A C T A O N C O L O G I C A Vol. 30 No. 2
1991
THE EPIDEMIOLOGY OF PROSTATIC CANCER
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Geographical distribution and time-trends C. S. MUIR, J. NECTOUX and J. STASZEWSKI
Abstract Prostate cancer is one of the most frequent tumours in males. Globally about 235000 new cases were estimated to occur in 1980. The cancer is particularly frequent in North America, where rates in blacks are often double those in whites, and in several European countries, being rare in much of Asia. After migration to the US, Chinese and Japanese show substantial increases. Incidence may be distorted by inclusion of varying numbers of so-called ‘latent’ cancers; for some comparisons mortality data are preferable. ‘Small’ latent cancers seem to be uniformly distributed irrespective of the incidence of the clinically manifest form. The incidence of prostate cancer seems to be increasing in most populations, particularly in Asia and Eastern Europe. In general, mortality follows suit. Birth cohort analysis shows that for US non-whites, cohorts born before 1896-1900 showed an increase in mortality for all age groups, but the death rates fell for cohorts born subsequently, a phenomenon also observed in Australia and England and Wales. Key words: Prostrate, cancer, epidemiology.
Clinical cancer of the prostate is one of the most frequent tumours in males. About 235 000 newly diagnosed cases of clinical prostatic cancer were estimated to have occurred in the world in 1980, this form of malignancy thus being in fifth rank for cancer in males throughout the world and in second or third rank in the industrialized countries (1). Very rare before the age of 50, it occurs for the most part among the older age groups, its incidence increasing up to a very advanced age. Very unequally distributed throughout the world, this cancer is particularly frequent in North America and in several European countries, while very rare in much of Asia. The great majority of prostatic cancers are adenocarcinomas. ‘Latent’ cancer of the prostate discovered incidentally following microscopic examination of prostate tissue is also very widespread, the frequency being much
greater than that of the clinical form of the disease. Contrary to invasive prostatic cancer for which the incidence varies greatly, the relative frequencies of latent cancer seem to be much the same in regions where the incidence of the invasive form of the disease differs greatly (see below). Latent cancer of the prostate
Latent cancer is much more frequent than clinical cancer There are several problems linked to the epidemiology of cancer of the prostate, in that this disease attacks the oldest ages, when diagnosis is frequently imprecise and when latent cancer is three to eight times more frequent than the clinical form of disease (2). Incidental discovery following histological examination of tissue removed during surgical intervention for adenomatous hyperplasia or at autopsy is very frequent. For example, in Malmo in Sweden, where the proportion of all dead necropsied is very high, in 1981 the age-adjusted incidence for these cancers was 151.1 in the commune of Malmo, a figure some 50% greater than that observed elsewhere in Sweden (3). At the national level, 298 cases were discovered at autopsy (7.6%), whereas in Malmo 61 of a total of 177 cases were discovered incidentally at autopsy (34.5%). As the International Classification of Diseases does not make any distinction between latent and invasive cancer,
From the International Agency for Research on Cancer, Lyon, France, and Institute of Oncology, Gliwice, Poland. Presented at the Conference on Early Prostatic Cancer. The WHO Collaborating Centre for Urological Tumours, Karolinska Hospital, Stockholm, March 21-23, 1990. Accepted for publication 22 September 1990. 133
134
C.
S. MUIR ET AL.
the incidence data for this form of malignancy may be seriously distorted. There is thus a degree of uncertainty in comparing incidence figures for prostatic cancer. The frequency of latent cancer rises with age
The frequency of latent cancer of the prostate increases with age. Many autopsy series show that the relative frequency of this cancer is between 5-14% for men aged 50-60, reaching 20-40% among those between 60 and 80 years of age.
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Latent cancer does not follow the geographical variations of clinical cancer
Examination of material from consecutive autopsies of men aged more than 44 years, undertaken in seven.different parts of the world (Israel, Hong Kong, Singapore, Uganda, Jamaica, Sweden and the Federal Republic of Germany) revealed a relative frequency of about 20% for this form of cancer (4).During this study there was very little variation in the frequency of small non-invasive latent cancers, by age or by geographical distribution, In constrast, much larger variation was observed for the same parameters for microinvasive latent cancers, variations which were close to those observed for invasive cancer of the prostate. These studies suggest that the factors leading to progression of latent cancers of the prostate towards the invasive clinically detectable forms, vary considerably from one region to another or, if similar, are not present to the same degree.
Clinical cancer Geographical distribution
The incidence rates for cancer of the prostate extracted from the fifth volume of Cancer Incidence in Five Continents ( 5 ) for the period 1978-1982, are given in Table 1 for 88 different populations. The variation in incidence is shown graphically in rank order for several cancer registries in Fig. 1. The rates are given per 100000 population per annum and have been age-adjusted to the world population structure and are hence comparable, in that the rates allow for the differing age structures of the populations compared. The highest incidence rates for cancer of the prostate occur in the continental United States and Hawaii: the black populations of the United States have the highest incidence with a particularly elevated rate of 91.2 in Atlanta in Georgia, where this cancer is in second rank, lung cancer being in first place with an age-standarized rate of 94.6. The rates recorded among white populations in the United States are between 40 and 60, globally in second place, although substantially lower than among black populations residing in the same region.
1 2 3 4. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58
Atlanta, Blacks Detroit, Blacks Alameda, blacks San Francixo, Bay Area, Blacks New Orleans, Blacks Utah Hawaii, Whites Canada, Saskatchewan Atlanta, Whites Detroit, Whites Switzerland, Basel San Francisco, Bay Area, Whites Alameda, Whites Sweden Switzerland. Zurich Canada, Alberta Norway New Orleans, Whites Hawaii, Hawaiians New Zealand, Maoris Finland Australia. NSW New Zealand, non-Maoris Brazil, Sao Paulo Bulawayo, Africans Hawaii, Japanese Puerto Rico Colombia, Cali Hawaii, Filipinos Jamaica, Kingston Denmark Canada, Newfoundland France, Bas-Rhin U K . S.E. Scotland UK, N.E. Scotland Hawaii, Chinese France, Doubs Spain, Navarra Italy. Varese Cuba German Democratic Republic UK, Mersey UK, Birmingham Israel, all Jews San Francisco, Bay Area, Japanese Czechoslovakia, Slovakia San Francixo, Bay Area, Chinese Poland. Cracow Hungary. Szabolcs Singapore, Indians India, Bombay Poland, Katowice Singapore, Chinese Japan, Miyagi Hong Kong Japan, Osaka Senegal, Dakar China, Shanghai
91.2 91.1 87.8 82.5 71.8 70.2 58.3 57.6 53.4 51.2 50.1 50.0 49.6 45.9 45.8 45.4 42 .O 42.0 40.9 35.4 34.2 33.8 33.3 33.0 32.3' 31.2 30.7 30.6 30.6 28.6 27.7 27.4 27.4 26.5 26.0 25.2 24.9 20.5 20.3 19.9' 19.9 19.2 18.9 18.8 16.5 15.8 14.9 13.8' 12.6 8.9 8.2 6.6 6.6 6.3 6.2 5.1 4.3" 1.8
" C15(IV) data
Fig. 1. Age-adjusted incidence rates from cancer of the prostate for 1978-1982, for several cancer registries.
