The National Cancer Registry Ireland

Research Strategy

Our current research strategy is centred on three complementary groups of aims:

Descriptive epidemiology/cancer surveillance:

• to describe and interpret patterns in cancer incidence and mortality in Ireland, including investigation of variations by age, sex, social class, area of residence and over time,
• to describe and interpret trends in the survival of cancer patients in Ireland, including investigation of factors associated with survival,
• to compare trends in cancer incidence, mortality and survival in Ireland with those in other countries/populations.

Aetiological research:

• to initiate and support studies in the following areas:
  -describing patterns of diagnosis and care of cancer patients in Ireland, with emphasis on exploring factors associated with access to care;
  -modelling the medical and economic consequences of therapeutic interventions;
  -evaluating the economic impact of cancer in the Irish population;
• evaluating the quality of life of cancer patients
• evaluating the effectiveness of cancer screening programmes and new screening/diagnostic tests.

Current Projects

A contact person is given for each project, but most of these projects involve collaboration both within and outside the Registry.

Cancer survival studies

In addition to the routine monitoring of cancer survival in Ireland, the results of which are published in a regular basis, the Registry is collaborating on a number of other studies of survival. These studies involve collaborations with clinical centres in Ireland, with colleagues in the UK and with other cancer registries in Europe. The studies currently underway include the following:

• Cancer survival in the UK and Ireland. This project, led by epidemiologists at the London School of Hygiene and Tropical Medicine, has involved collaboration between the UK and Irish Cancer Registries. The aim of the project is to describe geographical and socio-economic variations in cancer survival. Patterns of survival of cancer patients diagnosed in the years 1991-1999 have already been analysed and a paper for publication is in preparation. Grant funding has been obtained from Cancer Research UK to continue the project for a further 5 years (Contact: Dr. Paul Walsh) .
• EUROCARE-4: survival of European cancer patients diagnosed 1995 onwards. The EUROCARE project, led by the Istituto Tumori, Milan, has been under way for more than 10 years. The aim of the project is to describe and explain geographical variation in cancer survival across Europe. Several major reports, and many scientific papers, have already been published. The latest part of the project involves looking at survival in patients diagnosed since 1995, meaning that the Registry will be able to contribute to EUROCARE for the first time (Contact: Dr. Paul Walsh)

Consistency, appropriateness and management of cancer services

This work examines variations in cancer treatments and survival throughout Ireland, and relates them to (a) cancer factors such as cancer site and stage at presentation, (b) patient factors such as age, sex and place of residence, and (c) health service factors such as the treating hospital and consultant and their cancer workload. The aim is to identify variations in treatment which might affect prognosis. The first phase of this work, covering cancers incident in 1994-1998, has been published (NicAmhlaoibh R, Mahmud S, Comber H, 2004. Patterns of care and survival from cancer in Ireland 1994 to 1998). We will be producing a second report in 2006 based on cancers incident in 2001 with follow up to 2003. (Contact: Dr. Paul Walsh) .

Collaboration on related projects is underway with colleagues at the National Cancer Institute in the USA. The Registry is undertaking detailed analyses of patterns of care in two population-based series of cancer patients from the USA: (a) patients with colorectal cancer and (b) patients with non-Hodgkin's lymphoma. Manuscripts are in preparation from both of these analyses. This research has prompted interest in the investigation of patterns of care in patients with these cancers in Ireland. Analyses are underway for non-Hodgkin's lymphoma patients diagnosed in 1999-2001. In addition, funding is also being sought to investigate the extent to which treatment and cancer care factors explain the high mortality rate from colorectal cancer in Ireland (Contact: Dr. Deirdre Cronin.

Cancer Atlas of the UK and Ireland

The Registry was involved in a project to map and compare cancer incidence and mortality rates for different parts of Ireland and Britain during the period 1991-2000. The project was initiated by the Office for National Statistics (England & Wales), and also involves partner organisations responsible for cancer registration and mortality statistics in Scotland, Northern Ireland and Ireland. For Ireland, these are the National Cancer Registry and the Central Statistics Office. The analysis focused on 21 invasive cancer types that together account for almost 90% of all malignancies. Results, including colour maps, graphs and commentary, are presented by 'country' and by health-authority area. The atlas was published on July 4th, 2005 - see http://www.ncri.ie/pubs/pubs.shtml for online availability. (Contact: Dr. Paul Walsh) .

