Jul 2026· Cancer Epidemiology· Vol 104, pp.
103193
· 0 citations· 56 references
Medicine
TL;DR
MIR-based cancer outcomes improved in Iran, but marked cancer-specific and provincial disparities remained, and high MIRs for stomach cancer and in underserved provinces highlight the need for targeted early diagnosis, timely treatment, and equitable cancer control strategies.
Abstract
Background
Cancer incidence and mortality vary substantially across regions, whereas direct population-based survival data remain limited in many settings, including Iran. The mortality-to-incidence ratio (MIR) is increasingly used as a population-level proxy for cancer survival and health system performance where survival registries are incomplete. This study examined long-term subnational trends and geographic disparities in MIR for six major cancers across 31 Iranian provinces from 1990 to 2019.
Methods
This ecological study used Global Burden of Disease 2019 estimates. Age-standardized incidence rates (ASIRs) and mortality rates (ASMRs) were extracted for prostate, stomach, and colorectal cancers in men, and breast, stomach, and colorectal cancers in women. MIR was calculated annually as ASMR divided by ASIR for each province, cancer type, sex, and year. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals.
Results
ASIRs increased for prostate and colorectal cancers in men and for breast and colorectal cancers in women, while stomach cancer incidence declined modestly in both sexes. MIR declined significantly for all cancers studied. The greatest reductions were observed for prostate cancer in men (AAPC = -1.77%, p < 0.001) and breast cancer in women (AAPC = -1.54%, p < 0.001). Colorectal cancer MIR also declined in men (AAPC = -1.02%, p < 0.001) and women (AAPC = -0.56%, p < 0.001). Stomach cancer showed smaller reductions in men (AAPC = -0.32%, p < 0.001) and women (AAPC = -0.30%, p < 0.001), with high MIRs across most provinces. Sistan and Baluchistan remained a high-MIR province for several cancers.
Conclusions
MIR-based cancer outcomes improved in Iran, but marked cancer-specific and provincial disparities remained. High MIRs for stomach cancer and in underserved provinces highlight the need for targeted early diagnosis, timely treatment, and equitable cancer control strategies.
BACKGROUND
Cancer remains a significant public health concern in Thailand, with substantial regional variation. This study quantified long-term temporal trends and projected future burdens of major cancers in Thailand's upper central region, in the context of evolving public health policies and changing epidemiological patterns.
METHODS
Population-based cancer data from 2000 to 2022 were obtained from the Lopburi Cancer Hospital. Temporal trends were analyzed using joinpoint regression and the age-period-cohort model. Future burdens were projected to 2040 using joinpoint regression, the age-period-cohort model, and the NordPred model.
RESULTS
Infection-related cancers declined while lifestyle-associated cancers increased. Age-standardized incidence rates (ASIRs) and mortality rates (ASMRs) for liver and lung cancers declined among men. The colorectal cancer burden among men increased markedly, with ASIRs rising from 8.92 to 24.62 per 100,000 person-years (average annual percent change [AAPC] +4.72%, 95% confidence interval [CI], 3.46-6.47), and ASMRs increasing from 1.83 to 12.15 (AAPC +8.97%, 95% CI, 5.70-12.37). Among women, breast cancer incidence increased from 18.48 to 31.46 (AAPC +2.44%, 95% CI, 0.79-4.73), while mortality increased from 2.10 to 10.00 (AAPC +7.35%, 95% CI, 3.86-11.70). Cervical cancer declined in both incidence and mortality. Colorectal cancer incidence among women increased from 6.51 to 12.06 (AAPC +2.84%, 95% CI, 0.89-6.32), with rising mortality (AAPC +4.03%, 95% CI, 2.76-5.95).
CONCLUSIONS
Despite the declines in infection-related cancers, indicative of effective public health interventions, the overall cancer burden is projected to increase through 2040, mainly driven by increasing incidence and mortality of colorectal and breast cancers. This highlights the priority need for organized population-based screening programs and targeted interventions addressing modifiable lifestyle and dietary risk factors.
