ObjectivesThe purpose of the present study was to calculate the proportion of cancers in Canada attributable to tobacco smoking (ts), alcohol use (au), excess weight (ew), and physical inactivity (pia); to explore variation in the proportions of those risk factors (rfs) over time by sex and province; to estimate the economic burden of cancer attributable to the 4 rfs; and to calculate the potential reduction in cancers and economic burden if all provinces achieved rf prevalence rates equivalent to the best in Canada. MethodsWe used a previously developed approach based on population-attributable fractions (pafs) to estimate the cancer-related economic burden associated with the four rfs. Sex-specific relative risk and age-and sex-specific prevalence data were used in the modelling. The economic burden was adjusted for potential double counting of cases and costs. ResultsIn Canada, 27.7% of incident cancer cases [95% confidence interval (ci): 22.6% to 32.9%] in 2013 [47,000 of 170,000 (95% ci:38,400-55,900)] were attributable to the four rfs: ts, 15.2% (95% ci: 13.7% to 16.9%); ew, 5.1% (95% ci: 3.8% to 6.4%); au, 3.9% (95% ci: 2.4% to 5.3%); and pia, 3.5% (95% ci: 2.7% to 4.3%). The annual economic burden attributable to the 47,000 total cancers was $9.6 billion (95% ci: $7.8 billion to $11.3 billion): consisting of $1.7 billion in direct and $8.0 billion in indirect costs. Applying the lowest rf rates to each province would result in an annual reduction of 6204 cancers (13.2% of the potentially avoidable cancers) and a reduction in economic burden of $1.2 billion.Conclusions Despite substantial reductions in the prevalence and intensity of ts, ts remains the dominant risk factor from the perspective of cancer prevention in Canada, although ew and au are becoming increasingly important rfs.

OBJECTIVES:The objectives of this study were to determine the proportion of the population that meets or exceeds Canada's Food Guide (CFG) recommendations regarding the number of daily servings of fruits and vegetables (F/V), to assess trends in this proportion between 2000 and 2013, to estimate the annual economic burden attributable to inadequate F/V consumption within the context of other important risk factors, and to estimate the short-and long-term costs that could be avoided if modest improvements were made to F/V consumption in Canada. METHODS:We used a previously developed methodology based on population-attributable fractions and a prevalence-based cost-of-illness approach to estimate the economic burden associated with low F/V consumption. RESULTS:Over three quarters of Canadians are not meeting CFG recommendations regarding the number of daily servings of F/V, leading to an annual economic burden of $4.39 billion. If a 1% relative increase in F/V consumption occurred annually between 2013 and 2036, the cumulative reduction in economic burden over the 23-year period would reach $8.4 billion. Consumption levels of F/V, and the resulting economic burden, varied by sex, age and province.CONCLUSION: A significant majority of Canadians are not consuming the recommended daily servings of F/V, with important consequences to their health and the Canadian economy. Programs and policies are required to encourage F/V consumption in Canada.KEY WORDS: Economic burden of disease; populations at risk; risk factors; fruit and vegetable consumption La traduction du résumé se trouve à la fin de l'article.

OBJECTIVES: To investigate patterns of survival among brain cancer patients in Canada.METHODS: Canadian Cancer Registry data were obtained for all patients with first-ever primary malignant brain tumours diagnosed between 1992 and 2008 (n = 38,095). Follow-up ended with patient death or December 31, 2008, whichever occurred first. Crude Kaplan-Meier estimates were calculated at one, two and five years post-diagnosis. Cox proportional hazard models were used to obtain adjusted hazard ratios by region for major histology types. A time-specific generalized linear model was used to obtain 5-year survival estimates for specific age group, sex and region for major histology types. RESULTS:The overall five-year survival rate was 27%. No significant difference in survival rate over time is observed. The highest 5-year survival rate was 65% (95% CI: 62.5%-67.4%) for oligodendrogliomas and the lowest was 4.0% (95% CI: 3.7%-4.3%) for glioblastomas. Compared to Ontario, the adjusted 5-year glioblastoma survival estimates were lower in British Columbia, Alberta and the Prairie provinces (Manitoba and Saskatchewan), while the survival estimates were lower in all other regions for diffuse astrocytoma, and lower in Manitoba and Saskatchewan for anaplastic astrocytomas. Estimates were significantly higher for oligodendrogliomas in Alberta, and for anaplastic oligodendrogliomas in Alberta and Quebec (p < 0.05). CONCLUSION:These data are consistent with previous literature in observing higher survival rates at younger ages, in female patients and for tumours with mixed oligo components. There is a need to further explore the underlying reasons for the observed variation in survival rates by region in an effort to improve the prognosis of brain cancer in the Canadian patient population.KEY WORDS: Brain neoplasms; survival rate; Canada La traduction du résumé se trouve à la fin de l'article.