A very high incidence of 58.4, although based on a small population, has been consistently noted in the north of Ardeche in France (6). European rates are generally at an intermediate level, between 10 and 40. The highest incidence rates in Europe, after that of Ardkche, are recorded in Scandinavia with 45.9 in Sweden, 42.0 in Norway and in Switzerland (50.1 in Basel and 45.8 in Zurich). Roughly similar rates have been reported from several Canadian provinces ranging between 27.4 in Newfoundland and 57.6 in Saskatchewan and in New Zealand where the rates in Maoris of 35.4 are much the same as in the non-Maori population 33.3. Rates around 25 have been reported from France (the Departments of the Doubs, Bas-Rhin, Calvados and Isere), being much the same as those in Denmark, the Federal Republic of Germany and Great Britain. The lowest incidence rates in Europe occur in the
135
EPIDEMIOLOGY OF PROSTATIC CANCER
Table 1 Average annual age-standardized incidence rates, per loOooO, for cancer of the prostate and relative frequency as a proportion of all cancer around 1980
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Cancer registry Africa Bulawayo Africans* Senegal Dakar* Americas Brazil San Paulo Canada Alberta Brit. Columbia Manitoba Newfoundland NWT and Yukon Ontario Quebec Saskatchewan Colombia Cali Cuba* Jamaica Kingston* Netherlands Antilles USA Alameda, white Alameda, black San Francis0 Bay Area White Black Chinese Japanese Los Angeles White Latino Black Japanese Chinese Connecticut White Atlanta White Black Iowa Detroit White Black New Mexico White Hispanic American Indian New York City Puerto Rico Utah Asia China Shanghai Hong-Kong India Bombay Israel All Jews Born Israel Born Am./Eur. Born Afr./Asia Non-Jews
Age-stand. rate
Relative freq.
32.3
3.9
4.3
4.0
33.0
10.4
45.3 49.5 44.4 27.4 27.7 41.6 41.5 57.6
18.0 18.7 15.2 10.3 11.5 14.1 13.7 20.4
30.6 19.9
14.6 12.5
28.6 26.6
14.1 15.0
49.6 87.8
15.9 22.1
50.0 82.5 14.9 16.5
16.0 21.2 6.6 8.7
49.6 43.0 82.6 22.8 16.9
16.1 20.2 23.3 12.7 8.0
46.8
14.7
53.4 91.2 51.3
17.1 24.6 17.2
51.2 91.1
15.6 22.8
56.7 53.4 29.2 41.7 30.7 70.2
19.8 25.5 22.2 13.9 16.2 27.4
1.8 6.2
0.8 2.2
8.2
5.7
18.8 24.3 22.5 16.8 6.5
8.7 11.5 9.1
?I 5.5
Cancer registry Japan Miyagi Osaka Singapore Chinese Malay Indians Europe Czechoslovakia Slovakia Denmark FRG Hamburg Saarland Finland France Bas-Rhin Doubs GDR Hungary Szabolcs-Szatmar Vas Italy Varese Norway Poland Cracow City Katowicel Warsaw City Romania County Cluj Spain Navarra Zaragoza Sweden Switzerland Basel Zurich Vaud UK Birmingham & West Midlands Oxford Mersey N.E. Scotland S.E. Scotland Yugoslavia Slovenia Oceania Australia N.S.W. South New Zealand Maoris Non- Maoris Hawaii Hawaiians White Chinese Filipino Japanese
Age-stand. rate
Relative freq.
6.3 5.1
2.9 2.1
6.6 7.6
8.9
2.4 6.4 5.8
15.8 27.7
6.1 10.6
26.5 28.7 34.2
10.7 9.7 13.4
27.4 24.9 19.9
8.3 8.8 9.0
12.6 16.9
6.7 7.7
20.3 42.0
6.1 17.6
13.8 6.6 11.5
5.7 3.6 5.5
9.8
5.6
20.5 17.0 45.9
8.4 8.9 19.7
50. I 45.8 35.2
15.9 17.2 12.6
18.9 23.7 19.2 26.0 26.5
8.0 9.7 7.1 9.6 9.3
18.7
8.0
33.8 41.9
12.4 15.1
35.4 33.3
11.0 12.6
40.9 58.3 25.2 30.6 31.2
13.1 16.8 12.3 17.5 13.5
*Data from Volume IV of Cancer Incidence in Five Continents.
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
136
C. S. MUIR
central and eastern part of the continent, between 10 and 15. Slightly higher rates are observed in the various Jewish populations of Israel. The lowest rates are those observed in Asian populations (8.2 in Bombay in India, around 6 in Japan, and less than 2 in the People’s Republic of China). There is an interesting contrast between the incidence rates observed in the Chinese population of Shanghai (1.8) and those resident in Los Angeles (16.9) and Hawaii (25.2). A comparable difference is noted for Japanese in Miyagi prefecture (6.3) and Osaka (5.1), and the Japanese living in Los Angeles (22.8) and Hawaii (31.2) (Table 1). The contrast which seems to exist in Africa between very low levels recorded in Dakar (4.3) and a much higher rate of 32.3 in the African population of Bulawayo, may be due to underregistration in Dakar and by a particularly high proporticn of autopsies at Bulawayo during the period of registration. According to certain studies, raised relative frequencies for cancer of the prostrate have been observed in certain African populations (7).
ET AL.
with incidence rates which are the highest in the world, a fall in incidence can be observed after 80 years of age, whereas incidence continues to rise after 85 for Norwegian, French and Japanese populations. Mortality
The data for mortality from cancer of the prostate have the advantage of not being distorted by the presence of variable numbers of latent cancer which should, in principle, not appear on a death certificate. They are thus probably more genuinely comparable than incidence data. None the less the underlying cause of death given on the death certificate may be much less accurate for the oldest age groups in which cancer of the prostate is particularly common. The mortality rates for prostatic cancer, age-adjusted to the world population, are given in Fig. 3. These mortality rates extracted from the World Health Data Mortality Bank (8) show levels which are much lower than those for
Age factors
The incidence curves for cancer of the prostate are given in Fig. 2 for six populations with large differences in incidence. The steep rise in incidence with age is readily seen with few cases occurring before the age of 50. This age-associated increase is more striking when the risk is high. The age-specific incidence curve is particularly steep in the black population of Atlanta in the United States. For the black and white populations of the United States,
1
2 3 4 5
6 7 8 9 10 11 12 13 14 15 16 17 18 19
20 21
1600
22
1500
A
1400 1300
Atlanta.Blacks
1200 1100
-
1000
-
=
900-
E
800700
37 38 39
-
,France, BasRhtn
500 400 300 200 -
600
0
23 24 25 26 27 28 29 30 31 32 33 34 35 36
40
45
50
55
60
65
70
75
80
85+
Age
Fig. 2. Incidence curves of cancer of the prostate in the USA, Europe and Asia.
40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57
58 59 60
St VincentlGrenadines Martinique Bermuda Sweden Uruguay Norway Switzerland Belgium Hungary Luxembourg Trinidad&Tobago German Fed Rep Austiia New Zealand The Netherlands France Finland UK Northern Ireland Australia Barbados USA Denmark Cuba Puerto Rlco Canada Spain Ireland Portugal UK, England& Wales Argentina Czechoslovakia UK. Scotland Venezuela Italy German Dem Rep Costa Rlca Yugoslavia Paraguay Romania Poland Panama Israel. Jewish POP Iceland Greece Malta Mexico Bulgaria Ecuador Peru Colombia Dominican Republic Japan Singapore Guatemala HongKong Mauritius El Salvador Egypt SnLanka Thailand
Fig. 3. Age-adjusted mortality rates from cancer of the prostate for the period 1972-1977 (from Segi, 1980).