The FINBAR (Factors INfluencing the Barrett's/Adenocarcinoma Relationship) study

The FINBAR study is a case-control study investigating risk factors for adenocarcinoma of the oesophagus and for the precursor lesion, Barrett's oesophagus. The study is a collaboration with the Northern Ireland Cancer Registry, Queens University, Belfast and clinicians in Ireland and Northern Ireland. Funded by the Northern Ireland Research & Development Office, the Health Research Board and the Ulster Cancer Foundation, FINBAR began in 2003. Recruitment of study subjects has recently been completed. Detailed information on diet, lifestyle and medical history, together with DNA and biological samples, has been collected from 230 patients with adenocarcinoma, 223 with Barrett's oesophagus and 249 control subjects. Analyses of the data and samples are under way. Analyses that are being led by the Registry include investigation of the roles of (a) folate and related dietary factors and (b) sugars, carbohydrate and dietary glycaemic load, in the aetiology of oesophageal lesions. Funding is also being sought for 'add-on' studies which will exploit the availability of the biological samples and DNA to investigate, for example, genetic variations in nutrient metabolism (Contact: Ms. Linda Sharp).

Factors underlying differences and trends in prostate specific antigen testing, biopsy and prostate cancer incidence in Ireland, 1994-2003

The Registry is working with the Northern Ireland Cancer Registry (Dr Liam Murray and Dr Peter McCarron) on a new project on prostate cancer. During the period from 1994 to 2000, prostate cancer incidence rates increased dramatically in the Republic of Ireland but not in Northern Ireland, while mortality from prostate cancer did not change in either region. The new project aims to explore the reasons for these different trends. One possible explanation is that there are differences in rates of prostate specific antigen (PSA) testing a nd referrals for prostatic biopsies in the two regions; the project will investigate this. The project will have two parts:

• an examination of trends in PSA testing and prostatic biopsy in Ireland and Northern Ireland over the past ten years;
• a survey of a sample of GPs and urologists in Ireland and Northern Ireland to elicit attitudes towards PSA testing and awareness of current guidelines.

The project has been funded jointly by the Health Research Board and the Department of Health in Northern Ireland, and will last for two years (Contact: Ms. Linda Sharp, Dr. Frances Drummond).

Assessment of the economic impact of cancer in Ireland

The Registry is leading a five-year programme of work on the health economics of cancer in Ireland. The work has been funded by the Health Research Board and will be undertaken jointly with colleagues from University College Dublin, including Dr Anthony Staines of the Department of Public Health Medicine & Epidemiology and a recently appointed health economist, Dr Kanika Kapur.

Using colorectal cancer as a "model", the programme will estimate how much it costs to diagnose and treat the disease for all involved - the patient, their family, the health services and the wider community. Costs of tests, access to equipment, staff time, etc will be obtained from laboratories and hospitals. A survey of patients will be undertaken to estimate the costs they incur (e.g. travel to hospital, cost of drugs, loss of earnings, etc). Costs to the wider community (e.g. time lost from work) will also be assessed. There are several approaches to the prevention and early diagnosis of colorectal cancer, including screening by faecal occult blood tests or flexible sigmoidoscopy and, possibly, chemoprevention. The project will model these options to determine what would be the most cost-effective use of resources for the control of colorectal cancer in the Irish population.

Although diagnosis and treatment of cancer has substantial cost implications, there has been relatively little research on this topic as yet in Ireland. One of the main aims of the programme, therefore, is to develop a framework for this type of study in Ireland and to build a bank of expertise for other similar studies in the future (Contact: Ms. Linda Sharp).

Survey of public awareness and attitudes towards cancer prevention

The study of public awareness and attitudes regarding opportunities for preventing cancer, or for detecting it in the early stages, is an important starting point on the road to preventing cancer deaths. Surprisingly little research has been undertaken in Ireland in this area. Health attitudes and perceptions, as well as knowledge and awareness, are important influences on an individual's lifestyle choices. The proposed study will, for the first time, examine these issues in a representative sample of people from the island of Ireland. When the study is complete it will be known what the people of Ireland (and important subgroups) know about cancer prevention and early detection, what their attitudes are to these issues and what they do about reducing their risk of cancer. The envisaged study will involve both qualitative and quantitative research and will ask the questions:

• What attitudes do people hold and what do they know about preventing cancer and detecting it at an early stage?
• What attitudes do people hold and what do they know about preventing cancer and detecting it at an early stage?
• What is the most appropriate model for explaining these relationships and for guiding future health promotion and public health efforts designed to prevent cancer and improve early detection? (Contact: Dr. Harry Comber).

