Variation in Blame Attributions across Different Cancer Types

Background: People living with HIV (PLWH) are at an elevated risk of several cancer types. With widespread use of highly active antiretroviral therapy (HAART) to treat HIV, survival has improved among PLWH, resulting in an aging U.S. HIV population. Though HAART use has reduced the risk of certain cancers, in the near future, a larger fraction of PLWH will reach age groups where cancer risks are further elevated, potentially shifting the distribution of cancers in the population. Here, we projected cancer incidence rates and burden among U.S. PLWH through 2030 for Kaposi sarcoma, non-Hodgkin lymphoma (NHL) and cervical cancer (3 AIDS-defining cancers [ADCs]), and anal, breast, colon, lung, liver, prostate and oral cancers, Hodgkin lymphoma and all other cancers combined (all non-AIDS-defining cancers [NADCs]). Methods: We used cancer incidence data (2000-12) collected from the HIV/AIDS Cancer Match Study, a record linkage study of HIV and cancer registries. Using Poisson regression, we estimated cancer incidence rates in PLWH stratified by age group and, for some cancers, risk group (e.g., men who have sex with men, people who inject drugs) during 2013-30. The number of PLWH in the U.S. by age, risk group and calendar year (2006-30) was estimated using a dynamic compartmental model. To estimate cancer burden, observed and projected incidence rates and HIV population counts were multiplied. Results: The proportion of the total U.S. HIV population that is aged ≥65 years is projected to increase from 4.1% (of 1.06 million) in 2006 to 21.4% (of 1.09 million) in 2030. Based on significant declines during 2000-12, age-specific rates are projected to decrease across age groups for NHL, cervical cancer, lung cancer and all other cancers, and for some age groups for KS, Hodgkin lymphoma and colon cancer. All other age-specific rates did not change significantly, with the exception of prostate cancer rates, which are projected to continue to increase. We estimated that the total cancer burden in PLWH will decrease from 7908 cases in 2010 (2719 ADC and 5190 NADC) to 6495 cases in 2030 (701 ADC and 5794 NADC), indicating a strong decrease in ADCs and a slight increase in NADCs. In 2030, the most common cancers among PLWH will include: prostate (n=1624), lung (n=786), liver (n=498) and anal cancers (n=447) and NHL (n=429). Conclusions: Though cancer rates are generally decreasing, cancer will remain an important co-morbidity as the U.S. HIV population ages. If recent trends in cancer incidence continue into the future, the burden of NADCs, particularly prostate, lung, liver and anal cancers, will far exceed the burden of ADCs in 2030. Targeted cancer prevention, early detection and control efforts are needed for PLWH in the U.S., including smoking cessation, treatment of hepatitis C and B viruses, cancer screening and continued widespread treatment with HAART. Citation Format: Jessica Y. Islam, Philip S. Rosenberg, H Irene Hall, Evin U. Jacobson, Eric A. Engels, Meredith S. Shiels. Projections of cancer incidence and burden among the HIV-positive population in the United States through 2030 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5302. doi:10.1158/1538-7445.AM2017-5302

Adjuvant Chemotherapy Administration and Survival Outcomes in Lymphoma Survivors with Common Solid Tumors: A Population-Based Study

