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      Rare cancers are not so rare: the rare cancer burden in Europe.

      European Journal of Cancer
      Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Europe, epidemiology, Female, Humans, Incidence, Infant, Infant, Newborn, Male, Middle Aged, Neoplasms, Prevalence, Rare Diseases, Registries, Survival Analysis, Young Adult

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          Abstract

          Epidemiologic information on rare cancers is scarce. The project Surveillance of Rare Cancers in Europe (RARECARE) provides estimates of the incidence, prevalence and survival of rare cancers in Europe based on a new and comprehensive list of these diseases. RARECARE analysed population-based cancer registry (CR) data on European patients diagnosed from 1988 to 2002, with vital status information available up to 31st December 2003 (latest date for which most CRs had verified data). The mean population covered was about 162,000,000. Cancer incidence and survival rates for 1995-2002 and prevalence at 1st January 2003 were estimated. Based on the RARECARE definition (incidence <6/100,000/year), the estimated annual incidence rate of all rare cancers in Europe was about 108 per 100,000, corresponding to 541,000 new diagnoses annually or 22% of all cancer diagnoses. Five-year relative survival was on average worse for rare cancers (47%) than common cancers (65%). About 4,300,000 patients are living today in the European Union with a diagnosis of a rare cancer, 24% of the total cancer prevalence. Our estimates of the rare cancer burden in Europe provide the first indication of the size of the public health problem due to these diseases and constitute a useful base for further research. Centres of excellence for rare cancers or groups of rare cancers could provide the necessary organisational structure and critical mass for carrying out clinical trials and developing alternative approaches to clinical experimentation for these cancers. Copyright © 2011 Elsevier Ltd. All rights reserved.

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          Cancer survival corrected for heterogeneity in patient withdrawal.

          Survival from cancer over a certain time period is often measured by the 'relative survival rate'. This is the ratio of the observed survival rate in the group of patients to the survival rate expected in a group of people in the general population, who are similar to the patients with respect to all of the possible factors affecting survival at the beginning of the period, except for the disease under study. When patterns of patient withdrawal differ for a number of subgroups of patients with equal relative survival rates, the current method of derivation of the relative survival rate is biased. A method based on the concept of an 'expected life table' is proposed for removal of the bias. Examples based on material from the Finnish Cancer Registry suggest that the practical performance of the proposed method is better than that of other alternatives, even when the relative survival rates in the subgroups are not equal.
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            Measuring cancer prevalence in Europe: the EUROPREVAL project.

            Cancer prevalence is the proportion of individuals in a population who at some stage during their lifetime have been diagnosed with cancer, irrespective of the date of diagnosis. Cancer prevalence statistics have generally been provided by a limited number of well established cancer registries that have been in existence for several decades. The advent of systematic follow-up of life status of incident cases and the availability of new statistical methodologies, now makes it possible for registries established during the 1970s or 1980s to provide prevalence data. The main problems encountered in the estimation of prevalence are the inclusion of: (i) cases lost to follow-up; (ii) cases known only from their death certificate; (iii) cases diagnosed before the start of registration; and (iv) the treatment of multiple tumours and migrations. The main aim of this paper was to review these problems and discuss, through the experience gained with EUROPREVAL, how they can be overcome. A method is presented for the calculation of prevalence of all cancers combined in the populations covered by the 45 cancer registries participating in EUROPREVAL. Prevalence of cancer is estimated to be 2% on average, with the highest values (3%) in Sweden and the lowest in Eastern Europe, with a minimum of approximately 1% in Poland.
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              Strategy for randomised clinical trials in rare cancers.

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