Introdução: Estatísticas sobre a ocorrência de casos novos de câncer são fundamentais para o planejamento e monitoramento das ações de controle da doença. No estado de São Paulo, a incidência de câncer é obtida indiretamente por meio de estimativas oficiais (para o estado como um todo e sua capital) e, de forma direta, em municípios cobertos por Registro de Câncer de Base Populacional (RCBP). Existem, atualmente, três RCBP ativos (São Paulo, Jaú e Santos), um inativo (Barretos) e um em reimplantação (Campinas). Dado o desconhecimento do panorama da incidência de câncer em áreas não cobertas por RCBP, este estudo teve como objetivo estimar a incidência de câncer, calcular taxas brutas e padronizadas por idade, específicas por sexo e localização primária do tumor para as 17 Redes Regionais de Atenção à Saúde (RRAS) de São Paulo e municípios, em 2010. Método: Utilizou-se como estimador da incidência de câncer a razão Incidência/Mortalidade (I/M), por sexo, grupo etário quinquenal dos 0 aos 80 anos e localização primária do tumor. O numerador da razão foi formado pelo número agregado de casos novos entre 2006-2010, em dois RCBP ativos (Jaú e São Paulo, respectivamente, com cobertura correspondente a 0,3 por cento e 27,3 por cento da população estadual). No denominador, o número de óbitos oficial nas respectivas áreas e período. O número estimado de casos novos resultou da multiplicação das I/M pelo número de óbitos por câncer registrados em 2010 para o conjunto de municípios formadores de cada uma das RRAS ou para cada município. O método de referência foi aquele utilizado no Globocan series, da Agência Internacional de Pesquisa contra o Câncer. O ajuste por idade das taxas de incidência ocorreu pelo método direto, tendo como padrão a população mundial. Resultados: Estimaram-se 53.476 casos novos de câncer para o sexo masculino e 55.073 casos para o feminino (excluindo-se os casos de câncer de pele não melanoma), com taxas padronizadas de 261/100.000 e 217/100.000, respectivamente. No sexo masculino, a RRAS 6 apresentou para todos os cânceres a maior taxa de incidência padronizada (285/100.000), e a RRAS 10, a menor (207/100.000). Os cânceres mais incidentes em homens foram próstata (77/100.000), cólon/reto/anus (27/100.000) e traqueia/brônquio/pulmão (16/100.000). Entre as mulheres, as taxas de incidência padronizadas por idade foram de 170/100.000 (RRAS 11) a 252/100.000 (RRAS 07); o câncer de mama foi o mais incidente (58/100.000), seguido pelos tumores de cólon/reto/anus (23/100.000) e de colo uterino (9/100.000). Conclusões: Os resultados apontaram diferentes padrões de incidência com taxas que ultrapassaram a magnitude estadual. Dados provenientes de RCBP locais podem ser usados na obtenção indireta de estimativas regionais e locais. Neste estudo, as taxas de incidência apresentadas podem estar sub ou superestimadas refletindo a qualidade, completitude e padrões observados no RCBP de maior representatividade considerado na análise. / Introduction: Statistics on the occurrence of new cases of cancer are fundamental to the planning and monitoring of control measures. In Sao Paulo state, Brazil, cancer incidence can be obtained by the official estimates for the state as a whole and the capital and in municipalities covered by Population Based Cancer Registries (PBCR). The currently panorama of PBCR in Sao Paulo includes three active registries, one retired and one in re-deployment. Given the unknown cancer incidence in areas not covered by PBCR, this study aimed to estimate cancer incidence (standardized incidence rates = SIR) according to gender, age group and tumor type for 17 Regional Networks of Health Care (RNHC) and municipalities in São Paulo state, Brazil, in 2010. Methods: We used as estimator the Incidence:Mortality ratio (I:M) adjusted for sex, five-year age group (0-80 years) and primary tumor site. The ratio numerator was composed by the aggregated number of new cases diagnosed in 2006-2010 in two active PBCR, Jau and Sao Paulo, covering 0.3 per cent and 27.3 per cent of the state population, respectively, while the denominator was the official number of cancer deaths in the same areas and period. The estimated number of incident cases resulted from the multiplication of I:M by the number of deaths registered in 2010 for the set of municipalities that compose the region or for each local area. The reference method was the one used in Globocan series of the International Agency for Research on Cancer. Results: We had estimated a total of 53,476 new cases of cancer for males and 55,073 cases for females (excluding non melanoma skin cancers) in the state of São Paulo, corresponding to standardized rates (world population) of 261/100,000 and 217/100,000, respectively. Among males, RNHC-6 presented the highest standardized incidence rate of all cancers (285/100,000) and the RNHC-10, the lowest (207/100,000). Most frequent tumor sites in men were: prostate (SIR=77/100,000), colorectum/anus (SIR=27/100,000) and trachea/bronchus/lung (SIR=16/100,000). Among women, rates for all cancers excluding non-melanoma skin varied from 170/100,000 (RNHC-11) to 252/100,000 (RNHC-7); breast cancer was the most incident cancer site (SIR=58/100,000), followed by colorectum/anus (SIR=23/100,000) and cervix (SIR=9/100,000). Conclusions: Our results showed different patterns of regional incidence with rates that often exceeded the values presented for the state. Data from local PBCR can be used to obtain regional and local estimates. However, the estimated rates may be under- or overestimated reflecting the quality, completeness and the patterns observed in the most representative registry used in the analysis.

Introdução: Estatísticas sobre a ocorrência de casos novos de câncer são fundamentais para o planejamento e monitoramento das ações de controle da doença. No estado de São Paulo, a incidência de câncer é obtida indiretamente por meio de estimativas oficiais (para o estado como um todo e sua capital) e, de forma direta, em municípios cobertos por Registro de Câncer de Base Populacional (RCBP). Existem, atualmente, três RCBP ativos (São Paulo, Jaú e Santos), um inativo (Barretos) e um em reimplantação (Campinas). Dado o desconhecimento do panorama da incidência de câncer em áreas não cobertas por RCBP, este estudo teve como objetivo estimar a incidência de câncer, calcular taxas brutas e padronizadas por idade, específicas por sexo e localização primária do tumor para as 17 Redes Regionais de Atenção à Saúde (RRAS) de São Paulo e municípios, em 2010. Método: Utilizou-se como estimador da incidência de câncer a razão Incidência/Mortalidade (I/M), por sexo, grupo etário quinquenal dos 0 aos 80 anos e localização primária do tumor. O numerador da razão foi formado pelo número agregado de casos novos entre 2006-2010, em dois RCBP ativos (Jaú e São Paulo, respectivamente, com cobertura correspondente a 0,3 por cento e 27,3 por cento da população estadual). No denominador, o número de óbitos oficial nas respectivas áreas e período. O número estimado de casos novos resultou da multiplicação das I/M pelo número de óbitos por câncer registrados em 2010 para o conjunto de municípios formadores de cada uma das RRAS ou para cada município. O método de referência foi aquele utilizado no Globocan series, da Agência Internacional de Pesquisa contra o Câncer. O ajuste por idade das taxas de incidência ocorreu pelo método direto, tendo como padrão a população mundial. Resultados: Estimaram-se 53.476 casos novos de câncer para o sexo masculino e 55.073 casos para o feminino (excluindo-se