Journal of the National Cancer Institute Advance Access published online on December 11, 2007
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djm249
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© The Author 2007. Published by Oxford University Press.
BRIEF COMMUNICATION |
Interpreting Trends in Prostate Cancer Incidence and Mortality in the Five Nordic Countries
Affiliations of authors: The Cancer Registry of Norway, Oslo, Norway (RK, HOA, EH, BM, ST, EW, FB); Finnish Cancer Institute, Helsinki, Finland (AA); Tampere School of Public Health, University of Tampere, Tampere, Finland (AA); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (HOA, EW); Department of Epidemiology, Harvard School of Public Health, Boston, MA (HOA); Center for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden (AK); Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland (EP); Department of Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark (HHS); The Icelandic Cancer Registry, Reykjavik, Iceland (LT); Oslo Urological University Clinic, Aker University Hospital, Oslo, Norway (RW); Department of Genetic Epidemiology, Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland (EW); Department of Biostatistics, Institute of Basic Sciences, University of Oslo, Oslo, Norway (FB)
Correspondence to: Rune Kvåle, MD, The Cancer Registry of Norway, 0310 Oslo, Norway (e-mail: rune.kvale{at}kreftregisteret.no).
Trends in incidence and mortality rates of prostate cancer were analyzed using data from the national cancer registries of Denmark, Finland, Iceland, Norway, and Sweden. Joinpoint regression models were used to quantify temporal trends for the period from 1980 to 2004. Incidence rates were increasing and similar in the Nordic countries during the 1980s. Around 1990, a more rapid incidence increase began in all Nordic countries except Denmark, where an increase was seen 5 years later. In 2001, incidence rates in Denmark were half of those seen in the other Nordic countries, but mortality rates varied only marginally among countries. Mean annual declines in prostate cancer mortality of 1.9% (95% CI = 0.4% to 3.3%) and 1.8% (95% CI = 0.5% to 3.0%) were observed from 1996 to 2004 in Finland and Norway, respectively. During the same period, mortality rates leveled off in Iceland and Sweden but continued to increase in Denmark. The rapid increase in incidence during the early 1990s coincided with the introduction of the prostate-specific antigen (PSA) test and conveys little information about the occurrence of potentially lethal disease. Mortality rates, however, have recently stabilized or declined in countries where PSA testing and curative treatment have been commonly practiced since the late 1980s. Although other explanatory factors may be in operation, these trends are consistent with a moderate effect of increased curative treatment of early diagnosed prostate cancer and improved treatment of more advanced disease.
| CONTEXT AND CAVEATS Prior knowledge Previous studies concerning the relation between the intensity of prostate-specific antigen (PSA) testing and mortality from prostate cancer have been inconsistent. Study design Trends in prostate cancer incidence and mortality rates in the Nordic countries were analyzed using joinpoint regression models fitted to quantify linear changes with time. Contribution The temporal trends of prostate cancer incidence and mortality in the Nordic countries were found to be consistent with a moderate effect of early diagnosis and improved treatment of prostate cancer on mortality. Implications Incidence rates of prostate cancer in the Nordic countries are closely related to the extent of PSA testing and convey little information about the occurrence of potentially lethal disease. It will be important to closely monitor future trends in prostate cancer incidence and mortality alongside population-based data documenting the use of PSA and different treatment modalities. Limitations Population-based data on trends in PSA testing and the use of curative treatment are limited. Therefore, the relationships between these factors and changes in incidence and mortality were difficult to quantify.
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Manuscript received May 9, 2007; revised September 27, 2007; accepted November 2, 2007.
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J Natl Cancer Inst 2007 99: 1821.
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