137
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
EPlDEMlOLOGY OF PROSTATIC CANCER
incidence. The highest rates are found in St. Vincent/ Grenadines (29.1), Martinique (28.6), Bermuda (28.3), Sweden (21.0), Uruguay (19.7), Norway (19.7) and in Switzerland (19.2), the mortality rates for the United States as a whole (14.7) and Canada (13.8) occupying respectively the 21st and 25th ranks. Relatively high rates can be seen in Hungary (l6.7), Luxembourg (16.5) and the Federal Republic of Germany (16.1), in Austria (16.0), the Netherlands (15.5) and in Finland (15.2). Mortality rates are low in Israel ( K O ) , Iceland (7.8) Greece (7.0) and Bulgaria (6.1). In the countries of Asia, where incidence is very low, mortality rates are also low (2.5 in Japan, 2.4 in Singapore and 2.1 in Hong Kong). Very low rates have also been recorded in Mauritius (2.0), Egypt (0.8), Thailand (0.1) and in Nicaragua where the rate is so low that it does not attain a significant figure (0.0). None the less, it should be remembered that in several of these countries, death certification may lack precision. In the majority of countries such as, for example, France (9), there is very little evidence of geographical differences in mortality. The high incidence rates observed in the Ardeche are not reflected in the mortality rates for this department, the figures being practically identical to those reported at the national level. In the regions where data are available, incidence is generally higher in urban areas. Incidence and relative frequency in developing countries The relative frequency of cancer of the prostate compared to the total number of malignancies is given in Table 2 for a certain number of developing countries. These data are extracted from a recent publication on cancer in developing countries (10). The frequency of tumours of the prostate is accompanied by the world age-standardized incidence rate per 100000 persons, when the latter could be calculated. The lowest rates in the Americas are those observed in Bolivia (12.5) and in Panama (15.2). In Africa, the relative frequency shows considerable variation from one region to another, for example, from 3.9% in the Sudan to 11.3% in Liberia. In Asia, the incidence rates are generally very low, about 0.8 in Pakistan and 3.6 in Iran. Higher rates are observed in the Philippines (8.4) and in the non-Kuwaiti population of Kuwait (8.5). In Oceania, while rates are very low in Papua New Guinea (O.l), those in New Caledonia are some 13.3 per 100000. Time-trends The changes in the incidence of cancer of the prostate ( 11) described in this chapter are based on the data given
in five volumes of the Cancer Incidence in Five Continents series. The age-standardized rates and the average annual change from 1960 to 1980 are given in Table 3 for registries with data extending over a sufficiently long period of
Table 2 Percentage relative frequency and standardized incidence rates per IOOOOOpersons for cancer of the prostate in 24 cancer registries in heloping countries, around 1975
Cancer registry
Africa Liberia Nigeria Ibadan Uganda Kampala Sudan Tanzania Kilimanjaro Zambia Americas Argentina La Plata Tandil Bolivia La Paz Brazil Fortaleza Pernambuco Recife Costa Rica Martinique Panama Peru Lima Asia Burma Rangoon Korea India Ahmedabad Iran Fars Kuwait pop. Kuwaiti pop. non-Kuwaiti Pakistan Philippines Thailand Oceania New Caledonia Papua New Guinea
Percentage Yo
Stand. rate
11.3
-
10.7
-
5.6 3.9
-
11.2 8.0
-
8.3 10.8
20.7 29.3
9.6
12.5
8.2 10.0 10.0 24.2 15.1
27.7 33.4 25.8 44.4 15.2
10.8
15.7
1.3 1 .o
2.7 1.4
1.2
2.1
2.5
3.6
3.6 2.4 1.3 5.2 1.9
3.1 8.5 0.8 8.4 1.1
4.1 0.4
13.3 0.1
-
-
time. These trends are shown graphically for 12 selected registries in Fig. 4. In most cancer registries an increase in incidence can be observed. These average annual percentage rates of increase are most marked for the Chinese populations in Singapore (10.5%) and the Japanese (4.6%), Chinese and Hawaiian populations in Hawaii (6.5% and 3.6% respectively), for the inhabitants of Cracow in Poland (7.2%) and those living in Szabolcs in Hungary (6.4%). The increase is fairly large in Scandinavia (Finland, Sweden, Norway) as for the majority of the Canadian provinces with an average annual increase of some 2-5%. In the
138
C. S. MUIR ET AL.
Table 3 Time-trends in prostatic cancer incidence in selected cancer registries, average annual age-standardized rates per 1OOOOO and average annual percentage change
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Cancer registry
America Canada Alberta Manitoba Newfoundland Quebec Saskatchewan Colombia Cali Jamaica Kingston Puerto Rico USA Alameda White Black Bay Area White Black Chinese Connecticut New York State Asia India Bombay Israel All Jews Born Israel Born Am./Eur. Born Afr./Asia Non-Jews Japan Miyagi Singapore Chinese Europe Denmark Finland FRG Hamburg GDR Hungary Szabolcs Vas Norway Poland Katowice Cracow Sweden UK Birmingham Mersey Oxford S. Thames Yugoslavia Oceania N. Zealand Maoris Non-Maoris Hawaii Hawaiians White Chinese Japanese Filipino
Vol. Iv circa 1975
VOl. v circa 1980
VOl. I circa 1960
Vol. I1 circa 1965
Vol. 111 circa 1970
21.3 30.6 12.6 33.4
23.5 31.1 17.0 21.1 39.0
32.4 37.6 21.6 28.2 39.0
38.1 43.2 27.4 31.9 46.1
45.3 44.4 27.4 41.5 57.6
3.9 1.9 4.0 4.6 2.8
27.8
23.2
19.9
22.3
30.6
0.5
14.1 16.5
28.8 17.2
20.7 21.4
28.6 25.0
30.7
4.8 3.2
-
38.0 65.3
40.4 75.0
44.5 100.2
49.6 71.8
1.8 0.6
33.8 23.5
-
44.6 77.0 18.2 37.7 29.4
47.4 92.2 18.6 42.7 39.9
50.0 82.5 14.9 46.8 42.6
1.2 0.7
-
33.0 -
Average percentage change Decrease
Increase
-2.0
1.6 3.0
-
6.5
8.O
6.9
8.2
1.6
-
12.5 10.8 13.2 11.4 3.1
14.3 9.7 12.6 13.2 4.3
15.1 12.9 12.4 13.6 4.9
18.8 24.3 22.5 16.8 6.5
2.8 3.6 2.6 5.1
3.2
2.7
4.9
6.3
2.6
-
3.8
5.6
0.9
-
3.6
4.8
6.6
10.5
17.7 17.6
19.5 17.4
21.8 22.7
23.6 27.2
27.7 34.2
2.3 3.4
-
16.5
18.3 12.6
22.9 14.6
28.5 18.1
26.5 19.9
2.4 3.1
25.0
5.0 19.5 29.8
9.1 16.1 33.1
10.1 13.3 38.9
12.6 16.9 42.0
26.5
4.6 4.9 33.5
7.1 8.0 38.8
6.6 11.0 44.4
13.8 45.9
3.7 7.2 2.8
17.3 17.1
18.4 18.2 19.2 19.3 13.1
17.7 17.5 19.2 16.4 16.8
18.6 18.1 20.8 20.1 15.8
18.9 19.2 23.7 21.4 18.7
0.6 1.4 1.9 2.7
40.3 40.0
34.6 25.9
39.8 30.7
3 5.4 33.3
30.0 43.4 9.8 13.9 17.6
19.8 42.3 17.8 24.6 14.0
42.5 59.8 25.8 36.0 30.6
40.9 58.3 25.2 31.2 30.6
-
14.8 10.9 -
20.2 40.9
-
12.6
-
6.4 - 1.0
2.6
-0.8 - 1.2 3.6 1.8 6.5 4.6 3.8
139
EPIDEMIOLOGY OF PROSTATIC CANCER
;:/1
Colombia, Call
Canada, Alberta
20
20 1
2
3
4
1
5
2 3 Periods
4
5
1
2
3
4
5
1
2
3
4
Hmaii. Hawaiians
30 20 1
I&J
2
3
4
5
Psriods
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Israel, Jews
30
30
5 20
20
30
20
1
2
3
4
-
1
2
3
4
1
3
4
5
Permds
UK. Birmmgharn
Sweden 50
2
England and Wale8
I.
