E 2 | Orals | SPHC 2024

Room

2ème étage - F205


Theme

Different aspects of cancer diseases


Chair

TBD.



Title
Longitudinal metrics to evaluate organized breast cancer screening programmes

Name
Karen Brändle

Affiliation
Unisanté,


Abstract

Longitudinal adherence is a key factor of effectiveness of organized cancer screening programs. Guidelines and methods for evaluation remain cross-sectional, despite the repetitive nature of screening. While the issue of longitudinal metrics attracts growing interest, the complexity of rendering adherence over several rounds unavoidably leads to choices, which impair comparability of measures in the absence of established indicators. We compared longitudinal measures (proportion of time covered (PTC), number of times attended, graphical sequencing) to assess adherence to two long-standing breast cancer screening programs in Switzerland. Screening risks are also usually expressed by round, limiting appropriate appraisal of lifetime risks. We used survival analysis to assess cumulative risks of recall and false-positive results (FP) over 10 participations.
Our results confirmed those of cross-sectional indicators over time: PTC corresponded roughly to the participation rate over the last 10 years. Regular attenders were covered about 90% of their eligible time, while the whole population was covered between 50 and 60% of time. Sequence analysis with optimal matching showed that attendees are best grouped in regular (70%) and irregular (30%), while number of times attended by number of invitations allowed distinguishing 4 profiles: Systematic attenders (34-37%), frequent attenders (all screening rounds but one; 15-16%), occasional attenders (16-22%) and never attenders (24-35%). Cumulative risks of recall and FP were about 30% and 25%, respectively.
Longitudinal indicators of adherence used are complementary: PTC is intuitive, but does not indicate how the uncovered time is distributed. Profile-based indicators help categorizing participants into groups, but do not systematically take into account compliance with recommended screening interval. The impact of longitudinal adherence on screening outcome (i.e. cancer risk and stage of screen-detected cancer) remains yet to be thoroughly investigated. Knowledge about cumulative risks allows expressing screening benefits and risks on the same timescale favoring informed decision whether to participate.



Title
Monitoring of regional Swiss breast cancer screening programmes: results and perspectives

Name
Karen Brändle

Affiliation
Unisanté


Abstract

Regular monitoring is crucial to assess effectiveness of public health programmes, ensuring accountability of involved parties and allowing to identify strengths, benefits, and areas where improvements are needed. Organized breast cancer screening has developed regionally in Switzerland over the last 25 years, starting in 1999. In 2024, 60% of the female population aged 50 to 69 and 44% of women aged 70 to 74 years are covered by organized screening. National monitoring, started in 2010, measures key performance indicators of all breast cancer screening programmes in Switzerland against methodologically established standards. The sixth national monitoring report, published in early 2024, covers 10 regional programmes in 14 cantons, and over 3 million screening records between 2010 and 2021.

The COVID-19 pandemic had only a punctual impact on screening activity and participation. About half the invited women participated and once in the programme, almost 80% come back for screening in the next round. For the period 2019-2021, quality of screening varied strongly between screening rounds and programmes. While quality standards for recall rates and false-positive rates were met by all programmes for subsequent screening over the whole monitored period, both these quality indicators in first screening systematically exceeded the recommended thresholds. Risks and benefits of mammography screening vary considerably with age. The clinical profiles of screen-detected cancer in subsequent screening globally met requirements, with exception for the proportion of advanced stage cancers which remained constantly slightly over the recommended norm.

National performance and international norms provide a benchmark for programmes to be compared against and to take appropriate measures if necessary. The recommended focus of measures is to reduce the observed heterogeneity between programmes in order to ensure high quality screening for all women in Switzerland, independently of their place of residence.


Title
Concurrent utilisation of cancer screenings in the general population of Switzerland aged 50-69

Name
Jean-Luc Bulliard 

Affiliation
Unisanté


Abstract

Background:
Prostate cancer (PCa) is the most frequent cancer in men in Switzerland. The early detection of PCa using prostate specific antigen (PSA) testing promises to reduce PCa-specific mortality, but is also associated with harms due to overdiagnosis and overtreatment. Evidence from other countries showed a decrease in incidence and a shift in PCa stage at diagnosis after the US Preventive Services Task Force issued a recommendation against routine PSA testing in 2012. This study aimed to evaluate the trends in PCa incidence in Switzerland since 1980 and examine the evolution of PCa stage distribution at diagnosis.

Methods: 
We used national cancer registration data from the National Agency for Cancer Registration covering the years 1980–2020. Diagnosed PCas registered by registries with sufficient quality and coverage were included. Age-standardized incidence rates based on the 2013 European standard population were estimated overall, by age group, and stage according to SEER (local, regional, distant). Results over time were visualized and analyzed descriptively.


Results: 
Overall, estimated PCa incidence increased from 126.4 (95% confidence interval 108.5–146.3) per 100'000 men in 1980 to 207.3 (197.3–217.7) per 100'000 men in 2020. After an initial increase from 1980–2004, there was an overall decrease in PCa incidence around 2005-2014, which was followed by a marked increase from 2015-2020. These trends were observed primarily in the age groups ranging from 50–79 years, while PCa incidence in men aged 80+ years continuously decreased since 1994. The trends in incidence of local, regional, and distant (metastatic) PCa generally followed the overall incidence trends from 2011-2020, including an increase in metastatic PCa incidence over the last decade.


