Suchergebnisse

In this review we illustrate our view on the epidemiological relevance of geographically mapping cancer mortality. In the first part of this work, after delineating the history of cancer mapping with a view on interpretation of Cancer Mortality Atlases, we briefly illustrate the 'art' of cancer mapping. Later we summarise in a non-mathematical way basic methods of spatial statistics. In the second part of this paper, we employ the 'Atlas of Cancer Mortality in the European Union and the European Economic Area 1993-1997' in order to illustrate spatial aspects of cancer mortality in Europe. In particular, we focus on the cancer related to tobacco and alcohol epidemics and on breast cancer which is of particular interest in cancer mapping. Here we suggest and reiterate two key concepts. The first is that a cancer atlas is not only a visual tool, but it also contain appropriate spatial statistical analyses that quantify the qualitative visual impressions to the readers even though at times revealing fallacy. The second is that a cancer atlas is by no means a book where answers to questions can be found. On the contrary, it ought to be considered as a tool to trigger new questions.

Objective: To examine changes in colorectal cancer mortality in 34 European countries between 1970 and 2011. Design: Retrospective trend analysis. Data source: World Health Organization mortality database. Population: Deaths from colorectal cancer between 1970 and 2011. Profound changes in screening and treatment efficiency took place after 1988; therefore, particular attention was paid to the evolution of colorectal cancer mortality in the subsequent period. Main outcom esmeasures: Time trends in rates of colorectal cancer mortality, using joinpoint regression analysis. Rates were age adjusted using the standard European population. Results: From 1989 to 2011, colorectal cancer mortality increased by a median of 6.0% for men and decreased by a median of 14.7% for women in the 34 European countries. Reductions in colorectal cancer mortality of more than 25% in men and 30% in women occurred in Austria, Switzerland, Germany, the United Kingdom, Belgium, the Czech Republic, Luxembourg, and Ireland. By contrast, mortality rates fell by less than 17% in the Netherlands and Sweden for both sexes. Over the same period, smaller or no declines occurred in most central European countries. Substantial mortality increases occurred in Croatia, the former Yugoslav republic of Macedonia, and Romania for both sexes and in most eastern European countries for men. In countries with decreasing mortality, reductions were more important for women of all ages and men younger than 65 years. In the 27 European Union member states, colorectal cancer mortality fell by 13.0% in men and 27.0% in women, compared with corresponding reductions of 39.8% and 38.8% in the United States. Conclusion: Over the past 40 years, there has been considerable disparity in the level of colorectal cancer mortality between European countries, as well as between men and women and age categories. Countries with the largest reductions in colorectal cancer mortality are characterised by better accessibility to screening services, especially endoscopic screening, ...

Objective: To examine changes in colorectal cancermortality in 34 European countries between 1970 and 2011. Design: Retrospective trend analysis. Data source: World Health Organization mortality database. Population: Deaths from colorectal cancer between 1970and 2011. Profound changes in screening and treatment efficiency took place after 1988; therefore, particular attention was paid to the evolution of colorectal cancer mortality in the subsequent period. Main outcomes measures: Time trends in rates of colorectal cancer mortality, using joinpoint regression analysis. Rates were age adjusted using the standard European population. Results: From 1989 to 2011, colorectal cancer mortality increased by a median of 6.0% for men and decreased by a median of 14.7% for women in the 34 European countries. Reductions in colorectal cancer mortality of more than 25% in men and 30% in women occurred in Austria, Switzerland, Germany, the United Kingdom, Belgium, the Czech Republic, Luxembourg, and Ireland. By contrast, mortality rates fell by less than 17% in the Netherlands and Sweden for both sexes. Over the same period, smaller or no declines occurred in most central European countries. Substantial mortality increases occurred in Croatia, the former Yugoslav republic of Macedonia, and Romania for both sexes and in most eastern European countries for men. In countries with decreasing mortality, reductions were more important for women of all ages and men younger than 65 years. In the 27 European Union member states, colorectal cancer mortality fell by 13.0% in men and 27.0% in women, compared with corresponding reductions of 39.8% and 38.8% in the United States. Conclusion: Over the past 40 years, there has been considerable disparity in the level of colorectal cancer mortality between European countries, as well as between men and women and age categories. Countries with the largest reductions in colorectal cancer mortality are characterised by better accessibility to screening services, especially endoscopic screening, ...