os casos de câncer de pele não melanoma), com taxas padronizadas de 261/100.000 e 217/100.000, respectivamente. No sexo masculino, a RRAS 6 apresentou para todos os cânceres a maior taxa de incidência padronizada (285/100.000), e a RRAS 10, a menor (207/100.000). Os cânceres mais incidentes em homens foram próstata (77/100.000), cólon/reto/anus (27/100.000) e traqueia/brônquio/pulmão (16/100.000). Entre as mulheres, as taxas de incidência padronizadas por idade foram de 170/100.000 (RRAS 11) a 252/100.000 (RRAS 07); o câncer de mama foi o mais incidente (58/100.000), seguido pelos tumores de cólon/reto/anus (23/100.000) e de colo uterino (9/100.000). Conclusões: Os resultados apontaram diferentes padrões de incidência com taxas que ultrapassaram a magnitude estadual. Dados provenientes de RCBP locais podem ser usados na obtenção indireta de estimativas regionais e locais. Neste estudo, as taxas de incidência apresentadas podem estar sub ou superestimadas refletindo a qualidade, completitude e padrões observados no RCBP de maior representatividade considerado na análise. / Introduction: Statistics on the occurrence of new cases of cancer are fundamental to the planning and monitoring of control measures. In Sao Paulo state, Brazil, cancer incidence can be obtained by the official estimates for the state as a whole and the capital and in municipalities covered by Population Based Cancer Registries (PBCR). The currently panorama of PBCR in Sao Paulo includes three active registries, one retired and one in re-deployment. Given the unknown cancer incidence in areas not covered by PBCR, this study aimed to estimate cancer incidence (standardized incidence rates = SIR) according to gender, age group and tumor type for 17 Regional Networks of Health Care (RNHC) and municipalities in São Paulo state, Brazil, in 2010. Methods: We used as estimator the Incidence:Mortality ratio (I:M) adjusted for sex, five-year age group (0-80 years) and primary tumor site. The ratio numerator was composed by the aggregated number of new cases diagnosed in 2006-2010 in two active PBCR, Jau and Sao Paulo, covering 0.3 per cent and 27.3 per cent of the state population, respectively, while the denominator was the official number of cancer deaths in the same areas and period. The estimated number of incident cases resulted from the multiplication of I:M by the number of deaths registered in 2010 for the set of municipalities that compose the region or for each local area. The reference method was the one used in Globocan series of the International Agency for Research on Cancer. Results: We had estimated a total of 53,476 new cases of cancer for males and 55,073 cases for females (excluding non melanoma skin cancers) in the state of São Paulo, corresponding to standardized rates (world population) of 261/100,000 and 217/100,000, respectively. Among males, RNHC-6 presented the highest standardized incidence rate of all cancers (285/100,000) and the RNHC-10, the lowest (207/100,000). Most frequent tumor sites in men were: prostate (SIR=77/100,000), colorectum/anus (SIR=27/100,000) and trachea/bronchus/lung (SIR=16/100,000). Among women, rates for all cancers excluding non-melanoma skin varied from 170/100,000 (RNHC-11) to 252/100,000 (RNHC-7); breast cancer was the most incident cancer site (SIR=58/100,000), followed by colorectum/anus (SIR=23/100,000) and cervix (SIR=9/100,000). Conclusions: Our results showed different patterns of regional incidence with rates that often exceeded the values presented for the state. Data from local PBCR can be used to obtain regional and local estimates. However, the estimated rates may be under- or overestimated reflecting the quality, completeness and the patterns observed in the most representative registry used in the analysis.

