Global changes in bladder cancer mortality in the elderly

ElsevierVolume 82, February 2023, 102294Cancer EpidemiologyAuthor links open overlay panelAbstractBackground

Bladder cancer is the 14th most common cause of cancer deaths worldwide and has a mean age of diagnosis of 73 years. Elderly people have fewer curative treatment options for muscle invasive bladder cancer. The aim of this study is to investigate how bladder cancer mortality has changed over the past forty years in different world regions to assess discrepancies between elderly and younger patients with bladder cancer.

Methods

Bladder cancer mortality data were extracted from the World Health Organisation’s GLOBOCAN database. Age-standardised mortality rates (ASMR) for bladder cancer were computed by year, sex, region and Human Development Index (HDI) using the world standard population.

Results

Overall ASMR in all available countries with data between 1986 and 2014 for men aged ≥ 75 has decreased from 101.2 to 89.9 per 100,000 (−11.2%). The decrease in ASMR for men < 75 has been 0.3–2.0 per 100,000 (−39.4%). In women aged ≥ 75 ASMR has decreased from 26.9 to 22.5 per 100,000 (−16.4%) and in women < 75 the ASMR has decreased from 0.76 to 0.56 per 100,000 (−26.4%).

Correlation analysis showed a positive linear relationship between Human Development Index (HDI) and improvement in age-standardised mortality rate in all ages. Pearson’s coefficient showed that correlation was strongest in the 60–74 age group (r = −0.61, p < 0.001) and weakest in those aged ≥ 75 (r = −0.39, p = 0.01).

Conclusion

Bladder cancer mortality is not improving in the elderly at the same rate as the rest of the population. Particular focus should be applied in future research to enhance and expand treatment options for bladder cancer that are appropriate for elderly patients.

Introduction

Bladder cancer is the 14th most common cause of cancer deaths worldwide [1.], [2.]. Age is the greatest risk factor in developing bladder cancer and the median age of diagnosis in the US is 73 years of age [3.], [4.]. The combination of advanced age at diagnosis and a worldwide aging population will result in an increase in bladder cancer prevalence in the elderly [5]. People aged ≥ 75 make up nearly half of new bladder cancer diagnoses but have fewer treatment opportunities than younger patients. Curative treatment of Muscle Invasive Bladder Cancer (MIBC) is centred around cystectomy, a relatively high morbidity operation with low prevalence in the elderly [6.], [7.]. Intra-vesical Bacillus Calmette-Guérin (BCG) for Non-Muscle Invasive Bladder Cancer (NMIBC) appears under-utilised in the elderly [8].

The aim of this study is to investigate how bladder cancer mortality has changed over the past forty years in different world regions and to assess discrepancies between elderly and younger patients with bladder cancer.

Section snippetsMethods

Bladder cancer specific mortality was extracted from the World Health Organisation’s Global Cancer Observatory (GLOBOCAN) database in August 2022. Bladder cancer figures include both NMIBC and MIBC [9]. The GLOBOCAN database provides estimates of incidence and mortality by site and sex using the best available data in each region and is run by the International Agency for Research on Cancer [10]. Data is extracted from the CI5plus database, US Surveillance, Epidemiology, and End Results Program

Sex

Bladder cancer ASIR is higher in men than women in all regions, and across all age groups. Age-standardised bladder cancer incidence in 2010 (latest data available) across all 41 countries with 2010 incidence data was 16.0 per 100,000 in men and 3.8 per 100,000 in women.

Age

The 2010 ASIR for bladder cancer is higher in people aged ≥ 75 in all regions and in both sexes (Fig. 1). Overall ASIR in all available countries with incidence data between 1994 and 2010 or men aged ≥ 75 has remained static,

Discussion

Bladder cancer age-standardised mortality and incidence are far higher in people aged ≥ 75 than those aged < 75. Improvement in mortality has been less in the elderly than young populations in most regions of the globe.

Conclusion

Bladder cancer incidence only decreased slightly in the elderly between 1994 and 2010. Globally, there has been minimal improvement in bladder cancer mortality in the elderly over the study period. The mortality to incidence ratio is decreasing over time, perhaps reflecting advances in bladder cancer treatment and/or overall improvement in the populations’ health over the past thirty years. Regions with a higher human development index have seen a greater improvement in bladder cancer

Funding

None.

CRediT authorship contribution statement

Dr Jake Tempo: Conceptualisation, Data curation, Formal analysis, Methodology, Writing – original draft. Dr Ting Wai Yiu: Writing – review & editing. A/Prof Joseph Ischia: Methodology, Validation, Supervision, Writing – review & editing. A/Prof Damien Bolton: Validation, Supervision, Writing – review & editing. A/Prof Michael O’Callaghan: Conceptualisation, Formal analysis, Methodology, Supervision, Writing – review & editing.

Acknowledgements

None.

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