Raquel Comas

We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994–2013) and to estimate the all-cause mortality excess risk of diagnosed women.

Background/aim The residential environment of women diagnosed with breast cancer (BC) has been suggested to be a key modifier of their survival outcomes, with area deprivation and remoteness (i.e. rural/urban) as chief indicators. Here, we aimed to describe the survival of women diagnosed with an invasive BC in the Girona province (Spain) during 2000–2013 based on the characteristics of their residential area. Methods We restricted our analysis to incident invasive BC tumours (ICD-10: C50.X) diagnosed in the Girona province (2000–2013). Data on tumour characteristics and vital status of patients were collected from the population-based Girona Cancer Registry. Bilateral tumours, death certificate and autopsy only cases were excluded. The last updated address of the patients was used to spatially assign them to a census area. We updated and improved a previously validated census area level deprivation index for Spain1. For area remoteness, we used the recommended standard of 150 inhab/km². A multivariate hazard model for relative survival with frailty and spatial adjustment was fitted. The models were fully adjusted for all available clinical and demographic variables, and hazard ratios (HR) were estimated Results A total of 4609 women were diagnosed with invasive BC in the Girona province during 2000 and 2013. Women living in areas classified by our deprivation index as being affluent and deprived, showed slightly higher hazards of death (HR=1.12, 95% CI=0.93 to 1.34 and HR=1.08, 95% CI=0,91 to 1,29, respectively) compared to those with an intermediate deprivation level, yet differences were not significant. Nevertheless, women living in urban areas did show a slightly significant decreased risk of death compared to women living in rural areas (HR=0.84, 95% CI: 0.71 to 0.99). Conclusion This is the first study to assess the effect of census area deprivation and remoteness on BC survival in the Girona province, and one of a few in Spain. Our results suggest there is no significant inequity by census-area deprivation. However, there exists a slightly poorer survival for women living in rural areas. This can be used to support regulatory approaches to tackle social inequities.

Determining chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) incidence is challenging for two reasons: cancer registries tend to underreport CLL cases and its diagnostic criteria changed markedly in 2008. No studies have reported incidence rates dealing with both difficulties, and thus CLL/SLL burden in Europe is currently uncertain. Herein, we present accurate CLL/SLL incidence in a Spanish region during 1998–2013, using the population-based Girona Cancer Registry (GCR). We detected an 18.2% under-reporting of CLL/SLL cases when combining records from the GCR and additional information sources (i.e., records of flow cytometry laboratories, hospital registries and hematologists’ databases). In addition, age-adjusted rates (using the 2013 European population) changed from 7.57 (95% CI 6.87; 8.30) in 1998–2008 to 6.35 (95% CI 5.51; 7.30) in 2009–2013. Overall, completeness of CLL/SLL data requires accurate diagnosis and reporting of cases. Revision of cancer registry operations to include CLL/SLL-specific surveillance is likely to ensure that the monitoring of this malignancy is entirely accurate.

Hodgkin lymphoma (HL) is characterized by heterogeneous histologic findings, clinical presentation and outcomes. Using the Girona population-based cancer registry data we sought to explore the incidence of HL over three decades in Girona Province (Spain) and examine the relationship between clinical features at diagnosis and survival. From 1985 to 2013, 459 cases were recorded. Patients were stratified by sex, age group, stage at diagnosis, histological subtypes and the presence of B-symptoms. The crude incidence rate (CR) was 2.7 and the corresponding European age-adjusted rate was 2.6, being higher in men than in women (sex ratio=1.6). Incidence remained constant throughout the period of study. Nodular sclerosis was the most frequent histology and showed an increasing incidence over time [estimated annual percentage change=+2.4, 95% confidence interval (CI): 0.8–4.0]. The 5-year observed survival and relative survival of patients diagnosed with HL were 73.1% (95% CI: 69.0–77.5) and 74.6% (95% CI: 70.0–79.4), respectively. No statistical differences in observed survival were observed across the three decades of study (P=0.455). Clinical parameters negatively influencing 5-year relative survival in the multivariate analysis were as follows: age at diagnosis at least 65 years; clinical stage IV; and presence of B-symptoms. These current patterns of presentation and outcomes of HL help delineate key populations in order to explore risk factors for HL and strategies to improve treatment outcomes.