Introduction: Cardiovascular disease (CVD) and cancer share a common risk factor: chronic toxic stress/allostatic load (AL). Our previous research found that a 1-point increase in AL is linked to a 25-30% higher risk of major cardiac events (MACE) in prostate cancer patients. Hypothesis: Higher AL is associated with increased MACE risk in patients with breast, lung, and colon cancer. Methods: Patients ≥18 years diagnosed for the first time with the mentioned 3 cancers of interest between 2010-2019 at a large, hybrid academic-community practice were included in this retrospective cohort study. AL was modeled as an ordinal measure (0-11; Table 1 ). Adjusted Fine-Gray Cox proportional hazard regressions estimated the impact of AL pre- and 60 days post- cancer diagnosis on 2-year MACE. Results: Demographic characteristics are summarized in Table 1. Two-year mace MACE occurred in 12.3%, 23.3%, and 9.7% of breast, lung, and colon cancer patients, respectively. Heart failure was the most common MACE, observed in 7.9%, 14.4%, and 4.8% of breast, lung, and colon cancer patients, respectively. Before cancer diagnosis, a 1-point increase in AL raised MACE risk by 11% (aHR=1.11, 95% CI 1.07-1.16) in breast cancer, 18% (aHR=1.18, 95% CI 1.11-1.25) in lung cancer, and 9% (aHR=1.09, 95% CI 1.01-1.18) in colon cancer. After cancer diagnosis, a 1-point increase in AL increased MACE risk by 10% (aHR=1.10, 95% CI 1.06-1.15) in breast cancer and 19% (aHR=1.19, 95% CI 1.12-1.25) in lung cancer, but was not statistically significant in colon cancer (aHR=1.07, 95% CI 0.99-1.16). Conclusion(s): Higher AL levels prior to breast, lung, and colon cancer diagnoses are associated with increased MACE risk. Thus, effective implementation of patient-centered communication considering stress levels, stressors, and coping mechanisms is necessary during cardiovascular screening for these cancer patients. Further prospective studies are needed.

Health care is informed first and foremost by scientific and medical understanding of how to treat and prevent disease. Economics can, however, provide useful insights to inform policy in the design and implementation of the systems to provide health care, as well as in the process of prioritizing interventions to make the best use of scarce resources. Treating a single cancer patient may require the coordination of many inputs and may cost tens or even hundreds of thousands of dollars in high-income countries (HICs). Ongoing population cancer screening and early detection also require considerable coordination, including treatment for cases detected, and costs. Finally, although knowledge of cancer prevention is inadequate, prevention can be a costly endeavor—as demonstrated by the large sums spent on behavior change promotion (such as smoking cessation) or on vaccines to prevent cancer, such as against human papilloma virus to prevent cervical cancer and hepatitis B virus to prevent liver cancer—and economics can be informative.The second section of this chapter reviews how the availability of resources for cancer care varies by economic status, using the World Bank’s categories of low-income countries (LICs), middle-income countries (MICs) (comprising lower-middle-income countries and upper-middle-income countries), and HICs. At the same time, economy is not destiny. Countries at the same level of economic development differ because other factors intervene. Urbanization affects the patterns of cancer and the ability to access care. Local champions, governmental political leadership, and international partnerships can all loosen the constraints of local economic resources. Conversely, some countries are underachievers in cancer care despite their income level, perhaps because of leadership failures.The third section reviews the cost-effectiveness of interventions for cancer care, where care is here defined to include prevention. The cost-effectiveness of interventions has been well studied in HICs, but much less so in low- and middle-income countries (LMICs). This section summarizes the literature on the economics of cancer care in LMICs; the section also draws on the literature from HICs, particularly for cancer treatment, in areas where reliable studies for LMICs are particularly scarce. It may be possible to make inferences for one country using results from another country; the validity of these inferences rises with the extent of the similarities in the two countries. Where possible, we separate out the findings for high-income economies in Asia, since they are likely to be more relevant for LMICs in this region than the results from North America or Western Europe.We use the resource grouping suggested by Anderson and others (see chapter 3) for the Breast Health Global Initiative and apply this to other cancers. In this framework, facility resource environments fall into four categories of resource availability: Basic Limited Enhanced Maximal These categories are correlated with the World Bank income groupings. LICs have a preponderance of Basic facilities, rural areas in MICs have more facilities with Limited capabilities, urban areas in MICs have more facilities with Enhanced capabilities, and much of the population in HICs has access to facilities with Maximal capabilities. The implications for the availability of resources specific to cancer care are described. This section requires some interpolation on the authors’ part because of the paucity of previous work in the area and is subject to further validation by experts.The fourth and final section contains conclusions, consisting of summary recommendations of packages of cancer care appropriate for each of the four resource environments, as well as priority areas where further research is required. The appropriateness of a package is defined by feasibility (those resources can be expected to exist or could exist with reasonable investments) and by likely cost-effectiveness (within the limits of available data). Although there are internationally validated resource-specific care guidelines for breast cancer (the Breast Health Global Initiative), no such guidelines are available as yet for other cancers. The packages presented here have been validated in consultation with the chapter authors of this volume (chapters 3 through 8), but need to be further refined by expert consultation.