Few studies have assessed differences in the prevalence of and economic burden attributable to tobacco smoking, excess weight, physical inactivity, and alcohol use by gender. This article examines these gender differences in Canadians between the ages of 30 and 64 years. It also estimates the potential cost avoidance if the prevalence of the four risk factors (RFs) were reduced modestly in males. Data on the prevalence of the RFs and the relative risk of disease associated with each of the RFs were combined to calculate population-attributable fractions. A prevalence-based cost-of-illness approach was used to estimate the economic burden associated with the four RFs. Middle-aged Canadian males are more likely to smoke tobacco (26.4% vs. 20.2%), consume hazardous or harmful levels of alcohol (14.6% vs. 8.2%), and have excess weight (65.6% vs. 47.1%) than middle-aged Canadian females, resulting in an annual economic burden that is 27% higher in males than females. No significant differences were observed in the proportion of males who are physically inactive (48.4% vs. 49.4%). Modelling only a 1% annual relative reduction each year through to 2036 would result in a cumulative cost avoidance between 2013 and 2036 of $50.7 billion. The differences in RF prevalence between middle-aged males and females have an important effect on the population’s economic burden. A modest annual reduction in the four RFs in males can significantly affect population health and the economy over time.

Purpose : Breast Cancer (BC) is a genetic, heterogeneous disease and has a remarkable variability according to racial factors. Hypothetic explanations for these disparities include differences in tumor biology. The present study was designed to compare clinical and pathological features between Peruvian Latinas and Spanish women with BC; interest of this analysis increases if we take into account the relationship among historic ancestries of both ethnic groups (Incas emporium and Spanish conquers). Methods : Information was retrospectively reviewed from patients files and pathologic reports from Instituto Nacional de Enfermedades Neoplasicas (INEN) in Lima- Peru, and Hospital Universitario 12 de Octubre in Madrid- Spain. In order to produce comparative information and avoid subjective clinical measurements we selected only non-metastatic and non-bilateral invasive BC cases that underwent surgery as initial therapy. BC cases were classified as molecular subtypes: Luminal A [RE+ and/or RP+, HER2−], Lum B [RE+ and/or RP+, HER2+], triple negative (TN) [RE-, RP-, HER2−] and HER2 [RE-, RP-, HER2+]. Variables were compared with the X2 test and survival curves were evaluated with Kaplan-Meier method. Results: The study included 3765 BC cases. The Spanish cohort involved 1539 (40.9%) women consecutively diagnosed between 1997 and 2007 (median follow-up of 7.9 years). The Peruvian cohort involved 2226 (59.1%) women consecutively diagnosed between 2000 and 2006 (median follow-up of 6.3 years). In terms of pathological features, grade I tumors were more frequent in Spanish (16.2%) than Peruvian women (9.6%) (p&lt;0.001). Higher rates of lobular histology were also found in Spanish (12.5%) than Peruvian (6.0%) women (p&lt;0.001). Spanish cases presented at earlier stages when evaluated by lymph node status (N0 in 58.9% vs 47.1%) (p&lt;0.001) or by tumor size (T1 in 37.9% vs 17-2%). Conservative surgery were more frequent among Spanish cases (50.6% vs 16.8%) (p&lt;0.001). TN molecular subtype were more frequent among Peruvian cases (22.5% vs 12.4%) (p&lt;0.001). Brain (10.4% vs5.3%), and skin and subcutaneous (7.1% vs 2.4%) metastases were more frequently found in Peruvian patients. On the other hand, contralateral breast cancer was more frequent among Spanish patients (12.2% vs 2.8%). And when evaluated by molecular subtypes, bone metastases in TN were more frequent among Spanish (25.4%) than Peruvian (18.5%) cases. Disease-free survival rates at 7 years were similar between Spanish and Peruvian patients (80,3% vs 79,6%, p=0.197). However, overall survival at 7 years was better in Spanish women (90.4% vs 82.6%, p&lt;0.001). Conclusion : Epidemiologic differences in terms of histological features, clinical stage at diagnosis, molecular subtypes distribution, recurrence patterns and prognosis were found among Spanish and Peruvian BC patients in this retrospective analysis. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-14-09.