-
30
20 1
2
3
4
5
1
2
3
4
Periods
Note scale is different for this population
1
1
1
1
1
1
1
,
1
1
1
1
,
I
I
ISSO IS63 1967 1971 IS75 1978 IS83 IS61 1965 ISSS 1973 IS77 I981 1985 1957
I
Fig. 4. Time-trends of prostatic cancer incidence for certain cancer registries from 1960 (period 1) to 1980 (periods).
Fig. 5. Mortality from cancer of the prostate.
United States, the increase in this cancer is greater among black populations than among whites, with an average annual rate of increase of some 2.7%-3.7%, while the rate among whites is from 0.9%-1.2%. A recent fall in blacks in Alameda county, California, was not observed in, for example, Detroit. In contradiction to this virtually universal rise, a fall was noted in Vas in Hungary and among the non-Maoris in New Zealand, although the incidence in the Maori population remained stationary (Table 3). The time-trends for prostate cancer mortality, derived from a publication of Segi & Kurihara (12) and from the WHO Cancer Mortality Data Bank for the period 19501983, are graphed in Fig. 5. Although the period covered is not the same as that presented in the Cancer Incidence in Five Continents series, one can none the less observe the same tendency towards increase in the majority of countries. The increase is particularly noticeable and regular in Japan which is still currently a low-risk region. It is considerably less prominent in the non-white populations of the United States, in Scandinavia, England and Wales, France and Italy, thus confirming the trends noted for
incidence. In Sweden, however, a tendency to rise between 1955 and 1975 has been followed by a fall, a time-trend which is difficult to explain. A much clearer increase was observed between 1960 and 1970 for the non-white population of the United States which is largely composed of blacks (13). The study of time-trends in relation to year of birth for non-white US populations none the less suggests a possible future reversal of this trend of increase. For the birth cohorts born before 1896-1900 an increase can be observed for all age groups. Mortality falls for the cohorts born after 1896-1900 (Fig. 6). Holman & James (14) made the same observations in Australia and in England and Wales, where they showed that the mortality rates rose for successive cohorts until the cohort born in 1865- 1880, after which they observed a reduction in rates, apart from persons aged 50-69 years. Using the mortality data provided by Segi Institute of Cancer Epidemiology (15) one may see a fall in the mortality curves in Austria and among US whites, yet the incidence rates of white populations in the United States show an increase.
140
C. S. MUlR ET AL
may be, their distribution must correspond to that portrayed by descriptive epidemiology.
'9
1-74
Corresponding author: Dr Calum S. Muir, International Agency for Reseach on Cancer, 150 cows Albert Thomas, F-69372 Lyon Cedex, France.
'65-69 0 0 0
l 6 0 - 6 4
0
REFERENCES
0
r E
L 5 5 - 5 9
Lu
a
L
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
45-49
1846 650
1856 1866
i G o ieio
1876 1886 i f 8 0 1590
1896 i9%0
US. BLACKS: YEAR
1906 160
1921 192s
OF BIRTH
Fig. 6. Age-specific mortality rates for cancer of the prostate in the United States (non-whites) by year of birth (1846-1925).
Comment The descriptive epidemiology of prostatic cancer raises several fundamental questions, the solution of which may give rise to a better understanding of this disease. The apparently uniform distribution of 'latent' cancer of the prostate, compared to the large differences in the incidence of and mortality of clinical prostatic cancer, suggests the existence of one or several factors responsible for the progression of this disease. The identification of this or these factors would constitute considerable progress. If the differences in the occurrence of this cancer are genetically influenced and explain, a t least in part, the great geographical and ethnic differences, the relatively rapid rise in incidence and mortality in Japanese (and Chinese) migrants to the United States (16, 17) clearly suggests that the environment (in the broadest sense of the word, including factors such as diet and personal habits) plays a most important role. The very great disparity between black and white populations in the Unites States and the fall in mortality observed among the more recent year of birth cohorts in several countries, are probably not artefactual. Whatever the causes of cancer of the prostate
I . Parkin DM, Laara E, Muir CS. Estimates of the worldwide frequency of sixteen major cancers in 1980. Int J Cancer 1988; 41: 184-97. 2. Rotkin ID. Epidemiologic clues to the increased risk of prostate cancer. In: Male accessory glands. Spring-Mills and Halfez, ESE, North Holland: Biomedical Press, 1980: 291309. 3. National Board of Health and Welfare. The Cancer Registry Cancer Incidence in Sweden I98 1. Stockholm: Socialstyrelsen, 1984. 4. Breslow NE, Chan CW, Dhom G, et al. Latent carcinoma of prostate at autopsy in seven areas. Int J Cancer 1977; 20: 680-8. 5. Muir CS, Waterhouse J, Mack T, Powell J, Whelan S. eds. Cancer Incidence in Five Continents, Vol. V. IARC Scientific Publications No. 88, International Agency for Research on Cancer, Lyon, 1987. 6. Olaya F, Nectoux J. Le cancer en Ardkhe du Nord. Incidence 1983-1986. Registre des Tumeurs de 1'Ardtkhe du Nord, Annonay, 1987. 7. Jackson MA, Ahluwalia BS, Herson J, et al. Characterisation of prostate cancer among blacks: a continuation report. Cancer Treat Rep 1977; 61: 167-72. 8. World Health Organization Data Mortality Bank. WHO, Geneva, Switzerland. 9. Rezvani A, Doyon F, Flamant R. Statistique de Santt. Atlas de la mortalitt par cancer en France (1971-1978). Pans: Les Editions INSERM, 1987. 10. Parkin DM, ed. Cancer occurrence in developing countries. IARC Scientific Publications no. 75. International Agency for Research on Cancer, Lyon, 1986. 11. Zaridze DG, Boyle P, Smans M. International trends in prostatic cancer. Int J Cancer 1984; 33: 223-30. 12. Segi M, Kurihara M. Cancer mortality for selected sites in 24 countries. No. 4, 1962-1963. Department of Public Health, Tohoku University School of Medicine, Sendai, Japan, 1966. 13. Ernster VL, Seloin S, Winkelstein W. Cohort mortality for prostatic cancer among United States non-whites. Science 1978; 200: 1165-6. 14. Holman CDJ, James IR. Recent trends in mortality from prostate cancer in male populations of Australia and England and Wales. Br J Cancer 1981; 44: 340-8. 15. Segi Institute of Cancer Epidemiology. Age-adjusted death rates for cancer for selected sites (A classification) in 46 countries in 1978. February, 1984. 16. Haenszel W, Kurihara M. Studies of Japanese migrants. I. Mortality from cancer and other diseases among Japanese in the United States. J Natl Cancer Inst 1968; 40: 43-68. 17. Haenszel W. Studies of migrant populations. Am J Public Health 1985; 75: 225-6.