BackgroundCancer survivors are frequently excluded from clinical research, resulting in their omission from the development of many cancer treatment strategies. Quantifying the prevalence of prior cancer in newly diagnosed cancer patients can inform research and clinical practice. This study aimed to describe the prevalence, characteristics, and trends of prior cancer in newly diagnosed cancer patients in Japan.MethodsUsing Osaka Cancer Registry data, we examined the prevalence, characteristics, and temporal trends of prior cancer in patients who received new diagnoses of lung, stomach, colorectal, female breast, cervical, and corpus uterine cancer between 2004 and 2015. Site-specific prior cancers were examined for a maximum of 15 years before the new cancer was diagnosed. Temporal trends were evaluated using the Cochran-Armitage trend test.ResultsAmong 275,720 newly diagnosed cancer patients, 21,784 (7.9%) had prior cancer. The prevalence of prior cancer ranged from 3.3% (breast cancer) to 11.1% (lung cancer). In both sexes, the age-adjusted prevalence of prior cancer had increased in recent years (P values for trend < 0.001), especially in newly diagnosed lung cancer patients. The proportion of smoking-related prior cancers exceeded 50% in patients with newly diagnosed lung, stomach, colorectal, breast, and cervical cancer.ConclusionsThe prevalence of prior cancer in newly diagnosed cancer patients is relatively high, and has increased in recent years. Our findings suggest that a deeper understanding of the prevalence and characteristics of prior cancer in cancer patients is needed to promote more inclusive clinical research and support the expansion of treatment options.

Approximately 3% of invasive U.S. cancer diagnoses are made among veterans in a Veterans Affairs (VA) clinic each year, while VA patients only comprise about 1.9% of the U.S. population. Although some research has shown that veterans have higher incidence rates of cancer compared to civilians, evidence is sparse regarding possible disparities in rates of cancer screening between these populations. Thus, the purpose of this study is to compare differences in rates of screening for colorectal, lung, breast, and cervical cancers between current and former U.S. Military service members and civilians. Using the data extracted from the Behavioral Risk Factor Surveillance System, we assessed the rates of cancer screening among current and former U.S. Military service members compared to civilians from self-reported surveys assessing when individuals had been screened for colorectal or lung cancer among all participants and breast and cervical cancer among women participants. Persons greater than 25 years of age were included in the cervical cancer screening, 50 years of age for colon cancer screening, and 40 years of age for the breast cancer screening-the latter based on recommendations from the American Cancer Society. We used multivariate logistic regression models to determine the adjusted risk ratios (ARRs) of current and former U.S. Military service members receiving screening compared to civilians, adjusting for age, gender, race, education, and health care coverage. Current and former U.S. Military service members accounted for 2.6% of individuals included for the cervical cancer screening analysis, 2.2% for the breast cancer screening analyses, nearly 10% of the lung cancer screening, and 15% of the colorectal cancer (CRC) screening analyses. Prevalence of screening was higher for current and former U.S. Military service members among lung cancer and CRC. When controlling for age, race, education, and health care coverage, current and former U.S. Military service members were statistically more likely to be screened for CRC (ARR: 1.05; 95% confidence interval: 1.04-1.07) and lung cancer (ARR: 1.32; 95% confidence interval: 1.15-1.52). The odds of having completed a cervical or breast cancer screening were not significantly different between groups. Our study showed that current and former U.S. Military service members were more likely to complete CRC and lung cancer screenings, while no significant difference existed between each population with regard to cervical and breast cancer screenings. This is one of the few studies that have directly compared cancer screening usage among civilians and current and former U.S. Military service members. Although current and former U.S. Military service members were more likely to receive several cancer screenings, improvements can still be made to remove barriers and increase screening usage due to the disproportionate rates of cancer mortality in this population. These solutions should be comprehensive-addressing personal, organizational, and societal barriers-to improve prognosis and survival rates among current and former U.S. Military service members.

