Age-related variations in progression of cancer at diagnosis and completeness of cancer registry data

Adams, Jean; Audisio, Riccardo A.; White, Martin; Forman, David

doi:10.1016/j.suronc.2004.08.007

Cited by 20 publications

(14 citation statements)

References 18 publications

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“…The finding of more aggressive tumors among young patients was opposite to the survival data, which were better in young patients. Previous results on diagnostic age and tumor characteristics have been contradictory but the recent data on colon cancer are in agreement with the present results: younger patients present more aggressive and advanced tumors [11,14-16]. It was interesting that no age effect was noted for T, i.e., invasiveness of the primary tumor to near-by tissue structures did not differ between young and old patients.…”

Section: Discussionsupporting

confidence: 89%

“…If delayed diagnosis were the reason for the poor survival, tumor characteristics would show more advanced stages in older patients. Results on tumor characteristics of colorectal tumors have been ambiguous but the recent data on colon cancer tend to point to the opposite: younger patients present more aggressive and advanced tumors [11,14-16]. High education level has been shown to correlate with better survival in colon cancer and somewhat better survival in rectal cancer [17].…”

Section: Introductionmentioning

confidence: 99%

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Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes

et al. 2010

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BackgroundOld age at diagnosis is associated with poor survival in colorectal cancer (CRC) for unknown reasons. Recent data show that colonoscopy is efficient in preventing left-sided cancers only. We examine the association of Tumor Node Metastasis (TNM) classes with diagnostic age and patient characteristics.MethodsThe Swedish Family-Cancer Database has data on TNM classes on 6,105 CRC adenocarcinoma patients. Ordinal logistic regression analysis was performed to model tumor characteristics according to age at diagnosis, tumor localization, gender, socioeconomic status, medical region and family history. The results were compared to results from survival analysis.ResultsThe only parameters systematically associated with TNM classes were age and tumor localization. Young age at diagnosis was a risk factor for aggressive CRC, according to stage, N and M with odds ratios (ORs) ranging from 1.80 to 1.93 for diagnosis before age 50 years compared to diagnosis at 80+ years. All tumor characteristics, particularly T, were worse for colon compared to rectal tumors. Right-sided tumors showed worse characteristics for all classifiers but M. The survival analysis on patients diagnosed since 2000 showed a hazard ratio of 0.55 for diagnosis before age 50 years compared to diagnosis at over 80 years and a modestly better prognosis for left-sided compared to right-sided tumors.ConclusionsThe results showed systematically more aggressive tumors in young compared to old patients. The poorer survival of old patients in colon cancer was not related to the available tumor characteristics. However, these partially agreed with the limited colonoscopic success with right-sided tumors.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes

et al. 2010

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“…Some reasons may include scarcely visible anatomical locations of new pigmented lesions (i.e. scalp, back), loss of a partner's input on home examination, poor vision, less importance placed on changing lesions, and confusing new or changing benign seborrheic keratoses for pigmented lesions21, 22. Furthermore, early detection programs for melanoma have generally targeted younger age groups.…”

Section: Discussionmentioning

confidence: 99%

Malignant Melanoma in the Elderly: Different Regional Disease and Poorer Prognosis

Macdonald

Dueck²,

Gray³

et al. 2011

J. Cancer

104

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Purpose: Age is a poor prognostic factor in melanoma patients. Elderly melanoma patients have a different presentation and clinical course than younger patients. We evaluated the impact of age ≥70 years (yrs) on the diagnosis and natural history of melanoma.Methods: Retrospective review of 610 patients with malignant melanoma entered into a prospective sentinel lymph node (SLN) database, treated from June 1997 to June 2010. Disease characteristics and clinical outcomes were compared between patients ≥70 yrs vs. <70 yrs of age.Results: 237 patients (39%) were ≥70 yrs. Elderly patients had a higher proportion of head and neck melanomas (34% vs. 20%, p<0.001), and greater mean tumor thickness (2.4mm vs. 1.8mm, p<0.001). A greater proportion of T3 or T4 melanoma was seen in the elderly (p<0.001) as well as a greater mean number of mitotic figures: 3.6/mm2 vs. 2.7/mm2 (p=0.005). Despite greater mean thickness, the incidence of SLN metastases was less in the ≥70 yrs group with T3/T4 melanomas (18% vs. 33%, p=0.02). The elderly had a higher rate of local and in-transit recurrences, 14.5% vs. 3.4% at 5 yrs (p<0.001). 5 yr disease-specific mortality and overall mortality were worse for those ≥70 yrs: 16% vs. 8% (p=0.004), and 30% vs. 12% (p<0.001), respectively.Conclusions: Elderly (≥70 yrs) melanoma patients present with thicker melanomas and a higher mitotic rate but have fewer SLN metastases. Melanoma in the elderly is more common on the head and neck. Higher incidence of local/in-transit metastases is seen among the elderly. Five-year disease-specific mortality and overall mortality are both worse for these patients.

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“…One possible reason may be that GPs are less motivated to record cancer diagnoses in older people if they have other serious illnesses. Alternatively, recording details of the disease could be deemed to be less important for older people -it has been found that the stage or grade of tumour in cancer registry data is more likely to be missing if the patient is elderly (De Rijke et al, 1998;Adams et al, 2004). Another possible reason, which might partly explain the earlier peak in recorded ovarian cancer in the GPRD, could be a possible time lag between recording a diagnosis in GP records and informing the cancer registries (data for which come mostly from other sources including hospitals and the death registry).…”

Section: Discussionmentioning

confidence: 99%

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

2010

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Background: Recent studies suggest that older patients in the United Kingdom are not benefiting as much from improvements in cancer treatments as their younger counterparts. We investigate whether this might be partly due to differential referral rates using ovarian cancer as an example. Methods: From the General Practice Research Database (GPRD), we identified all women aged 40–80 years on 1 June 2002 with a Read code for ovarian cancer between 1 June 2002 and 31 May 2007. Using these records, we compared the GPRD incidence of ovarian cancer with rates compiled from the UK cancer registries and investigated the relationship between age and coded investigations for suspected ovarian cancer. Results: The GPRD rates peaked earlier, at 70–74, and were lower than registry rates for nearly all ages particularly for patients over 59. The proportion investigated or referred by the GP decreased significantly with age and delays between first coded symptom and investigation showed a U-shaped distribution by age. Conclusions: GPs appear to be less likely to recognise and to refer patients presenting with ovarian cancer as they get older. If our findings extend to other cancers, lack of or delays in referral to secondary care may partly explain poor UK cancer mortality rates of older people.

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Age-related variations in progression of cancer at diagnosis and completeness of cancer registry data

Cited by 20 publications

References 18 publications

Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes

Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes

Malignant Melanoma in the Elderly: Different Regional Disease and Poorer Prognosis

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

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