1991
THE EPIDEMIOLOGY OF PROSTATIC CANCER
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Geographical distribution and time-trends C. S. MUIR, J. NECTOUX and J. STASZEWSKI
Abstract Prostate cancer is one of the most frequent tumours in males. Globally about 235000 new cases were estimated to occur in 1980. The cancer is particularly frequent in North America, where rates in blacks are often double those in whites, and in several European countries, being rare in much of Asia. After migration to the US, Chinese and Japanese show substantial increases. Incidence may be distorted by inclusion of varying numbers of so-called ‘latent’ cancers; for some comparisons mortality data are preferable. ‘Small’ latent cancers seem to be uniformly distributed irrespective of the incidence of the clinically manifest form. The incidence of prostate cancer seems to be increasing in most populations, particularly in Asia and Eastern Europe. In general, mortality follows suit. Birth cohort analysis shows that for US non-whites, cohorts born before 1896-1900 showed an increase in mortality for all age groups, but the death rates fell for cohorts born subsequently, a phenomenon also observed in Australia and England and Wales. Key words: Prostrate, cancer, epidemiology.
Clinical cancer of the prostate is one of the most frequent tumours in males. About 235 000 newly diagnosed cases of clinical prostatic cancer were estimated to have occurred in the world in 1980, this form of malignancy thus being in fifth rank for cancer in males throughout the world and in second or third rank in the industrialized countries (1). Very rare before the age of 50, it occurs for the most part among the older age groups, its incidence increasing up to a very advanced age. Very unequally distributed throughout the world, this cancer is particularly frequent in North America and in several European countries, while very rare in much of Asia. The great majority of prostatic cancers are adenocarcinomas. ‘Latent’ cancer of the prostate discovered incidentally following microscopic examination of prostate tissue is also very widespread, the frequency being much
greater than that of the clinical form of the disease. Contrary to invasive prostatic cancer for which the incidence varies greatly, the relative frequencies of latent cancer seem to be much the same in regions where the incidence of the invasive form of the disease differs greatly (see below). Latent cancer of the prostate
Latent cancer is much more frequent than clinical cancer There are several problems linked to the epidemiology of cancer of the prostate, in that this disease attacks the oldest ages, when diagnosis is frequently imprecise and when latent cancer is three to eight times more frequent than the clinical form of disease (2). Incidental discovery following histological examination of tissue removed during surgical intervention for adenomatous hyperplasia or at autopsy is very frequent. For example, in Malmo in Sweden, where the proportion of all dead necropsied is very high, in 1981 the age-adjusted incidence for these cancers was 151.1 in the commune of Malmo, a figure some 50% greater than that observed elsewhere in Sweden (3). At the national level, 298 cases were discovered at autopsy (7.6%), whereas in Malmo 61 of a total of 177 cases were discovered incidentally at autopsy (34.5%). As the International Classification of Diseases does not make any distinction between latent and invasive cancer,
From the International Agency for Research on Cancer, Lyon, France, and Institute of Oncology, Gliwice, Poland. Presented at the Conference on Early Prostatic Cancer. The WHO Collaborating Centre for Urological Tumours, Karolinska Hospital, Stockholm, March 21-23, 1990. Accepted for publication 22 September 1990. 133
134
C.
S. MUIR ET AL.
the incidence data for this form of malignancy may be seriously distorted. There is thus a degree of uncertainty in comparing incidence figures for prostatic cancer. The frequency of latent cancer rises with age
The frequency of latent cancer of the prostate increases with age. Many autopsy series show that the relative frequency of this cancer is between 5-14% for men aged 50-60, reaching 20-40% among those between 60 and 80 years of age.
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Latent cancer does not follow the geographical variations of clinical cancer
Examination of material from consecutive autopsies of men aged more than 44 years, undertaken in seven.different parts of the world (Israel, Hong Kong, Singapore, Uganda, Jamaica, Sweden and the Federal Republic of Germany) revealed a relative frequency of about 20% for this form of cancer (4).During this study there was very little variation in the frequency of small non-invasive latent cancers, by age or by geographical distribution, In constrast, much larger variation was observed for the same parameters for microinvasive latent cancers, variations which were close to those observed for invasive cancer of the prostate. These studies suggest that the factors leading to progression of latent cancers of the prostate towards the invasive clinically detectable forms, vary considerably from one region to another or, if similar, are not present to the same degree.
Clinical cancer Geographical distribution
The incidence rates for cancer of the prostate extracted from the fifth volume of Cancer Incidence in Five Continents ( 5 ) for the period 1978-1982, are given in Table 1 for 88 different populations. The variation in incidence is shown graphically in rank order for several cancer registries in Fig. 1. The rates are given per 100000 population per annum and have been age-adjusted to the world population structure and are hence comparable, in that the rates allow for the differing age structures of the populations compared. The highest incidence rates for cancer of the prostate occur in the continental United States and Hawaii: the black populations of the United States have the highest incidence with a particularly elevated rate of 91.2 in Atlanta in Georgia, where this cancer is in second rank, lung cancer being in first place with an age-standarized rate of 94.6. The rates recorded among white populations in the United States are between 40 and 60, globally in second place, although substantially lower than among black populations residing in the same region.
1 2 3 4. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58
Atlanta, Blacks Detroit, Blacks Alameda, blacks San Francixo, Bay Area, Blacks New Orleans, Blacks Utah Hawaii, Whites Canada, Saskatchewan Atlanta, Whites Detroit, Whites Switzerland, Basel San Francisco, Bay Area, Whites Alameda, Whites Sweden Switzerland. Zurich Canada, Alberta Norway New Orleans, Whites Hawaii, Hawaiians New Zealand, Maoris Finland Australia. NSW New Zealand, non-Maoris Brazil, Sao Paulo Bulawayo, Africans Hawaii, Japanese Puerto Rico Colombia, Cali Hawaii, Filipinos Jamaica, Kingston Denmark Canada, Newfoundland France, Bas-Rhin U K . S.E. Scotland UK, N.E. Scotland Hawaii, Chinese France, Doubs Spain, Navarra Italy. Varese Cuba German Democratic Republic UK, Mersey UK, Birmingham Israel, all Jews San Francisco, Bay Area, Japanese Czechoslovakia, Slovakia San Francixo, Bay Area, Chinese Poland. Cracow Hungary. Szabolcs Singapore, Indians India, Bombay Poland, Katowice Singapore, Chinese Japan, Miyagi Hong Kong Japan, Osaka Senegal, Dakar China, Shanghai
91.2 91.1 87.8 82.5 71.8 70.2 58.3 57.6 53.4 51.2 50.1 50.0 49.6 45.9 45.8 45.4 42 .O 42.0 40.9 35.4 34.2 33.8 33.3 33.0 32.3' 31.2 30.7 30.6 30.6 28.6 27.7 27.4 27.4 26.5 26.0 25.2 24.9 20.5 20.3 19.9' 19.9 19.2 18.9 18.8 16.5 15.8 14.9 13.8' 12.6 8.9 8.2 6.6 6.6 6.3 6.2 5.1 4.3" 1.8
" C15(IV) data
Fig. 1. Age-adjusted incidence rates from cancer of the prostate for 1978-1982, for several cancer registries.
