Incidence and mortality from colon and rectal cancer in Midwestern Brazil

ABSTRACT: Objective: To describe the incidence and mortality rates from colon and rectal cancer in Midwestern Brazil. Methods: Data for the incidence rates were obtained from the Population-Based Cancer Registry (PBCR) according to the available period. Mortality data were obtained from the Mortality Information System (SIM) for the period between 1996 and 2008. Incidence and mortality rates were calculated by gender and age groups. Mortality trends were analyzed by the Joinpoint software. The age-period-cohort effects were calculated by the R software. Results: The incidence rates for colon cancer vary from 4.49 to 23.19/100,000, while mortality rates vary from 2.85 to 14.54/100,000. For rectal cancer, the incidence rates range from 1.25 to 11.18/100,000 and mortality rates range between 0.30 and 7.90/100,000. Colon cancer mortality trends showed an increase among males in Cuiabá, Campo Grande, and Goiania. For those aged under 50 years, the increased rate was 13.2% in Campo Grande. For those aged over 50 years, there was a significant increase in the mortality in all capitals. In Goiânia, rectal cancer mortality in males increased 7.3%. For females below 50 years of age in the city of Brasilia, there was an increase of 8.7%, while females over 50 years of age in Cuiaba showed an increase of 10%. Conclusion: There is limited data available on the incidence of colon and rectal cancer for the Midwest region of Brazil. Colon cancer mortality has generally increased for both genders, but similar data were not verified for rectal cancer. The findings presented herein demonstrate the necessity for organized screening programs for colon and rectal cancer in Midwestern Brazil.

Does calcium in drinking water modify the association between nitrate in drinking water and risk of death from colon cancer?

The objective of this study was to explore whether calcium (Ca) levels in drinking water modified the effects of nitrate on colon cancer risk. A matched case–control study was used to investigate the relationship between the risk of death from colon cancer and exposure to nitrate in drinking water in Taiwan. All colon cancer deaths of Taiwan residents from 2003 through 2007 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to the cases by gender, year of birth and year of death. Information on the levels of nitrate-nitrogen (NO3-N) and Ca in drinking water have been collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cases and controls was assumed to be the source of the subject's NO3-N and Ca exposure via drinking water. We observed evidence of an interaction between drinking water NO3-N and Ca intake via drinking water. This is the first study to report effect modification by Ca intake from drinking water on the association between NO3-N exposure and risk of colon cancer mortality.

Receipt of chemotherapy among Medicaid-enrolled patients diagnosed with regional colon cancer

e15016 Background: Although overall improvements in colon cancer mortality have been observed, persistent disparities marked by socioeconomic inequality remain. Inadequate treatment received by the poor leads to disparities in overall and disease-free survival. This paper evaluates the patient, health services, and community characteristics associated with receipt of chemotherapy among poor Medicaid beneficiaries diagnosed with SEER-staged regional colon cancer. Methods: A dataset was constructed from Medicaid-enrolled patients diagnosed with colon cancer from 1999 to 2002 (n=692). Using claims data, North Carolina Central Cancer Registry data, and U.S. Census data, multivariable models were constructed to evaluate the association between patient, health services, and community characteristics and adjuvant chemotherapy. Results: Characteristics of the study population include: 66% female; 25% ages 65–74 and 46% ages 75+; and 42% African American. 1 in 4 of individuals with regional stage colon cancer had a Medicaid or Medicare claim for chemotherapy within 12 months of diagnosis. Individuals under age 65 (OR 6.4, CI 3.6–11.1) and ages 65- 74 (OR 4.4, CI 2.6–7.7) were significantly more likely to receive chemotherapy than individuals 75 and older in the multivariable model. Although non-cancer related comorbidity, class of case, and poverty were significantly associated with received chemotherapy in unadjusted models, their effects were no longer significant after controlling for age. Conclusions: A substantial percentage of Medicaid enrollees do not receive recommended adjuvant chemotherapy. The poor elderly may be especially at risk for under treatment. No significant financial relationships to disclose.