Saksin Simsin, Siriporn Kamsa-ard, Supot Kamsa-ard et al.· Cancer Epidemiology· 0 citations
Background As CRC survival improves, the shifting contributions of metastatic and non-cancer causes to mortality remain poorly characterized, with implications for survivorship care and public health policy. This study aimed to examine temporal trends in CRC mortality with selected contributing conditions from 1999 to 2023 and project rates through 2040 across demographic and geographic subgroups in the United States. Methods This population-based cohort study utilized mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. The study included 1,323,609 US residents aged 25 years or older who died from 1999 through 2023 with colorectal cancer listed as the underlying cause of death. We analyzed selected contributing conditions recorded in the multiple cause-of-death field, including heart failure, ischemic heart disease, liver metastasis, lung metastasis, pulmonary embolism, and sepsis. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons. Temporal trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Future mortality rates were projected to 2040 using autoregressive integrated moving average (ARIMA) modeling. Results Overall CRC AAMR declined from 32.06 in 1999 to 19.57 in 2023 (AAPC,−2.08%). Recent significant increases were observed in liver metastasis mortality from 2016 to 2023 (APC: 2.89%), lung metastasis mortality from 2017 to 2023 (APC: 2.08%), pulmonary embolism mortality from 2012 to 2023 (APC: 3.59%), and heart failure mortality from 2013 to 2023 (APC: 3.16%). These trends were most pronounced among adults aged 35–64 years, non-Hispanic Black individuals, and residents of the Southern US. Model-based projections indicate that overall lung metastasis mortality will continue to increase through 2040, whereas liver metastasis mortality will peak in 2028 and subsequently decline. In pre-pandemic sensitivity analyses, the post-2012 increase in PE mortality persisted, whereas recent increases in IHD, HF, liver metastasis, and sepsis mortality were attenuated or no longer statistically significant. Conclusions Despite declining overall CRC mortality, recent increases were observed in several metastatic and noncancer contributing conditions. However, pre-pandemic sensitivity analyses suggested that some late-period changes may have been amplified during the COVID-19 era, whereas the increase in PE mortality clearly preceded the pandemic.
Zi-Chen He, Ya-Dong Chen, Yu-Xing Hu et al.· Frontiers in Public Health· 0 citations
Divergent trends between incidence and mortality likely reflect reduced detection during the pandemic rather than true changes in disease burden, and highlight the importance of maintaining continuity of cancer screening and diagnostic services during health-system disruptions.
Nomin-Erdene Tsogtgerel, Dolgorkhand Adiyadorj, Gan-Erdene Ganbaatar et al.· Frontiers in Oncology· 0 citations
This study systematically analyzes the incidence, mortality, age distribution, racial disparities, and geographic trends of ovarian cancer in the United States from 1999 to 2023 using Centers for Disease Control and Prevention surveillance data; evaluates changes in disease burden; and identifies health imbalances. This population-based ecological trend analysis used data from the Centers for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiologic Research database. Age-adjusted mortality rates (AAMR, 1999/2018–2023) and age-adjusted incidence rates (1999/2017–2022) were extracted at national, state, racial (White, Black, American Indian/Alaska Native, Asian, and Hispanic), and regional (Northeast, Midwest, South, and West) levels. Joinpoint regression was used to calculate the annual percent change (APC) with 95% confidence intervals for trend analysis. Epidemiological characteristics were compared across the demographic and geographic strata. From 1999 to 2022/2023, a significant decreasing trend was observed in both age-adjusted incidence rate (14.1–9.9 per 100,000) and AAMR (8.8–5.5 per 100,000). The substantial gap between incidence rank (14th among all cancers) and mortality rank (seventh among all cancers) highlights the high lethality of ovarian cancer relative to its incidence, reflecting the poor prognosis associated with this malignancy. Markedly divergent trends have been observed across racial and regional groups. Racial analysis revealed statistically significant declines in AAMR for both White and Black populations. Geographically, the Midwest and South showed significant improvement (APC = −2.7% and −2.5%, respectively), while the West exhibited a nonsignificant decline (APC = −1.7%, P = .0904). The age distribution demonstrated a sharp increase in mortality burden after age 40, peaking in the 65 to 74 age group. Overall progress in ovarian cancer control has been achieved in the United States. However, the disease burden remained substantial and uneven. Significant racial and geographic disparities have led to profound health inequities. Future strategies should focus on monitoring disparities, precise prevention of high-risk groups, and ensuring equitable access to medical advancements.