A very high incidence of 58.4, although based on a small population, has been consistently noted in the north of Ardeche in France (6). European rates are generally at an intermediate level, between 10 and 40. The highest incidence rates in Europe, after that of Ardkche, are recorded in Scandinavia with 45.9 in Sweden, 42.0 in Norway and in Switzerland (50.1 in Basel and 45.8 in Zurich). Roughly similar rates have been reported from several Canadian provinces ranging between 27.4 in Newfoundland and 57.6 in Saskatchewan and in New Zealand where the rates in Maoris of 35.4 are much the same as in the non-Maori population 33.3. Rates around 25 have been reported from France (the Departments of the Doubs, Bas-Rhin, Calvados and Isere), being much the same as those in Denmark, the Federal Republic of Germany and Great Britain. The lowest incidence rates in Europe occur in the
135
EPIDEMIOLOGY OF PROSTATIC CANCER
Table 1 Average annual age-standardized incidence rates, per loOooO, for cancer of the prostate and relative frequency as a proportion of all cancer around 1980
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Cancer registry Africa Bulawayo Africans* Senegal Dakar* Americas Brazil San Paulo Canada Alberta Brit. Columbia Manitoba Newfoundland NWT and Yukon Ontario Quebec Saskatchewan Colombia Cali Cuba* Jamaica Kingston* Netherlands Antilles USA Alameda, white Alameda, black San Francis0 Bay Area White Black Chinese Japanese Los Angeles White Latino Black Japanese Chinese Connecticut White Atlanta White Black Iowa Detroit White Black New Mexico White Hispanic American Indian New York City Puerto Rico Utah Asia China Shanghai Hong-Kong India Bombay Israel All Jews Born Israel Born Am./Eur. Born Afr./Asia Non-Jews
Age-stand. rate
Relative freq.
32.3
3.9
4.3
4.0
33.0
10.4
45.3 49.5 44.4 27.4 27.7 41.6 41.5 57.6
18.0 18.7 15.2 10.3 11.5 14.1 13.7 20.4
30.6 19.9
14.6 12.5
28.6 26.6
14.1 15.0
49.6 87.8
15.9 22.1
50.0 82.5 14.9 16.5
16.0 21.2 6.6 8.7
49.6 43.0 82.6 22.8 16.9
16.1 20.2 23.3 12.7 8.0
46.8
14.7
53.4 91.2 51.3
17.1 24.6 17.2
51.2 91.1
15.6 22.8
56.7 53.4 29.2 41.7 30.7 70.2
19.8 25.5 22.2 13.9 16.2 27.4
1.8 6.2
0.8 2.2
8.2
5.7
18.8 24.3 22.5 16.8 6.5
8.7 11.5 9.1
?I 5.5
Cancer registry Japan Miyagi Osaka Singapore Chinese Malay Indians Europe Czechoslovakia Slovakia Denmark FRG Hamburg Saarland Finland France Bas-Rhin Doubs GDR Hungary Szabolcs-Szatmar Vas Italy Varese Norway Poland Cracow City Katowicel Warsaw City Romania County Cluj Spain Navarra Zaragoza Sweden Switzerland Basel Zurich Vaud UK Birmingham & West Midlands Oxford Mersey N.E. Scotland S.E. Scotland Yugoslavia Slovenia Oceania Australia N.S.W. South New Zealand Maoris Non- Maoris Hawaii Hawaiians White Chinese Filipino Japanese
Age-stand. rate
Relative freq.
6.3 5.1
2.9 2.1
6.6 7.6
8.9
2.4 6.4 5.8
15.8 27.7
6.1 10.6
26.5 28.7 34.2
10.7 9.7 13.4
27.4 24.9 19.9
8.3 8.8 9.0
12.6 16.9
6.7 7.7
20.3 42.0
6.1 17.6
13.8 6.6 11.5
5.7 3.6 5.5
9.8
5.6
20.5 17.0 45.9
8.4 8.9 19.7
50. I 45.8 35.2
15.9 17.2 12.6
18.9 23.7 19.2 26.0 26.5
8.0 9.7 7.1 9.6 9.3
18.7
8.0
33.8 41.9
12.4 15.1
35.4 33.3
11.0 12.6
40.9 58.3 25.2 30.6 31.2
13.1 16.8 12.3 17.5 13.5
*Data from Volume IV of Cancer Incidence in Five Continents.
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
136
C. S. MUIR
central and eastern part of the continent, between 10 and 15. Slightly higher rates are observed in the various Jewish populations of Israel. The lowest rates are those observed in Asian populations (8.2 in Bombay in India, around 6 in Japan, and less than 2 in the People’s Republic of China). There is an interesting contrast between the incidence rates observed in the Chinese population of Shanghai (1.8) and those resident in Los Angeles (16.9) and Hawaii (25.2). A comparable difference is noted for Japanese in Miyagi prefecture (6.3) and Osaka (5.1), and the Japanese living in Los Angeles (22.8) and Hawaii (31.2) (Table 1). The contrast which seems to exist in Africa between very low levels recorded in Dakar (4.3) and a much higher rate of 32.3 in the African population of Bulawayo, may be due to underregistration in Dakar and by a particularly high proporticn of autopsies at Bulawayo during the period of registration. According to certain studies, raised relative frequencies for cancer of the prostrate have been observed in certain African populations (7).
ET AL.
with incidence rates which are the highest in the world, a fall in incidence can be observed after 80 years of age, whereas incidence continues to rise after 85 for Norwegian, French and Japanese populations. Mortality
The data for mortality from cancer of the prostate have the advantage of not being distorted by the presence of variable numbers of latent cancer which should, in principle, not appear on a death certificate. They are thus probably more genuinely comparable than incidence data. None the less the underlying cause of death given on the death certificate may be much less accurate for the oldest age groups in which cancer of the prostate is particularly common. The mortality rates for prostatic cancer, age-adjusted to the world population, are given in Fig. 3. These mortality rates extracted from the World Health Data Mortality Bank (8) show levels which are much lower than those for
Age factors
The incidence curves for cancer of the prostate are given in Fig. 2 for six populations with large differences in incidence. The steep rise in incidence with age is readily seen with few cases occurring before the age of 50. This age-associated increase is more striking when the risk is high. The age-specific incidence curve is particularly steep in the black population of Atlanta in the United States. For the black and white populations of the United States,
1
2 3 4 5
6 7 8 9 10 11 12 13 14 15 16 17 18 19
20 21
1600
22
1500
A
1400 1300
Atlanta.Blacks
1200 1100
-
1000
-
=
900-
E
800700
37 38 39
-
,France, BasRhtn
500 400 300 200 -
600
0
23 24 25 26 27 28 29 30 31 32 33 34 35 36
40
45
50
55
60
65
70
75
80
85+
Age
Fig. 2. Incidence curves of cancer of the prostate in the USA, Europe and Asia.
40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57
58 59 60
St VincentlGrenadines Martinique Bermuda Sweden Uruguay Norway Switzerland Belgium Hungary Luxembourg Trinidad&Tobago German Fed Rep Austiia New Zealand The Netherlands France Finland UK Northern Ireland Australia Barbados USA Denmark Cuba Puerto Rlco Canada Spain Ireland Portugal UK, England& Wales Argentina Czechoslovakia UK. Scotland Venezuela Italy German Dem Rep Costa Rlca Yugoslavia Paraguay Romania Poland Panama Israel. Jewish POP Iceland Greece Malta Mexico Bulgaria Ecuador Peru Colombia Dominican Republic Japan Singapore Guatemala HongKong Mauritius El Salvador Egypt SnLanka Thailand
Fig. 3. Age-adjusted mortality rates from cancer of the prostate for the period 1972-1977 (from Segi, 1980).
