Cancer prevalence and mortality in centenarians: A systematic review

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Abstract

Life expectancy has dramatically expanded, the global population has aged unprecedentedly and the number of centenarians has significantly increased. The analysis of autopsy series, cancer registries data, vital statistics and surveys specific to this age group allows unique observations with respect to incidence and prevalence, cause of death by cancer, frequency of primary tumours, metastatic patterns, occurrence of incidental cancers and of multiple primary tumours.

Data analysis demonstrates how cancer incidence and cause of death present a threefold decrease after age 90 and reach 0–4% above age 100. In addition, the number of metastatic sites are remarkably less and incidental malignant tumours or multiple primary cancers are more frequent, indicating that cancer in centenarians carries a more indolent behaviour.

The unique features of malignant tumours in this population is hereby presented and discussed following a systematic review of the available literature.

Cancer in the very elderly is relatively uncommon as a disease and as a cause of death. It is characterized by a slow growth and a modest life-threatening potential.

Introduction

Worldwide, life expectancy at birth has been expanding during the last two centuries, especially in the second part of the 20th century, resulting into a major increase in the older age group. Since centenarians and supercentenarians surpass the current human life expectancy by 20–25 years, they represent the best model to study human longevity and to investigate the “healthy aging model”. Centenarians have been healthy throughout their lives and different geographical areas associate with a remarkable longevity such as the Japanese island of Okinawa, Sardinia in Italy or Loma Linda in California [1], [2], [3], [4], [5], [6].

It has been clearly demonstrated that cancer is an age-related disease and that advanced age associated to the highest cancer risk. Although the incidence of cancer rises exponentially up to the 80s, there is adequate evidence to say that centenarians can be protected from various common chronic fatal conditions, including cancer. Decreased cancer prevalence, mortality and cancer related deaths, have been repeatedly reported in the very advanced age groups as compared to the earlier decades of life [7], [8], [9], [10].

Clinically evident tumours decrease after the eighties and autopsy studies performed in unselected populations clearly show how cancer prevalence decrease and tumour spread is limited. Metastatic disease is less frequent in nonagenarians and centenarians and where the tumour takes the patient to death, this is often related to local complications like haemorrhage or infections [11].

In this article we systematically review the literature evidence related to cancer prevalence, cancer mortality, cancer as cause of death, the incidence of primary sites, of multiple cancers and of incidental cancers as well as the metastatic pattern of the oldest individuals.

Section snippets

Materials and methods

We searched the MEDLINE (last search, February 2011) online database with the keywords: (centenarians OR supercentenarians OR nonagenarians OR old age OR very elderly OR geriatric) AND (cancer incidence OR morbidity OR mortality OR cause of death) AND (cancer registries OR autopsies OR forensic pathology).

We reviewed articles in English language. Cross-searches were performed on MEDLINE using the names of investigators who were lead authors in at least one article.

Our intention was to perform a

Data sources and demographics

Sixteen articles referred to autopsy studies and 7 were deriving from Vital Statistics, cancer registries, death certificates or surveys using questionnaires. The time period of these studies was ranging from 1918 to 2002.

Thirty-nine percent of the studies were originated from USA, 34% from Europe (Italy, Netherlands, Austria, Iceland, Switzerland and Czech Republic), 21% from Japan, 4% from New Zealand and 4% from Brazil. One of these studies was a collaboration between USA and the Czech

Discussion

In the U.S.A. the number of people aged ≥85 years was 0.3% of the onational population (365,000) in 1940, and increased to 1.5% (4.2 million) in 2000 [34]. As life expectancy continues to increase we should expect to come across more age-related diseases. However, centenarians seem to be represent a potential exception: they markedly delay or escape age-associated morbidity from chronic degenerative illnesses such as cardiovascular disease, cancer, Alzheimer's or diabetes.

The literature

Conclusions

Despite any possible biases of selection due to the lack of large amount of recent data the epidemiology of cancer in individuals of very advanced age could be characterized by: (a) decrease prevalence, (b) increase incidence of latent or incidental tumours, (c) decrease metastatic rate, (d) probably higher incidence of multiple primary cancers and (e) decrease cancer mortality. In general, cancer in oldest-olds seem to be a more silent disease, of slower growth and of less-threatening

Conflict of interest

None declared.

Reviewers

Professor Lodovico Balducci, M.D., H. Lee Moffitt Cancer Center and Research Institute, Senior Adult Oncology Program, Tampa, FL 33612, United States.

Catherine Terret, M.D., Ph.D., Centre Léon Bérard, Department of Medical Oncology, 28, rue Laënnec, F-69373 Lyon Cedex 08, France.

Nicholas Pavlidis M.D., Ph.D. is professor of medical oncology in the University of Ioannina, Greece. He is a member of the Steering Committee of ESMO Educational Committee and Chairman of the Guidelines Working Group. He is the programme coordinator and Chairman of European School of Oncology for Euro-Arab (EASO), of Annual ESO Masterclasses and of the Annual ESO Course for Medical Students. He is Editor-in-Chief of Cancer Treatment Reviews and Associate Editor of European Journal of Clinical

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  • Cited by (0)

    Nicholas Pavlidis M.D., Ph.D. is professor of medical oncology in the University of Ioannina, Greece. He is a member of the Steering Committee of ESMO Educational Committee and Chairman of the Guidelines Working Group. He is the programme coordinator and Chairman of European School of Oncology for Euro-Arab (EASO), of Annual ESO Masterclasses and of the Annual ESO Course for Medical Students. He is Editor-in-Chief of Cancer Treatment Reviews and Associate Editor of European Journal of Clinical Investigation.

    Giorgio Stanta is Professor of Pathology at the University of Trieste. For many years his main interests have been tumour epidemiology especially in the elderly and molecular pathology in fixed and paraffin-embedded tissues, called “archive tissues”. He has developed several methods in particular for RNA analysis in archive tissues. Prof. Stanta is the coordinator of the European group IMPACTS (www.impactsnetwork.eu), which involves over 20 European Universities in 11 different countries and whose task is to validate molecular methods for translational research and diagnostics in archive tissues. He is interested in the development of biobanking networks, starting from archive tissue biorepositories. The IMPACTS research group has prepared the Guidelines for Molecular Analysis in Archive Tissues, recently published by Springer Verlag.

    Riccardo A. Audisio was trained at the National Cancer Institute of Milan (1980–1994) he was appointed deputy director at the Department of General Surgery of European Institute of Oncology, Milan (1994–1998). He moved to the United Kingdom in 1999 to become Consultant Surgical Oncologist and Honorary Professor at the University of Liverpool. He is Editor-in-Chief of Surgical Oncology, Elsevier Publisher. He is member of several international scientific societies including BASO, ESSO, SSO, ASGBI, ESMO, ASCRS, AAA, SIOG and EUSOMA. He is ESMO Committee Member, chairs the Education & Training Committee of ESSO and is Honorary Scientific & Meeting Secretary for BASO. His clinical research focuses on Breast Cancer and Geriatric Oncology; President of SIOG (International Society of Geriatric Oncology).

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