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Recent incidence and surgery trends for prostate cancer: Towards an attenuation of overdiagnosis and overtreatment?

ABSTRACT: BACKGROUND:Screening for prostate cancer is frequent in high-income countries, including Switzerland. Notably due to overdiagnosis and overtreatment, various organisations have recently recommended against routine screening, potentially having an impact on incidence, mortality, and surgery rates. Our aim was therefore to examine whether secular trends in the incidence and mortality of prostate cancer, and in prostatectomy rates, have recently changed in Switzerland. METHODS:We conducted a population-based trend study in Switzerland from 1998 to 2012. Cases of invasive prostate cancer, deaths from prostate cancer, and prostatectomies were analysed. We calculated changes in age-standardised prostate cancer incidence rates, stratified by tumor stage (early, advanced), prostate cancer-specific mortality, and prostatectomy rates. RESULTS:The age-standardised incidence rate of prostate cancer increased greatly in men aged 50-69 years (absolute mean annual change +4.6/100,000, 95% CI: +2.9 to +6.2) between 1998 and 2002, and stabilised afterwards. In men aged ? 70 years, the incidence decreased slightly between 1998 and 2002, and more substantially since 2003. The incidence of early tumor stages increased between 1998 and 2002 only in men aged 50-69 years, and then stabilised, while the incidence of advanced stages remained stable across both age strata. The rate of prostatectomy increased markedly until 2002, more so in the 50 to 69 age range than among men aged ? 70 years; it leveled off after 2002 in both age strata. Trends in surgery were driven by radical prostatectomy. Since 1998, the annual age-standardised mortality rate of prostate cancer slightly declined in men aged 50-69 years (absolute mean annual change -0.1/100,000, 95% CI: -0.2 to -0.1) and ? 70 years (absolute mean annual change -0.5/100,000, 95% CI: -0.7 to -0.3). CONCLUSIONS:The increases in the incidence of early stage prostate cancer and prostatectomy observed in Switzerland among men younger than 70 years have concomitantly leveled off around 2002/2003. Given the decreasing mortality, these trends may reflect recent changes in screening and clinical workup practices, with a possible attenuation of overdiagnosis and overtreatment.

SUBMITTER: Jegerlehner S

PROVIDER: S-EPMC6361620 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Recent incidence and surgery trends for prostate cancer: Towards an attenuation of overdiagnosis and overtreatment?

Jegerlehner Sabrina S Chiolero Arnaud A Aujesky Drahomir D Rodondi Nicolas N Germann Simon S Konzelmann Isabelle I Bulliard Jean-Luc JL

PloS one 20190204 2

<h4>Background</h4>Screening for prostate cancer is frequent in high-income countries, including Switzerland. Notably due to overdiagnosis and overtreatment, various organisations have recently recommended against routine screening, potentially having an impact on incidence, mortality, and surgery rates. Our aim was therefore to examine whether secular trends in the incidence and mortality of prostate cancer, and in prostatectomy rates, have recently changed in Switzerland.<h4>Methods</h4>We con ...[more]

PMID: 30716740

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Project description:BACKGROUND:It is estimated that one of the potential cause of the increasing prevalence of thyroid cancer (TC) is the easier and widespread access to diagnostic tools. If an individual evaluates the thyroid gland due to a mentioned mechanism without considering TC risk factors or symptoms, we can describe this phenomenon as cancer screening activity (CSA). AIM OF THE STUDY:We 1) estimated what types of TC were diagnosed due to CSA, 2) analyzed what clinicopathological features were characteristic of TCs diagnosed by CSA, 3) determined if these features were characteristic of indolent cases, and finally we 4) assessed whether CSA could have resulted in the increasing incidence of potentially indolent papillary thyroid cancer (PTC). MATERIALS AND METHODS:A retrospective review of 4,701 medical records of patients admitted and surgically treated at one surgical center between 2008 and 2017 was performed. Among the enrolled patients, 569 (12.1%) had thyroid malignancy, and 514 (10.9%) were diagnosed with PTC. We divided these patients into two groups: 1) patients in whom TC diagnostics were performed without considering any TC risk factors or symptoms (CSA-yes) and 2) those in whom TC was diagnosed due to TC risk factors or symptoms (CSA-no). We then compared the clinicopathological features of these two groups. RESULTS:The most common type of TC diagnosed in the CSA-group was PTC (p = 0.024). CSA-yes patients showed a significantly lower degree of Tumor-Node-Metastasis (TNM) staging and demonstrated a significantly lower rate of multifocality, but not of bilaterality (p<0.0001 and p = 0.198, respectively). In the CSA-yes group, the number of TC foci was significantly lower than that in the CSA-no group (p<0.0001). All clinicopathological features characteristic of aggressive cases of TC were absent in CSA-yes patients (p<0.0001), while all features observed in CSA-yes patients were characteristic of indolent cases (p<0.0001). CONCLUSIONS:The use of CSA results in the diagnosis of indolent cases of PTC and may be one of the potential causes of overdiagnosis and overtreatment of this malignancy.

Project description:ImportanceSurgery after initial lumpectomy to obtain more widely clear margins is common and may lead to mastectomy.ObjectiveTo describe surgeons' approach to surgical margins for invasive breast cancer, and changes in postlumpectomy surgery rates, and final surgical treatment following a 2014 consensus statement endorsing a margin of "no ink on tumor."Design, setting, and participantsThis was a population-based cohort survey study of 7303 eligible women ages 20 to 79 years with stage I and II breast cancer diagnosed in 2013 to 2015 and identified from the Georgia and Los Angeles County, California, Surveillance, Epidemiology, and End Results registries. A total of 5080 (70%) returned a survey. Those with bilateral disease, missing stage or treatment data, and with ductal carcinoma in situ were excluded, leaving 3729 patients in the analytic sample; 98% of these identified their attending surgeon. Between April 2015 and May 2016, 488 surgeons were surveyed regarding lumpectomy margins; 342 (70%) responded completely. Pathology reports of all patients having a second surgery and a 30% sample of those with 1 surgery were reviewed. Time trends were analyzed with multinomial regression models.Main outcomes and measuresRates of final surgical procedure (lumpectomy, unilateral mastectomy, bilateral mastectomy) and rates of additional surgery after initial lumpectomy over time, and surgeon attitudes toward an adequate lumpectomy margin.ResultsThe 67% rate of initial lumpectomy in the 3729 patient analytic sample was unchanged during the study. The rate of final lumpectomy increased by 13% from 2013 to 2015, accompanied by a decrease in unilateral and bilateral mastectomy (P = .002). Surgery after initial lumpectomy declined by 16% (P < .001). Pathology review documented no significant association between date of treatment and positive margins. Of 342 responding surgeons, 69% endorsed a margin of no ink on tumor to avoid reexcision in estrogen receptor-positive progesterone receptor-positive cancer and 63% for estrogen receptor-negative progesterone- receptor-negative cancer. Surgeons treating more than 50 breast cancers annually were significantly more likely to report this margin as adequate (85%; n = 105) compared with those treating 20 cases or fewer (55%; n = 131) (P < .001).Conclusions and relevanceAdditional surgery after initial lumpectomy decreased markedly from 2013 to 2015 concomitant with dissemination of clinical guidelines endorsing a minimal negative margin. These findings suggest that surgeon-led initiatives to address potential overtreatment can reduce the burden of surgical management in patients with cancer.

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Recent incidence and surgery trends for prostate cancer: Towards an attenuation of overdiagnosis and overtreatment?

Publications

Recent incidence and surgery trends for prostate cancer: Towards an attenuation of overdiagnosis and overtreatment?

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