Introducing the Community Guide's Reviews of Evidence on Interventions to Increase Screening for Breast, Cervical, and Colorectal Cancers

One of the leading cause of death in the entire world is cancer. More than 10 millions of people die from cancer every year but with early identification and leading to prompt treatment could relieve people from suffering and death. There are several types of cancer among which 30% are preventable. Mostly women suffer from breast cancer and cervical cancer which are preventable with early diagnosis. This research was conducted to identify the opportunities and barriers in using current screening services for the early detection of cervical and breast cancer among rural women in tertiary care centre in Sitapur, U.P.: The systemic study was planned to perform at the Hind institute of medical sciences Sitapur. At the centre the research was performed through systemic sampling procedure and with the help of academic research and industry professionals. A statistical analysis was conducted to determine the comparison of factors associated with awareness of breast and cervical cancer among study population.: We observed and concluded that breast cancer is more common than cervical cancer in India. The knowledge about cervical cancer is relatively low among women which is revealed in this research.: This study is concluded by stating that the women in this study population have less knowledge about cervical cancer than breast cancer due to lack of education.Therefore, promoting awareness among people about cervical and breast cancer would lead to early identification and diagnosis which would help women with less suffering and cost effective treatment.

SummaryBackgroundThe knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of prophylactic vaccines to prevent HPV infection and HPV assays that detect nucleic acids of the virus. WHO has launched a Global Initiative to scale up preventive, screening, and treatment interventions to eliminate cervical cancer as a public health problem during the 21st century. Therefore, our study aimed to assess the existing burden of cervical cancer as a baseline from which to assess the effect of this initiative.MethodsFor this worldwide analysis, we used data of cancer estimates from 185 countries from the Global Cancer Observatory 2018 database. We used a hierarchy of methods dependent on the availability and quality of the source information from population-based cancer registries to estimate incidence of cervical cancer. For estimation of cervical cancer mortality, we used the WHO mortality database. Countries were grouped in 21 subcontinents and were also categorised as high-resource or lower-resource countries, on the basis of their Human Development Index. We calculated the number of cervical cancer cases and deaths in a given country, directly age-standardised incidence and mortality rate of cervical cancer, indirectly standardised incidence ratio and mortality ratio, cumulative incidence and mortality rate, and average age at diagnosis.FindingsApproximately 570 000 cases of cervical cancer and 311 000 deaths from the disease occurred in 2018. Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2·1 million cases), colorectal cancer (0·8 million) and lung cancer (0·7 million). The estimated age-standardised incidence of cervical cancer was 13·1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100 000 women. Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa. The highest incidence was estimated in Eswatini, with approximately 6·5% of women developing cervical cancer before age 75 years. China and India together contributed more than a third of the global cervical burden, with 106 000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India. Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore). The global average age at death from cervical cancer was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed.InterpretationCervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. The global scale-up of HPV vaccination and HPV-based screening—including self-sampling—has potential to make cervical cancer a rare disease in the decades to come. Our study could help shape and monitor the initiative to eliminate cervical cancer as a major public health problem.FundingBelgian Foundation Against Cancer, DG Research and Innovation of the European Commission, and The Bill & Melinda Gates Foundation.

Differences in the average age at cancer diagnosis are observed across countries. We therefore aimed to assess international variation in the median age at diagnosis of common cancers worldwide, after adjusting for differences in population age structure. We used IARC's Cancer Incidence in Five Continents (CI5) Volume XI database, comprising cancer diagnoses between 2008 and 2012 from population-based cancer registries in 65 countries. We calculated crude median ages at diagnosis for lung, colon, breast and prostate cancers in each country, then adjusted for population age differences using indirect standardization. We showed that median ages at diagnosis changed by up to 10 years after standardization, typically increasing in low- and middle-income countries (LMICs) and decreasing in high-income countries (HICs), given relatively younger and older populations, respectively. After standardization, the range of ages at diagnosis was 12 years for lung cancer (median age 61-Bulgaria vs 73-Bahrain), 12 years for colon cancer (60-the Islamic Republic of Iran vs 72-Peru), 10 years for female breast cancer (49-Algeria, the Islamic Republic of Iran, Republic of Korea vs 59-USA and others) and 10 years for prostate cancer (65-USA, Lithuania vs 75-Philippines). Compared to HICs, populations in LMICs were diagnosed with colon cancer at younger ages but with prostate cancer at older ages (both pLMICS-vs-HICs < 0.001). In countries with higher smoking prevalence, lung cancers were diagnosed at younger ages in both women and men (both pcorr < 0.001). Female breast cancer tended to be diagnosed at younger ages in East Asia, the Middle East and Africa. Our findings suggest that the differences in median ages at cancer diagnosis worldwide likely reflect population-level variation in risk factors and cancer control measures, including screening.

