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INTRODUCTION: This study aimed to determine the prevalence of colorectal cancer screening among cancer survivors and compare the likelihood of colorectal cancer screening among cancer survivors with that of the cancer-free general population. METHODS: A systematic search of MEDLINE (Ovid), EMBASE, PubMed, and CINAHL databases from inception through September 16, 2024 was conducted. Studies reporting colorectal cancer screening among cancer survivors or in both cancer survivors and cancer-free controls were included. Random effects meta-analyses were conducted to pool estimates. Analyses were performed across primary cancer sites where at least 3 studies were identified. RESULTS: Of the 2,492 articles identified, 59 fulfilled the inclusion criteria. The overall pooled prevalence of colorectal cancer screening (up to date for screening or had been screened during a specific time period after noncolorectal cancer diagnosis) was 0.53 (95% CI=0.46, 0.61), with estimates ranging from 0.72 (prostate) to 0.51 (breast) across primary cancer sites. Cancer survivors were more likely to participate in colorectal cancer screening than cancer-free controls (OR=1.39, 95% CI=1.26, 1.52), but there was some evidence of publication bias (Egger's test p=0.092). Study design, method of colorectal cancer screening ascertainment (self-report versus medical records), and first primary cancer site were significant sources of heterogeneity. DISCUSSION: Cancer survivors were more likely to undergo colorectal cancer screening than cancer-free controls, but overall rates were well below generally recommended levels for population-based screening. Future studies should evaluate the predictors of nonadherence to colorectal cancer screening among cancer survivors to inform policymakers in targeting populations with lower screening rates.
IntroductionHuman papillomavirus (HPV) is a well-established cause of cervical cancer and is increasingly recognized as an important risk factor for non-cervical cancers, including oropharyngeal, anal, vulvar, vaginal, and penile cancers. This study assessed temporal trends in the incidence of HPV-related cervical and non-cervical cancers in Canada and the Netherlands by sex assigned at birth and cancer type using population-based registry data.MethodsThis study is a registry-based observational study, in which we analyzed retrospective data from the Canadian Cancer Registry (1992-2022) and the Netherlands Cancer Registry (2000-2019) for HPV-related cancers. Age-standardized incidence rates, annual percentage changes (APC), and average annual percentage changes (AAPC), with corresponding 95% confidence intervals (95% CI), were estimated using Joinpoint regression.ResultsIn Canada, cervical cancer incidence rate generally declined since 1992 but has increased by 1.1% (0.5, 2.7) annually between 2013 and 2022. In the Netherlands, cervical cancer rates remained stable until 2015, followed by a 5.1% (1.9, 11.5) annual increase between 2015 and 2019. Non-cervical HPV-related cancers generally increased in both countries. In Canada, from 1992 to 2022, incidence rates increased for oropharyngeal (AAPC: 2.0% [1.6, 2.4]), anal (1.7% [1.3, 2.2]), and vulvovaginal (1.9% [1.6, 2.3]) cancers. In the Netherlands, from 2000 to 2019, incidence rates increased for anal (5.3% [4.2, 6.8]), vulvar (3.0% [2.2, 4.0]), penile cancers (2.8% [1.7, 4.0]), and oropharyngeal cancer (0.7% [0.1, 1.2]).ConclusionIn general, we observed similar trends in both countries: that the incidence of HPV-related cervical and non-cervical cancers in Canada and the Netherlands is rising. These findings highlight the need to expand HPV vaccination programs, optimize HPV-related cancer screening programs, and enhance public health initiatives for the prevention and early detection of non-cervical HPV-related cancers.