137
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
EPlDEMlOLOGY OF PROSTATIC CANCER
incidence. The highest rates are found in St. Vincent/ Grenadines (29.1), Martinique (28.6), Bermuda (28.3), Sweden (21.0), Uruguay (19.7), Norway (19.7) and in Switzerland (19.2), the mortality rates for the United States as a whole (14.7) and Canada (13.8) occupying respectively the 21st and 25th ranks. Relatively high rates can be seen in Hungary (l6.7), Luxembourg (16.5) and the Federal Republic of Germany (16.1), in Austria (16.0), the Netherlands (15.5) and in Finland (15.2). Mortality rates are low in Israel ( K O ) , Iceland (7.8) Greece (7.0) and Bulgaria (6.1). In the countries of Asia, where incidence is very low, mortality rates are also low (2.5 in Japan, 2.4 in Singapore and 2.1 in Hong Kong). Very low rates have also been recorded in Mauritius (2.0), Egypt (0.8), Thailand (0.1) and in Nicaragua where the rate is so low that it does not attain a significant figure (0.0). None the less, it should be remembered that in several of these countries, death certification may lack precision. In the majority of countries such as, for example, France (9), there is very little evidence of geographical differences in mortality. The high incidence rates observed in the Ardeche are not reflected in the mortality rates for this department, the figures being practically identical to those reported at the national level. In the regions where data are available, incidence is generally higher in urban areas. Incidence and relative frequency in developing countries The relative frequency of cancer of the prostate compared to the total number of malignancies is given in Table 2 for a certain number of developing countries. These data are extracted from a recent publication on cancer in developing countries (10). The frequency of tumours of the prostate is accompanied by the world age-standardized incidence rate per 100000 persons, when the latter could be calculated. The lowest rates in the Americas are those observed in Bolivia (12.5) and in Panama (15.2). In Africa, the relative frequency shows considerable variation from one region to another, for example, from 3.9% in the Sudan to 11.3% in Liberia. In Asia, the incidence rates are generally very low, about 0.8 in Pakistan and 3.6 in Iran. Higher rates are observed in the Philippines (8.4) and in the non-Kuwaiti population of Kuwait (8.5). In Oceania, while rates are very low in Papua New Guinea (O.l), those in New Caledonia are some 13.3 per 100000. Time-trends The changes in the incidence of cancer of the prostate ( 11) described in this chapter are based on the data given
in five volumes of the Cancer Incidence in Five Continents series. The age-standardized rates and the average annual change from 1960 to 1980 are given in Table 3 for registries with data extending over a sufficiently long period of
Table 2 Percentage relative frequency and standardized incidence rates per IOOOOOpersons for cancer of the prostate in 24 cancer registries in heloping countries, around 1975
Cancer registry
Africa Liberia Nigeria Ibadan Uganda Kampala Sudan Tanzania Kilimanjaro Zambia Americas Argentina La Plata Tandil Bolivia La Paz Brazil Fortaleza Pernambuco Recife Costa Rica Martinique Panama Peru Lima Asia Burma Rangoon Korea India Ahmedabad Iran Fars Kuwait pop. Kuwaiti pop. non-Kuwaiti Pakistan Philippines Thailand Oceania New Caledonia Papua New Guinea
Percentage Yo
Stand. rate
11.3
-
10.7
-
5.6 3.9
-
11.2 8.0
-
8.3 10.8
20.7 29.3
9.6
12.5
8.2 10.0 10.0 24.2 15.1
27.7 33.4 25.8 44.4 15.2
10.8
15.7
1.3 1 .o
2.7 1.4
1.2
2.1
2.5
3.6
3.6 2.4 1.3 5.2 1.9
3.1 8.5 0.8 8.4 1.1
4.1 0.4
13.3 0.1
-
-
time. These trends are shown graphically for 12 selected registries in Fig. 4. In most cancer registries an increase in incidence can be observed. These average annual percentage rates of increase are most marked for the Chinese populations in Singapore (10.5%) and the Japanese (4.6%), Chinese and Hawaiian populations in Hawaii (6.5% and 3.6% respectively), for the inhabitants of Cracow in Poland (7.2%) and those living in Szabolcs in Hungary (6.4%). The increase is fairly large in Scandinavia (Finland, Sweden, Norway) as for the majority of the Canadian provinces with an average annual increase of some 2-5%. In the
138
C. S. MUIR ET AL.
Table 3 Time-trends in prostatic cancer incidence in selected cancer registries, average annual age-standardized rates per 1OOOOO and average annual percentage change
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Cancer registry
America Canada Alberta Manitoba Newfoundland Quebec Saskatchewan Colombia Cali Jamaica Kingston Puerto Rico USA Alameda White Black Bay Area White Black Chinese Connecticut New York State Asia India Bombay Israel All Jews Born Israel Born Am./Eur. Born Afr./Asia Non-Jews Japan Miyagi Singapore Chinese Europe Denmark Finland FRG Hamburg GDR Hungary Szabolcs Vas Norway Poland Katowice Cracow Sweden UK Birmingham Mersey Oxford S. Thames Yugoslavia Oceania N. Zealand Maoris Non-Maoris Hawaii Hawaiians White Chinese Japanese Filipino
Vol. Iv circa 1975
VOl. v circa 1980
VOl. I circa 1960
Vol. I1 circa 1965
Vol. 111 circa 1970
21.3 30.6 12.6 33.4
23.5 31.1 17.0 21.1 39.0
32.4 37.6 21.6 28.2 39.0
38.1 43.2 27.4 31.9 46.1
45.3 44.4 27.4 41.5 57.6
3.9 1.9 4.0 4.6 2.8
27.8
23.2
19.9
22.3
30.6
0.5
14.1 16.5
28.8 17.2
20.7 21.4
28.6 25.0
30.7
4.8 3.2
-
38.0 65.3
40.4 75.0
44.5 100.2
49.6 71.8
1.8 0.6
33.8 23.5
-
44.6 77.0 18.2 37.7 29.4
47.4 92.2 18.6 42.7 39.9
50.0 82.5 14.9 46.8 42.6
1.2 0.7
-
33.0 -
Average percentage change Decrease
Increase
-2.0
1.6 3.0
-
6.5
8.O
6.9
8.2
1.6
-
12.5 10.8 13.2 11.4 3.1
14.3 9.7 12.6 13.2 4.3
15.1 12.9 12.4 13.6 4.9
18.8 24.3 22.5 16.8 6.5
2.8 3.6 2.6 5.1
3.2
2.7
4.9
6.3
2.6
-
3.8
5.6
0.9
-
3.6
4.8
6.6
10.5
17.7 17.6
19.5 17.4
21.8 22.7
23.6 27.2
27.7 34.2
2.3 3.4
-
16.5
18.3 12.6
22.9 14.6
28.5 18.1
26.5 19.9
2.4 3.1
25.0
5.0 19.5 29.8
9.1 16.1 33.1
10.1 13.3 38.9
12.6 16.9 42.0
26.5
4.6 4.9 33.5
7.1 8.0 38.8
6.6 11.0 44.4
13.8 45.9
3.7 7.2 2.8
17.3 17.1
18.4 18.2 19.2 19.3 13.1
17.7 17.5 19.2 16.4 16.8
18.6 18.1 20.8 20.1 15.8
18.9 19.2 23.7 21.4 18.7
0.6 1.4 1.9 2.7
40.3 40.0
34.6 25.9
39.8 30.7
3 5.4 33.3
30.0 43.4 9.8 13.9 17.6
19.8 42.3 17.8 24.6 14.0
42.5 59.8 25.8 36.0 30.6
40.9 58.3 25.2 31.2 30.6
-
14.8 10.9 -
20.2 40.9
-
12.6
-
6.4 - 1.0
2.6
-0.8 - 1.2 3.6 1.8 6.5 4.6 3.8
139
EPIDEMIOLOGY OF PROSTATIC CANCER
;:/1
Colombia, Call
Canada, Alberta
20
20 1
2
3
4
1
5
2 3 Periods
4
5
1
2
3
4
5
1
2
3
4
Hmaii. Hawaiians
30 20 1
I&J
2
3
4
5
Psriods
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
Israel, Jews
30
30
5 20
20
30
20
1
2
3
4
-
1
2
3
4
1
3
4
5
Permds
UK. Birmmgharn
Sweden 50
2
England and Wale8
I.