Conclusions:
Our study showed a relevant decrease in PCa incidence from 2005–2014 in Switzerland, followed by a marked increase in recent years among screening-eligible men. While various explanations for these observations need to be considered, our findings suggest that PSA testing activity may have increased substantially in recent years. Meanwhile, a shift in stages of registered PCa cases at diagnosis was not observed, although the incidence of metastatic PCa has been increasing since 2015. Further research is necessary to evaluate the drivers of these PCa incidence trends in Switzerland.



Title
National trends in prostate cancer incidence in Switzerland from 1980 until 2020

Name
Menges Dominik

Affiliation
Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH)


Abstract

Background: Prostate cancer (PCa) is the most frequent cancer in men in Switzerland. The early detection of PCa using prostate specific antigen (PSA) testing promises to reduce PCa-specific mortality, but is also associated with harms due to overdiagnosis and overtreatment. Evidence from other countries showed a decrease in incidence and a shift in PCa stage at diagnosis after the US Preventive Services Task Force issued a recommendation against routine PSA testing in 2012. This study aimed to evaluate the trends in PCa incidence in Switzerland since 1980 and examine the evolution of PCa stage distribution at diagnosis.

Methods: We used national cancer registration data from the National Agency for Cancer Registration covering the years 1980–2020. Diagnosed PCas registered by registries with sufficient quality and coverage were included. Age-standardized incidence rates based on the 2013 European standard population were estimated overall, by age group, and stage according to SEER (local, regional, distant). Results over time were visualized and analyzed descriptively.

Results: Overall, estimated PCa incidence increased from 126.4 (95% confidence interval 108.5–146.3) per 100'000 men in 1980 to 207.3 (197.3–217.7) per 100'000 men in 2020. After an initial increase from 1980–2004, there was an overall decrease in PCa incidence around 2005-2014, which was followed by a marked increase from 2015-2020. These trends were observed primarily in the age groups ranging from 50–79 years, while PCa incidence in men aged 80+ years continuously decreased since 1994. The trends in incidence of local, regional, and distant (metastatic) PCa generally followed the overall incidence trends from 2011-2020, including an increase in metastatic PCa incidence over the last decade.

Conclusions: Our study showed a relevant decrease in PCa incidence from 2005–2014 in Switzerland, followed by a marked increase in recent years among screening-eligible men. While various explanations for these observations need to be considered, our findings suggest that PSA testing activity may have increased substantially in recent years. Meanwhile, a shift in stages of registered PCa cases at diagnosis was not observed, although the incidence of metastatic PCa has been increasing since 2015. Further research is necessary to evaluate the drivers of these PCa incidence trends in Switzerland.



Title
INCIDENCE AND MORTALITY OF CANCER IN ADOLESCENTS AND YOUNG ADULTS (AYAs) IN SWITZERLAND

Name
Céline Bolliger 

Affiliation
University of Lucerne


Abstract

Background:
Compared to cancers in younger and older age, cancers in adolescents and young adults (AYAs) aged 15-39 years have distinct biological features and the composition of cancer types differs. They therefore require special attention in epidemiological research and public health. This is the first comprehensive nationwide study of cancer incidence and mortality in AYAs in Switzerland.


Methods:
We included primary cancers diagnosed in Swiss AYA residents between 1980-2019. Cancer data were obtained from the Childhood Cancer Registry (15-19 years) and the National Agency for Cancer Registration (20-39 years). Swiss resident population and mortality data were obtained from the Federal Statistical Office. Cancers were coded according to ICD-O-3 and regrouped according to an AYA-specific classification system. Cancer deaths were coded according to ICD-8 (before 1995) and ICD-10. We weighted the observed number of AYA cancers to adjust for regional differences in cancer registration in the past. We calculated crude incidence and mortality rates, and age-standardized rates using the European standard population (1976). We used NIH’s Joinpoint regression software to investigate cancer incidence and mortality trends.


Results:
We observed 44,075 (69,332 after adjustment) primary cancers and 9,973 cancer deaths in Swiss AYA residents between 1980-2019. Most cancers (40%) were carcinomas, mostly of the breast, thyroid, colon, skin, and genital sites (excl. ovary and testis). Testis tumors, melanomas, lymphomas, central nervous system (CNS) tumors, leukemias, and sarcomas also occurred frequently. The most frequent cancer type in females was breast, in males the most frequent type was testis, for both of which we observed increasing incidence trends (average annual percent change (AAPC) 1980-2019: breast = 0.8, 95% CI: [0.3, 1.4], testis = 0.8 [0.1, 1.5]). We found a higher incidence and stronger increase in cancer incidence in female compared to male AYAs over time (1980-1989: 58.74 vs. 54.17, 2010-2019: 82.16 vs. 64.20 per 100,000 person-years). We observed decreasing mortality trends over the study period.


Discussion and Conclusion: 
This first nationwide investigation of AYA cancer incidence in Switzerland revealed a similar distribution of cancer types by age and similar time trends as found in other European countries.