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BACKGROUND: Cancer is the leading cause of death and has major health and economic impacts on people in Canada. We sought to provide updated estimates of cancer incidence and mortality to highlight progress and areas of need for planning and awareness. METHODS: We estimated cases, deaths, and age-standardized incidence (ASIR) and mortality rates (ASMR) in 2026, standardized to the 2021 Canadian standard population, by sex and province or territory. We used data from the Canadian Cancer Registry (until 2022) and the Canadian Vital Statistics Death Database (until 2023). We modelled incidence and mortality with the canproj projection package. RESULTS: In Canada, an estimated 254 100 people will be diagnosed with cancer and 87 900 will die from cancer in 2026. Overall, the ASIR (591.4 per 100 000) and the ASMR (200.0 per 100 000) are projected to decrease from previous years. Lung, breast, prostate, and colorectal cancers are projected to account for 47% of all new cases. The ASIR for all cancers combined is anticipated to be 16% higher among males than females (642.2 v. 553.9 per 100 000), and the ASMR 36% higher (235.8 v. 172.8 per 100 000). Notable findings in cancer-specific rates by sex were observed. INTERPRETATION: Age-standardized cancer incidence and mortality rates are projected to decline in Canada; however, the numbers of new cases and deaths are expected to remain at high levels, given the growing and aging population, with differential impacts expected by sex. These findings suggest that continued investment and diligence are needed to continue the major progress in cancer control in the face of changing population demographics.
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BACKGROUND: Melanoma is a rapidly increasing cancer in Canada, largely due to ultraviolet radiation (UVR) exposure. The objective of this study was to examine age- and sex-specific melanoma incident trends in Canada to determine if public health efforts related to UVR exposure are having an impact on melanoma incidence. METHODS: Data on melanoma incidence was obtained from the Canadian Cancer Registry (1992-2022). Annual percent changes in age-specific incidence rates were analyzed with segmented regression. Birth cohort effects were estimated with age-period-cohort models and reported as cohort incidence rate ratios (IRRs) with respect to the 1953-57 cohort. RESULTS: From 1992-2022, the incidence of melanoma has steadily increased for females over 40 and males over 50 with larger increases for older age groups. In contrast, melanoma rates have been decreasing for females under 30 and males under 40. Compared to the baby boom generation, recent birth cohorts (1998-2007 for males and 1993-2007 for females) have a lower incidence of melanoma. CONCLUSIONS: While melanoma rates continue to increase for older adults, incidence among younger Canadians is declining. These results may indicate that public health efforts are having an impact on melanoma prevention for recent birth cohorts.
Rates of colorectal cancer diagnosed before age 50 (early-onset colorectal cancer) are increasing in many countries. Many regions have lowered the age of screening initiation to 45 in response. Although early studies suggest increases in early cancer detection and improved outcomes among newly eligible individuals, some of the fastest increases are among those below 45, particularly for rectal cancers. In those below 45, population-wide screening is not likely to be cost-effective. Research to understand the factors driving the increases is essential in these younger groups. Recent data suggest that both novel and known exposures play a role. Novel initiators such as colibactin-producing Escherichia coli have been identified, and known promoters such as obesity, poor diet, and inactivity, among others, are increasing in prevalence among younger generations. Data from Baek and colleagues reinforce the role of metabolic and lifestyle factors, with differences observed between sexes. Their findings support the concept that early exposure to known promoters increases the risk of carcinogenesis. Future studies that incorporate biomarkers along with purposefully collected early-life data will be integral to identifying causal exposures and informing targeted cancer prevention strategies. See related article by Baek et al., p. 647.
The objectives of this study were to systematically identify studies that (i) quantified the prevalence of breast cancer screening among female survivors of a prior cancer other than breast cancer and (ii) compared the likelihood of undergoing breast cancer screening between cancer survivors and cancer-free controls. Effect estimates were pooled using random-effects meta-analyses. Stratified analyses were performed across primary cancer sites with three or more studies. Sixty-two studies were included in this review. The prevalence of breast cancer screening among female cancer survivors was 0.67 [95% confidence interval (CI), 0.62-0.71], ranging from 0.49 (lung) to 0.75 (cervical) across primary cancer sites. The prevalence of breast cancer screening was higher among studies that ascertained screening through self-report and studies conducted in North America. The odds of undergoing breast cancer screening were significantly greater among cancer survivors compared with cancer-free controls (odds ratio: 1.24; 95% CI, 1.13-1.36). Although cancer survivors had higher rates of breast cancer screening compared with cancer-free controls, overall rates were below population-based screening targets. Given that cancer survivors are at an elevated risk of subsequent breast cancer, future studies should evaluate predictors of screening nonadherence and explore targeted approaches to improve participation in breast cancer screening among cancer survivors.