-
30
20 1
2
3
4
5
1
2
3
4
Periods
Note scale is different for this population
1
1
1
1
1
1
1
,
1
1
1
1
,
I
I
ISSO IS63 1967 1971 IS75 1978 IS83 IS61 1965 ISSS 1973 IS77 I981 1985 1957
I
Fig. 4. Time-trends of prostatic cancer incidence for certain cancer registries from 1960 (period 1) to 1980 (periods).
Fig. 5. Mortality from cancer of the prostate.
United States, the increase in this cancer is greater among black populations than among whites, with an average annual rate of increase of some 2.7%-3.7%, while the rate among whites is from 0.9%-1.2%. A recent fall in blacks in Alameda county, California, was not observed in, for example, Detroit. In contradiction to this virtually universal rise, a fall was noted in Vas in Hungary and among the non-Maoris in New Zealand, although the incidence in the Maori population remained stationary (Table 3). The time-trends for prostate cancer mortality, derived from a publication of Segi & Kurihara (12) and from the WHO Cancer Mortality Data Bank for the period 19501983, are graphed in Fig. 5. Although the period covered is not the same as that presented in the Cancer Incidence in Five Continents series, one can none the less observe the same tendency towards increase in the majority of countries. The increase is particularly noticeable and regular in Japan which is still currently a low-risk region. It is considerably less prominent in the non-white populations of the United States, in Scandinavia, England and Wales, France and Italy, thus confirming the trends noted for
incidence. In Sweden, however, a tendency to rise between 1955 and 1975 has been followed by a fall, a time-trend which is difficult to explain. A much clearer increase was observed between 1960 and 1970 for the non-white population of the United States which is largely composed of blacks (13). The study of time-trends in relation to year of birth for non-white US populations none the less suggests a possible future reversal of this trend of increase. For the birth cohorts born before 1896-1900 an increase can be observed for all age groups. Mortality falls for the cohorts born after 1896-1900 (Fig. 6). Holman & James (14) made the same observations in Australia and in England and Wales, where they showed that the mortality rates rose for successive cohorts until the cohort born in 1865- 1880, after which they observed a reduction in rates, apart from persons aged 50-69 years. Using the mortality data provided by Segi Institute of Cancer Epidemiology (15) one may see a fall in the mortality curves in Austria and among US whites, yet the incidence rates of white populations in the United States show an increase.
140
C. S. MUlR ET AL
may be, their distribution must correspond to that portrayed by descriptive epidemiology.
'9
1-74
Corresponding author: Dr Calum S. Muir, International Agency for Reseach on Cancer, 150 cows Albert Thomas, F-69372 Lyon Cedex, France.
'65-69 0 0 0
l 6 0 - 6 4
0
REFERENCES
0
r E
L 5 5 - 5 9
Lu
a
L
Acta Oncol Downloaded from informahealthcare.com by University of Kent on 11/05/14 For personal use only.
45-49
1846 650
1856 1866
i G o ieio
1876 1886 i f 8 0 1590
1896 i9%0
US. BLACKS: YEAR
1906 160
1921 192s
OF BIRTH
Fig. 6. Age-specific mortality rates for cancer of the prostate in the United States (non-whites) by year of birth (1846-1925).
Comment The descriptive epidemiology of prostatic cancer raises several fundamental questions, the solution of which may give rise to a better understanding of this disease. The apparently uniform distribution of 'latent' cancer of the prostate, compared to the large differences in the incidence of and mortality of clinical prostatic cancer, suggests the existence of one or several factors responsible for the progression of this disease. The identification of this or these factors would constitute considerable progress. If the differences in the occurrence of this cancer are genetically influenced and explain, a t least in part, the great geographical and ethnic differences, the relatively rapid rise in incidence and mortality in Japanese (and Chinese) migrants to the United States (16, 17) clearly suggests that the environment (in the broadest sense of the word, including factors such as diet and personal habits) plays a most important role. The very great disparity between black and white populations in the Unites States and the fall in mortality observed among the more recent year of birth cohorts in several countries, are probably not artefactual. Whatever the causes of cancer of the prostate
I . Parkin DM, Laara E, Muir CS. Estimates of the worldwide frequency of sixteen major cancers in 1980. Int J Cancer 1988; 41: 184-97. 2. Rotkin ID. Epidemiologic clues to the increased risk of prostate cancer. In: Male accessory glands. Spring-Mills and Halfez, ESE, North Holland: Biomedical Press, 1980: 291309. 3. National Board of Health and Welfare. The Cancer Registry Cancer Incidence in Sweden I98 1. Stockholm: Socialstyrelsen, 1984. 4. Breslow NE, Chan CW, Dhom G, et al. Latent carcinoma of prostate at autopsy in seven areas. Int J Cancer 1977; 20: 680-8. 5. Muir CS, Waterhouse J, Mack T, Powell J, Whelan S. eds. Cancer Incidence in Five Continents, Vol. V. IARC Scientific Publications No. 88, International Agency for Research on Cancer, Lyon, 1987. 6. Olaya F, Nectoux J. Le cancer en Ardkhe du Nord. Incidence 1983-1986. Registre des Tumeurs de 1'Ardtkhe du Nord, Annonay, 1987. 7. Jackson MA, Ahluwalia BS, Herson J, et al. Characterisation of prostate cancer among blacks: a continuation report. Cancer Treat Rep 1977; 61: 167-72. 8. World Health Organization Data Mortality Bank. WHO, Geneva, Switzerland. 9. Rezvani A, Doyon F, Flamant R. Statistique de Santt. Atlas de la mortalitt par cancer en France (1971-1978). Pans: Les Editions INSERM, 1987. 10. Parkin DM, ed. Cancer occurrence in developing countries. IARC Scientific Publications no. 75. International Agency for Research on Cancer, Lyon, 1986. 11. Zaridze DG, Boyle P, Smans M. International trends in prostatic cancer. Int J Cancer 1984; 33: 223-30. 12. Segi M, Kurihara M. Cancer mortality for selected sites in 24 countries. No. 4, 1962-1963. Department of Public Health, Tohoku University School of Medicine, Sendai, Japan, 1966. 13. Ernster VL, Seloin S, Winkelstein W. Cohort mortality for prostatic cancer among United States non-whites. Science 1978; 200: 1165-6. 14. Holman CDJ, James IR. Recent trends in mortality from prostate cancer in male populations of Australia and England and Wales. Br J Cancer 1981; 44: 340-8. 15. Segi Institute of Cancer Epidemiology. Age-adjusted death rates for cancer for selected sites (A classification) in 46 countries in 1978. February, 1984. 16. Haenszel W, Kurihara M. Studies of Japanese migrants. I. Mortality from cancer and other diseases among Japanese in the United States. J Natl Cancer Inst 1968; 40: 43-68. 17. Haenszel W. Studies of migrant populations. Am J Public Health 1985; 75: 225-6.
