Risk of skin cancer following phototherapy for neonatal jaundice: retrospective

cohort study David H Brewster,1,2 Janet S Tucker,3,4 Michael Fleming,1 Carole Morris,1 Diane L Stockton,1 David J Lloyd,3,4 Sohinee Bhattacharya,3,4 James WT Chalmers1,2

1Information Services Division, NHS National Services Scotland

2University of Edinburgh

3University of Aberdeen

4Aberdeen Maternity Hospital

Colorectal Cancer Study Day

Stirling

13 September 2012

How Scotland compares to other countries

Outline

• Risk factors• Mortality• Incidence• Survival

Risk factors / protective factors (1)

Family history and inherited conditions• Familial adenomatous polyposis (FAP)• Hereditary non polyposis colorectal cancer (HNPCC or

Lynch syndrome)• Ashkenazi Jewish background

Other medical conditions• Ulcerative colitis• Crohn's disease• Diabetes mellitus• Acromegaly• PMH of large bowel cancer, endometrial cancer,

testicular cancer, or lymphoma• PMH of cholecystectomy• PMH of organ transplant

Risk factors / protective factors (2)

Diet• Red and processed meat increase risk• Fruit, vegetable, fibre decrease risk• Calcium may reduce risk

Other factors• Age• Excess weight increases risk• Alcohol probably increases risk• Smoking (long-term) may increase risk• Physical activity decreases risk• Aspirin (and other NSAIDs) probably decrease risk• HRT and OC may decrease risk• Vitamin D may decrease risk• Screening reduces risk of dying from colorectal cancer

(and endoscopic screening reduces incidence)

Population Age-standardised incidence rate

  Slovakia (1998-2002)   52.5

  France, Bas-Rhin (1998-2002)   48.7

  Australia, Victoria (1998-2002)   48.3

  Singapore: Chinese (1998-2002)   46.0

  Italy, Varese Province (1998-2000)   43.4

  UK, Scotland (1998-2002)   43.1

  Canada (1998-2002)   42.6

  Norway (1998-2002)   40.7

  The Netherlands (1998-2002)   39.8

  Spain, Navarra (1998-2002)   39.4

  Denmark (1998-2002)   39.3

  USA, SEER (9 Registries): White (1998-2002)   37.9

  Japan, Osaka Prefecture (1998-2002)   37.4

  Sweden (1998-2002)   30.0

  Finland (1998-2002)   25.6

Source: Cancer Incidence in Five Continents, Volume IX

Colorectal cancer (males)

Population Age-standardised incidence rate

  Australia, Victoria (1998-2002)   33.1

  Norway (1998-2002)   32.7

  Singapore: Chinese (1998-2002)   31.7

  Denmark (1998-2002)   29.8

  Canada (1998-2002)   29.4

  The Netherlands (1998-2002)   28.7

  USA, SEER (9 Registries): White (1998-2002)   27.9

  Italy, Varese Province (1998-2000)   27.5

  UK, Scotland (1998-2002)   27.5

  Slovakia (1998-2002)   26.7

  France, Bas-Rhin (1998-2002)   26.1

  Switzerland, Geneva (1998-2002)   24.9

  Sweden (1998-2002)   23.4

  Spain, Navarra (1998-2002)   22.1

  Japan, Osaka Prefecture (1998-2002)   21.7

  Finland (1998-2002)   19.5

Source: Cancer Incidence in Five Continents, Volume IX

Colorectal cancer (females)

Age-standardised relative survival from colorectal cancer by survival time and period of diagnosis

0

10

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60

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100

1983-1987 1988-1992 1993-1997 1998-2002 2003-2007

Period of diagnosis

% s

urv

iva

l

1-year

3-year

5-year10-year

Some factors to consider in population-based survival comparisons

Data quality factors Tumour-related factors

Population coverage Extent of diseaseCompleteness of ascertainment Site (and sub-site) of tumour Accuracy of registration Tumour morphology Completeness of follow-up Tumour biology ‘Death certificate only’ registrations

Host factors Health care-related factors

Age ScreeningSex Diagnostic facilitiesSocio-economic status Treatment facilitiesRace/Ethnicity Quality of treatmentCo-morbidity Follow-up careMortality from other causesBehaviour

Colorectal cancer diagnosed 1995-99. Five year relative survival vs survival conditional on surviving at least one year

0

10

20

30

40

50

60

70

80

5-year Relative survival Conditional survival

% s

urv

ivin

g Denmark

England

Scotland

Finland

Norway

Sweden

Colorectal cancer diagnosed 2002: the delay-survival paradox

The waiting time paradox: the colorectal cancer example…

Source: Torring ML et.al. Time to diagnosis and mortality in colorectal cancer: a cohort study in primary care.Br J Cancer 2011;104:934–40.

Risk of skin cancer following phototherapy for neonatal jaundice: retrospective

cohort study David H Brewster,1,2 Janet S Tucker,3,4 Michael Fleming,1 Carole Morris,1 Diane L Stockton,1 David J Lloyd,3,4 Sohinee Bhattacharya,3,4 James WT Chalmers1,2

1Information Services Division, NHS National Services Scotland

2University of Edinburgh

3University of Aberdeen

4Aberdeen Maternity Hospital

Our statistics on incidence, survival, and mortality, and on the prevalence of lifestyle risk factors suggest that we can

So how does Scotland compare to other countries, and can we do better?