Introduction: The Mortality–Incidence Ratio complement [1 – MIR] is an indicator validated in various populations to estimate five-year cancer survival, but its validity remains unreported in Peru. This study aims to determine if the MIR correlates directly with five-year survival in patients diagnosed with the ten most common types of cancer in metropolitan Lima. Materials and methods: The Metropolitan Lima Cancer Registry (RCLM in Spanish) for 2004–2005 was used to determine the number of new cases and the number of deaths of the following cancers: breast, stomach, prostate, thyroid, lung, colon, cervical, and liver cancers, as well as non-Hodgkin’s lymphoma and leukaemia. To determine the five-year survival, the five-year vital status of cases recorded was verified in the National Registry of Identification and Civil Status (RENIEC in Spanish). A linear regression model was used to assess the correlation between [1 – MIR] and total observed five-year survival for the selected cancers. Results: Observed and estimated five-year survival determined by [1 – MIR] for each neoplasia were thyroid (66.7%, 86.7%), breast (69.6%; 68%), prostate (64.3%, 63.8%) and cervical (50.1%, 58.5%), respectively. Pearson’s r coefficient for the correlation between [MIR – 1] and observed survival was = 0.9839. Using the coefficient of determination, it was found that [1 – MIR] (X) captures the 96.82% of observed survival (Y). Conclusion: The Mortality–Incidence Ratio complement [1 – MIR] is an appropriate tool for approximating observed five-year survival for the ten types of cancers studied. This study demonstrates the validity of this model for predicting five-year survival in cancer patients in metropolitan Lima.

Les objectifs de cette thèse étaient d’étudier les tendances du risque de second cancer primitif (SPC) selon l’année de diagnostic d’un premier cancer des voies aéro-digestives supérieures (VADS) dans le Bas-Rhin, de produire les premières estimations de l’incidence des SPC à l’échelle nationale en France et d’estimer la survie des patients atteints d’un cancer des VADS selon la présence d’antécédents de cancer. Ce travail a montré que : 1) L’excès de risque de SPC des VADS et de l’œsophage a diminué de 53% entre 1975 et 2006 dans le Bas-Rhin, mais que le risque de SPC du poumon est resté stable ; 2) Le risque de SPC en France est augmenté de 36% chez les patients atteints de cancer par rapport à la population générale ; 3) La survie des hommes atteints d’un cancer des VADS était fortement associée à la présence d’antécédents de cancer. Des perspectives se dégagent de ce travail en termes de recherche épidémiologique, de recherche clinique et de politiques de santé publique. / The objectives of this PhD thesis were: to study the trends of the risk of second primary cancer (SPC) among patients with a head and neck (HNSCC) cancer in Bas-Rhin, to provide first nationwide estimates of the risk of SPC in France and to assess the survival of patients with a HNSCC depending on their history of cancer. This work showed that : 1) The excess risk of SPC of head and neck and esophagus sites decreased by 53% over three decades among patients with a HNSCC, and that the excess risk of SPC of the lung did not change significantly. 2) The risk of SPC among cancer survivors in France was increased by 36% compared to the general population. 3) History of cancer was strongly associated with survival among HNSCC patients. Several epidemiological and clinical research perspectives can be established based on this work. These results also present an interest in a public health perspective in the framework of the third cancer plan.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Cancer registries collect tumor-related data to monitor incident rates and support population-based research. A common concern with using population-based registry data for research is reporting timeliness. Data timeliness have been recognized as an important data characteristic by both the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM). Yet, few recent studies in the United States (U.S.) have systemically measured timeliness. The goal of this research is to evaluate the quality of cancer data and examine methods by which the reporting process can be improved. The study aims are: 1- evaluate the timeliness of cancer cases at the Indiana State Department of Health (ISDH) Cancer Registry, 2- identify the perceived barriers and facilitators to timely reporting, and 3- reengineer the current reporting process to improve turnaround time. Method: For Aim 1: Using the ISDH dataset from 2000 to 2009, we evaluated the reporting timeliness and subtask within the process cycle. For Aim 2: Certified cancer registrars reporting for ISDH were invited to a semi-structured interview. The interviews were recorded and qualitatively analyzed. For Aim 3: We designed a reengineered workflow to minimize the reporting timeliness and tested it using simulation. Result: The results show variation in the mean reporting time, which ranged from 426 days in 2003 to 252 days in 2009. The barriers identified were categorized into six themes and the most common barrier was accessing medical records at external facilities. We also found that cases reside for a few months in the local hospital database while waiting for treatment data to become available. The recommended workflow focused on leveraging a health information exchange for data access and adding a notification system to inform registrars when new treatments are available.