Cervical cancer is the fourth most common cancer among females worldwide. In spite of advances in detection and treatment, it is still one of the most dangerous gynecological malignancies in the world, especially in developing countries, and seriously threatens human health. Circular RNA (circRNA) is a special new type of endogenous noncoding RNA discovered recently. They form a covalently closed continuous loop and are specifically expressed in the eukaryotic transcriptome. With further understanding of circular RNA, a large number of studies have determined the key regulatory role of circRNA in a variety of diseases, especially cancer (including cervical cancer, liver cancer, and lung cancer). In addition, it has also been found that the abnormal expression of circRNA is related to its pathological characteristics in cervical cancer tissue, which can be used as a potential indicator for early screening and diagnosis of cervical cancer, targeted therapy, and prognosis prediction. This article summarizes the recent research achievements of circRNAs in cervical cancer. We briefly described the abnormal expression of circRNA in cervical cancer and discussed the involvement of circRNA in the occurrence process of cervical cancer by regulating cell proliferation, migration, invasion, and apoptosis. We believe that circRNA has potential value as a biomarker in the diagnosis and prognosis of cervical cancer.

Realizing the benefits of cancer screening requires testing of eligible individuals and processes to ensure follow-up of abnormal results. To test interventions to improve timely follow-up of overdue abnormal breast, cervical, colorectal, and lung cancer screening results. Pragmatic, cluster randomized clinical trial conducted at 44 primary care practices within 3 health networks in the US enrolling patients with at least 1 abnormal cancer screening test result not yet followed up between August 24, 2020, and December 13, 2021. Automated algorithms developed using data from electronic health records (EHRs) recommended follow-up actions and times for abnormal screening results. Primary care practices were randomized in a 1:1:1:1 ratio to (1) usual care, (2) EHR reminders, (3) EHR reminders and outreach (a patient letter was sent at week 2 and a phone call at week 4), or (4) EHR reminders, outreach, and navigation (a patient letter was sent at week 2 and a navigator outreach phone call at week 4). Patients, physicians, and practices were unblinded to treatment assignment. The primary outcome was completion of recommended follow-up within 120 days of study enrollment. The secondary outcomes included completion of recommended follow-up within 240 days of enrollment and completion of recommended follow-up within 120 days and 240 days for specific cancer types and levels of risk. Among 11 980 patients (median age, 60 years [IQR, 52-69 years]; 64.8% were women; 83.3% were White; and 15.4% were insured through Medicaid) with an abnormal cancer screening test result for colorectal cancer (8245 patients [69%]), cervical cancer (2596 patients [22%]), breast cancer (1005 patients [8%]), or lung cancer (134 patients [1%]) and abnormal test results categorized as low risk (6082 patients [51%]), medium risk (3712 patients [31%]), or high risk (2186 patients [18%]), the adjusted proportion who completed recommended follow-up within 120 days was 31.4% in the EHR reminders, outreach, and navigation group (n = 3455), 31.0% in the EHR reminders and outreach group (n = 2569), 22.7% in the EHR reminders group (n = 3254), and 22.9% in the usual care group (n = 2702) (adjusted absolute difference for comparison of EHR reminders, outreach, and navigation group vs usual care, 8.5% [95% CI, 4.8%-12.0%], P < .001). The secondary outcomes showed similar results for completion of recommended follow-up within 240 days and by subgroups for cancer type and level of risk for the abnormal screening result. A multilevel primary care intervention that included EHR reminders and patient outreach with or without patient navigation improved timely follow-up of overdue abnormal cancer screening test results for breast, cervical, colorectal, and lung cancer. ClinicalTrials.gov Identifier: NCT03979495.