Data analysis service

The National Cancer Registry provides a rapid response service to individuals or organizations who need information on cancer incidence, mortality, treatment or survival. The responses to these requests range from simple counts or cross-tabulations to lengthy reports. This service is available free of charge within the health services. As an extension to this service we also provide an interactive web-based data query service which allows users to create their own data tables, and to download subsets of our dataset (Contact: Dr. Sandra Deady).

Other projects

The Registry is involved in a wide range of other research projects, details of which are given on our website (www.ncri.ie). Some of these are described briefly below; further details can be obtained from the contact person.

Cancer in Irish women

This project, describing the current impact of cancer on Irish women, is a collaboration with the Women's Health Council. The report was published in 2006 - see http://www.ncri.ie/pubs/pubs.shtml for an online copy. (Contact: Ms. Linda Sharpe). (Contact: Ms. Linda Sharp).

Studies of breast cancer

Screening for breast cancer is undeveloped in Ireland by European standards, but the incidence is increasing rapidly, so we have placed a strong emphasis on breast cancer studies. Among the areas we are involved in are:

• investigating the rising incidence of breast carcinoma with micro-metastatic involvement (Contact: Dr. Deirdre Cronin).
• trends and geographic variation in breast cancer surgery in Ireland and Northern Ireland - see http://www.ncri.ie/pubs/pubs.shtml for an online copy. (Contact: Dr. Paul Walsh).
• possible influence of screening on breast cancer incidence, mortality and stage in Ireland and Northern Ireland (Contact: Dr. Paul Walsh).
• case-only study of breast cancer in women under 40 (Contact: Ms. Linda Sharp).

Trends and predictions of Irish cancer mortality 1953-2010.

This work has examined trends in cancer mortality in Ireland since 1950 and uses a number of modeling approaches to predict cancer mortality rates and numbers of deaths up to 2015. Predictions of this nature are important for planning services. A report will be published in 2006. (Contact: Dr. Harry Comber).

International collaborative studies

We are involved in a number of collaborative projects with researchers in the UK, Europe and the USA. These include participation in the EUROCHIP study of cancer health status indicators, the EUROCARE-4 study of cancer survival in Europe and the CONCORD study of cancer survival in Europe, the US and Canada (Contact: Dr. Harry Comber, Dr. Deirdre Cronin).

Recent publications

Reports

Campo J, Comber H, Gavin AT. 2004. All-Ireland cancer statistics 1998-2000 (with the Northern Ireland Cancer Registry).

Comber H, Deady S. 2004. Cancer in County Louth. A report from the National Cancer Registry.

National Cancer Registry. 2005. Cancer in Ireland 1994-2001.

National Cancer Registry. 2004. Cancer in Ireland 1994-2000.

National Cancer Registry. 2003. Cancer in Ireland 1994-2002. Incidence, mortality, treatment and survival.

NicAmhlaoibh R, Mahmud S, Comber H. 2004. Patterns of care and survival from cancer in Ireland 1994 to 1998.

Peer-reviewed publications

Moloney FJ Comber H, O Lorcain P, O'Kelly P, Conlon PJ, Murphy GM. A population-based study of skin cancer incidence and prevalence in renal transplant recipients. British Journal of Dermatology (accepted for publication).

Walsh PM, McCarron P, Middleton RJ, Comber H, Gavin AT, Murray L. Influence of mammographic screening on trends in breast-conserving surgery in Ireland. European Journal of Cancer Prevention (accepted for publication).

Comber H, Cronin D, Deady S, O Lorcain P, Riordan P. Delays in treatment in the Irish cancer services: impact on cancer stage and survival. Irish Medical Journal (accepted for publication).

Comber H, Gavin A. 2004. Recent trends in cervical cancer mortality in Britain and Ireland: the case for population-based cervical cancer screening. British Journal of Cancer 91: 1902-1904.

O'Lorcain P, Comber H. 2004. Lung cancer mortality predictions for Ireland 2001-2015 and current trends in North Western Europe. Lung Cancer 46: 157-163.

Contacts

For information on any of the projects listed here, or to discuss research collaboration, please contact:

• Dr. Harry Comber Tel. 021 4703922
• Dr. Sandra DeadyTel. 021 4703927
• Dr. Frances DrummondTel. 021 4703931
• Dr. Linda SharpTel. 021 4703926
• Dr. Paul Walsh Tel. 021 4703928