cancer diagnosis adjusting for breast cancer survival. Mean HRQoL (VAS) was 66.2 (standard deviation, SD: 21.1) for women with screen-detected breast cancer (n = 1141) and 62.5 (SD: 21.2) for women with symptomatic breast cancer (n = 1561). Women with screen-detected breast cancer had 3.8 (95 % confidence interval, CI, 2.3, 5.4) and 3.7 (95 %CI 2.1, 5.2) higher HRQoL VAS-scores compared to women with symptomatic breast cancer in the models adjusted for tumor characteristics and treatment, respectively. Women with screen-detected breast cancer and women with symptomatic breast cancer accrued 2.30 and 2.06 QALYs, respectively. Women with screen-detected breast cancer demonstrated higher estimates of long-term HRQoL and QALYs compared to women with symptomatic cancer. More favorable long-term quality of life outcomes were shown for women diagnosed with breast cancer by organized mammographic screening compared to women diagnosed due to symptoms.