SummaryBackgroundFew studies have investigated the risks of subsequent primary neoplasms after adolescent and young adult (AYA) cancer. We investigated the risks of specific subsequent primary neoplasms after each of 16 types of AYA cancer.MethodsThe Teenage and Young Adult Cancer Survivor Study is a population-based cohort of 200 945 survivors of cancer diagnosed when aged 15–39 years in England and Wales from Jan 1, 1971, to Dec 31, 2006. The cohort was established using cancer registrations from the Office for National Statistics and the Welsh Cancer registry. Follow-up was from 5-year survival until the first occurrence of death, emigration, or study end date (Dec 31, 2012). In this analysis, we focus on the risk of specific subsequent primary neoplasms after 16 types of AYA cancer: breast; cervical; testicular; Hodgkin lymphoma (female); Hodgkin lymphoma (male); melanoma; CNS (intracranial); colorectal; non-Hodgkin lymphoma; thyroid; soft-tissue sarcoma; ovarian; bladder; other female genital; leukaemia; and head and neck cancer. We report absolute excess risks (AERs; per 10 000 person-years) and cumulative incidence of specific types of subsequent primary neoplasm after each type of AYA cancer.FindingsDuring the 2 631 326 person-years of follow-up (median follow-up 16·8 years, IQR 10·5–25·2), 12 321 subsequent primary neoplasms were diagnosed in 11 565 survivors, most frequently among survivors of breast cancer, cervical cancer, testicular cancer, and Hodgkin lymphoma. AERs of any subsequent primary neoplasms were 19·5 per 10 000 person-years (95% CI 17·4–21·5) in survivors of breast cancer, 10·2 (8·0–12·4) in survivors of cervical cancer, 18·9 (16·6–21·1) in survivors of testicular cancer, 55·7 (50·4–61·1) in female survivors of Hodgkin lymphoma, and 29·9 (26·3–33·6) in male survivors of Hodgkin lymphoma. The cumulative incidence of all subsequent primary neoplasms 35 years after diagnosis was 11·9% (95% CI 11·3–12·6) in survivors of breast cancer, 15·8% (14·8–16·7) in survivors of cervical cancer, 20·2% (18·9–21·5) in survivors of testicular cancer, 26·6% (24·7–28·6) in female survivors of Hodgkin lymphoma, and 16·5% (15·2–18·0) in male survivors of Hodgkin lymphoma. In patients who had survived at least 30 years from diagnosis of cervical cancer, testicular cancer, Hodgkin lymphoma in women, breast cancer, and Hodgkin lymphoma in men, we identified a small number of specific subsequent primary neoplasms that account for 82%, 61%, 58%, 45%, and 41% of the total excess number of neoplasms, respectively. Lung cancer accounted for a notable proportion of the excess number of neoplasms across all AYA groups investigated.InterpretationOur finding that a small number of specific subsequent primary neoplasms account for a large percentage of the total excess number of neoplasms in long-term survivors of cervical, breast, and testicular cancer, and Hodgkin lymphoma provides an evidence base to inform priorities for clinical long-term follow-up. The prominence of lung cancer after each of these AYA cancers indicates the need for further work aimed at preventing and reducing the burden of this cancer in future survivors of AYA cancer.FundingCancer Research UK, National Institute for Health Research, Academy of Medical Sciences, and Children with Cancer UK.