Cervical cancer is largely preventable through effective screening and human papillomavirus (HPV) vaccination; however, mortality disparities remain a persistent public health challenge in the United States. This study aimed to examine long-term trends and socio-demographic and geographic inequalities in cervical cancer mortality.
We conducted a population-based study of cervical cancer mortality among U.S. women aged ≥25 years from 1999 to 2023 using national mortality data from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Temporal trends were evaluated using Joinpoint regression to estimate annual percent changes (APCs) and average annual percent changes (AAPCs). Analyses were stratified by census region, race/ethnicity, urbanization level, age group, and state. Age restrictions were harmonized across bridged-race and single-race population estimates, and corrected estimates were used for trend analyses.
Overall cervical cancer mortality declined substantially from 1999 to 2023, with the female-specific AAMR decreasing from 4.37 to 2.09 per 100,000 women (AAPC, −3.27%; 95% CI, −3.81 to −2.73). Despite this overall decline, substantial disparities persisted. Mortality rates remained consistently higher in the Southern region and lowest in the Northeast, which showed the greatest reduction over time (AAPC, −4.23%; 95% CI, −5.31 to −3.13). Non-Hispanic Black women experienced persistently higher mortality compared with other racial and ethnic groups, and women residing in nonmetropolitan areas had elevated mortality rates. Considerable geographic variation was observed across states, with mortality rates in higher-burden states approximately two- to four-fold higher than those in lower-burden states. Sensitivity analyses restricted to women aged ≥25 years confirmed consistent long-term mortality trends between bridged-race and corrected single-race estimates. No evidence of an accelerated decline around 2019/2020 was identified, and the previously reported post-2019 acceleration was attributable to inconsistent age restrictions during data extraction rather than a true epidemiological change.
Although cervical cancer mortality has declined significantly in the United States over the past two decades, substantial socio-demographic and geographic disparities persist. These findings highlight the need for targeted public health strategies to improve equitable access to screening, HPV vaccination, and timely treatment, particularly in high-risk populations and underserved regions.
Jie Liu, Yong-Lin Liu, Yan-Jiao Jiang et al.· Frontiers in Public Health· 0 citations
INTRODUCTION
Adolescents and young adults (AYAs) with cancer constitute a distinct population with unique biological and survivorship challenges. Long-term, population-based analyses of incidence and mortality trends in AYAs remain limited.
METHODS
We conducted a retrospective, longitudinal population-based cohort study using data from the Childhood, Adolescent, and Young Adult Cancer Survivor program in British Columbia, Canada, from 1971 to 2020. We analyzed age-standardized incidence rates (ASIR) for the 16 cancer types with the highest incidence and age-standardized mortality rates (ASMR) for the 8 cancer types with the highest mortality, overall and by sex. Trends were evaluated using annual percentage change (APC) and average APC from joinpoint regression analyses.
RESULTS
The cohort included 43,588 patients with a first cancer diagnosis and 6825 deaths. From 1971 to 2020, cancer incidence rose overall (AAPC 0.1; 95% confidence interval [CI]: -1.0, 1.3), with a brief decline in the mid-1990s. Significant increases in ASIR were observed for thyroid (APC1983-2020: 3.0, 95% CI: 2.4, 3.6) and gastrointestinal cancers (APC1988-2020: 1.9, 95% CI: 1.3, 2.6). Female AYAs showed rising trends in Hodgkin and non-Hodgkin lymphoma, while testicular cancer incidence increased among males. Male AYAs had higher all-cause mortality (51.6%). Cancer mortality declined beginning in the early 1990s; however, gastrointestinal cancer mortality increased in males (APC1990-2020: 1.7, 95% CI: 0.3, 3.1).
CONCLUSIONS
Cancer incidence among AYAs has risen over five decades, particularly for thyroid and gastrointestinal cancers, with concerning increases in gastrointestinal cancer mortality among males. These findings emphasize the need for targeted prevention, screening, and intervention strategies.
J. Mehareen, R. M. Altman, Mary A. De Vera et al.· Journal of Adolescent and Yo...· 0 citations
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