Background: The incidence of cancer is on the rise in India as well as around the globe. Earlier oral, breast, and cervical cancers constituted a major burden of cancer in India. However, the recent world statistics suggest that the proportion of lung, colorectal, breast, and prostate cancers is increasing. The Indian National Cancer Registry reports provide robust data regarding the cancer incidence in India. Objectives: We aimed to analyze the Indian National Cancer Registry report of 2020 to determine whether there has been a change in the trend of cancer incidence. Materials and Methods: Six population-based cancer registries (PBCR) with the highest number of patients were selected from each zone of the country. From these, a total of 1,87,891 patients were included in the study to ensure a pan-India representation. The relative proportion of oral, breast, cervical, lung, ovarian, endometrial, and prostate cancers was determined from these PBCRs. The mean of these values for each of these cancer types from the six PBCRs was considered the mean proportion of these cancer types across the country. Results: According to data from the PBCRs, lung and oral cancers were found to be the leading cancer types among men, and breast and cervix uteri cancers among women. The mean relative proportions showed that oral, breast, and cervical cancers still constitute the major bulk of this disease in India. Moreover, it was observed that the incidence of lung cancer has significantly increased. Likewise, the incidence of the cancers of the prostate, ovary and endometrium is also on the rise. The highest age-adjusted incidence rates (AAR) for men were noted in the Aizawl district of Mizoram and the highest AAR for women was in Papumpare district of Arunachal Pradesh. Conclusion: There continues to be a disproportionately high incidence of cancers in northeast India. Policymakers and healthcare professionals should focus on the emerging cancers along with oral, breast, and cervical cancers, which still constitute the major cancer burden in our country.

Background: The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Cancer (CA) is an increasing public health burden for Ethiopia and Sub- Saharan Africa at large. In Ethiopia, hospital records show that there are more than 150,000 cancer cases per year and currently cancer accounts for 4% of all deaths. Objective: The present prospective cross-sectional study was designed to assess the prevalence of cancer and its associated risk factors in patients visiting Tikur Anbessa Specialized Hospital (TASH). Methods: A prospective cross-sectional study was carried out in patients of all age groups visiting oncology unit of TASH during the study period of November 2015 to June 2016. Sample size was computed using margin of error 5%, confidence level of 95% and estimating cancer patients visiting TASH per annum equal to 20000. The response distribution was taken 10%, considering the 2012 Cancer Prevalence Report of the WHO in East Africa 5% to 10%. The calculated sample size then was 142. Result and discussion: The mean age of the participants in our study was 42.27 year with a standard deviation of 16.8, and 2 and 86 years were the age range. More than half of the patients in the study (61.3%, n=87) were females and about (38.7%, n=55) were males. In the study area uterine, breast, cervical, colorectal and gastric CA were more prevalent in the age group between 25-49 years while Acute Lymphoblastic Leukemia (ALL) was more common in 13-18 years of age, Ewing sarcoma was seen in age between 19 and 24 years. In our findings, breast CA (14.8%, n=21) was the most frequent type of CA followed by uterine CA (14.1%, n=20), colorectal CA (11.3%, n=16), gastric cancer CA (7.7%, n=11), cervical and esophageal cancers (7%, n=10). ALL was commonly seen in students, while gastric, lung, AML, osteosarcoma; and squamous cell CA were common in farmers. Furthermore, among 20 patients who had breast CA, 65% (n=13) were used contraceptives at least once in their last 10 years period, while uterine cancer patients (40%, n=8) were used either oral or injectable contraceptives. The prevalence of breast CA was not affected by the duration of contraceptive use rather it was stable across the duration of use. Many patients who were developed colorectal CA 12 (8.5%) and gastric CA 9 (6.3%) were reported that they were regularly consuming uncooked red meat as their favorite meal. In our study, many patients were receiving radiation therapy for cases such as uterine, breast, cervical and colorectal CA while chemotherapy was predominantly used in cases such as colorectal, squamous cell, osteosarcoma, ALL, AML and lung cancer. The multinomial regression analysis result further revealed that there was a significant association between breast CA with age (25-49 year, P. value 0.016), Uterine and Cervical CA with gender (female, P. value 0.001); and eating of uncooked red raw meat with colorectal CA (P. value 0.011). Conclusion: Cancer prevalence in the study area looks greatly jeopardizing the life of many Ethiopians in association with life styles. Hence, further studies should be done. Awareness creation programs to the people, allocation of public health preventive medicine approaches and in-depth governmental involvement in the area are highly needed.