Bladder Cancer Mortality Trend in Montenegro: 1990-2021
,
Abstract
Background: Bladder cancer accounts for more than 200,000 deaths annually on a global level, with an age-standardized mortality rate of 2.9 per 100,000 individuals. Despite declining global rates, it remains a substantial public health burden. We aimed to analyze the mortality trend of bladder cancer in Montenegro and identify the measures taken to combat this tumor.
Methods: Bladder cancer mortality data in Montenegro from 1990 to 2021 were collected. Mortality rates were age-standardized to the World Standard Population. The joinpoint, linear and Poisson regressions were used to assess bladder cancer mortality trend.
Results: There was a consistent increase in mortality rates due to bladder cancer, with statistical significance for both the overall population and specifically for males, with an average annual percent change (AAPC) of 1.5% (95% CI: 1.5 (0.5-2.9)) and 1.6% (AAPC (95% CI): 1.6 (0.4-3.3)) respectively. Additionally, there was a notable annual increase in the number of bladder cancer cases: average annual increase was 3.4% for the overall population, 3.5% in male and 2.9% in female, with statistical parameters (AAPC (95% CI), P-value) for join point regression: 3.4 (2.4-4.8), <0.001; 3.5 (2.3-5.1), 0.003; and 2.9 (1.2-5.1), 0.004, respectively. The majority of bladder cancer deaths occurred in the age groups of 65-74 (35.8%), 75-84 (33.6%), and 55-64 (16.8%).
Conclusion: The ongoing increase in bladder cancer mortality in Montenegro, particularly among men and elderly should encourage policymakers to take action to reverse this unfavorable trend.
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6. Joshi HN, Makaju R, Karmacharya R, et al (2013). Urinary bladder carcinoma: im-pact of smoking, age and its clinico-pathological spectrum. Kathmandu Univ Med J (KUMJ), 11(44):292–5.
7. Xu Y, Huo R, Chen X, et al (2017). Diabetes mellitus and the risk of bladder cancer: a PRISMA-compliant meta-analysis of cohort studies. Medicine (Baltimore), 96 (46): e8588.
8. Zhu Z, Wang X, Shen Z, et al (2013). Risk of bladder cancer in patients with dia-betes mellitus: an updated meta-analysis of 36 observational studies. BMC Cancer, 13:310.
9. Cumberbatch MG, Cox A, Teare D, et al (2015). Contemporary occupational car-cinogen exposure and bladder cancer: a systematic review and meta-analysis. JAMA Oncol, 1(9): 1282–90.
10. Schmitz-Drager BJ, Droller M, Lokeshwar VB, et al (2015). Molecular markers for bladder cancer screening, early diagno-sis, and surveillance: the WHO/ICUD consensus. Urol Int, 94(1):1–24.
11. Apolo AB, Vogelzang NJ, Theodorescu D. (2015). New and promising strategies in the management of bladder cancer. Am Soc Clin Oncol Educ Book, 2015:105–112.
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14. Lotan Y, Elias K, Svatek RS, et al (2009): Bladder cancer screening in a high risk asymptomatic population using a point of care urine based protein tumor marker. J Urol, 182:52-57.
15. Lotan Y, Elias K, Svatek RS, et al (2022). Eu-ropean Association of Urology Guide-lines on Non-muscle-invasive Bladder Cancer (Ta, T1, and Carcinoma in Situ). Eur Urol, 81(1):75-94.
16. Damjanov I, Golubovic M. (2011). Histo-pathology of Urinary Bladder Carcino-ma: Less Common Variants. Srp Arh Celok Lek, 139(9-10):693-699.
17. Leivo MZ, Elson PJ, Tacha DE, et al (2016). A combination of p40, GATA-3 and uroplakin II shows utility in the diagno-sis and prognosis of muscle-invasive urothelial carcinoma. Pathology, 48(6):543-9.
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26. Antoni S, Ferlay J, Soerjomataram I, et al (2017). Bladder Cancer Incidence and Mortality: A Global Overview and Re-cent Trends. Eur Urol, 71(1):96-108.
27. Liu X, Jiang J, Yu C, et al (2019). Secular trends in incidence and mortality of bladder cancer in China, 1990-2017: A joinpoint and age period-cohort analy-sis. Cancer Epidemiol, 61:95-103.
28. Bitiņa-Barlote Ē, Plonis J, Cauce V, et al (2021). Bladder cancer trends in Latvia during 1990–2017: incidence, mortality, and survival rates. Cent European J Urol, 74(1):14-23.
29. Shariat SF, Sfakianos JP, Droller MJ, et al (2010). The effect of age and gender on bladder cancer: a critical review of the literature. BJU Int, 105(3):300-308.
30. Noon A, Albertsen P, Thomas F, et al (2013). Competing mortality in patients diagnosed with bladder cancer: evi-dence of undertreatment in the elderly and female patients. Br J Cancer, 108(7):1534-1540.
31. World Health Organization. Prevalence of tobacco smoking Internet Geneva (CH): World Health Organization; 2016. Age-standardized prevalence of current to-bacco smoking among persons aged 15 years and older.
32. World Bank Group. Montenegro Overview of Tobacco Use, Tobacco Control Leg-islation, and Taxation A Country Brief. Available from: https://openknowledge.worldbank.org/server/api/core/bitstreams/d4e8f659-5cb4-549a-bde2-def712d89e14/content
33. Nedović-Vuković M, Laušević D, Ljaljević A, et al (2019). Lung cancer mortality in Montenegro, 1990 to 2015. Croat Med J, 60(1):26-32.
34. General population survey on substance use in Montenegro 2017: http://www.emcdda.europa.eu/attachements.cfm/att_261864_EN_2-%20Final%20Report%20GPS%20Montenegro%202017.pdf
35. Likić D. Izvještaj o obolijevanju od šećerne bolesti u 2015. godini. Institut za javno zdravlje Crne Gore. Available at: https://www.ijzcg.me/me/izvjestaji/godisnji-izvjestaji-o-obolijevalju-od-secerne-bolesti-u-crnoj-gori
36. Ferlay J, Colombet M, Soerjomataram I, et al (2018). Global and Regional Estimates of the Incidence and Mortality for 38 Cancers: GLOBOCAN 2018. Lyon: In-ternational Agency for Research on Cancer/World Health Organization; Available from: https://gco.iarc.fr/
37. Vlada Crne Gore, Ministarstvo zdravlja, rada i socijalnog staranja. Strategija za prevenciju i kontrolu hroničnih nezaraznih bolesti, 2008.
38. Ministarstvo zdravlja, Vlada Republike Crne Gore. Zdravstvena politika u Re-publici Crnoj Gori do 2020 (2001).
39. Ministarstvo zdravlja Crne Gore. Nacio-nalni program za kontrolu raka, 2011. Available at: https://www.gov.me/en/documents/ae7dd230-22e0-48ef-8095-16cf176f9b9b
40. Hall MC, Chang SS, Dalbagni G, et al (2007): Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol, 178(6):2314-2330.
41. Jain K, Datta C, Sengupta M, et al (2023). Quest to develop a standard screening method for urothelial carcinoma using liquid-based cytology (The Paris System) and CK20. Indian J Pathol Microbiol, 66(4):720-726.
42. Beukers W, van der Keur KA, Kandimalla R, et al (2017). FGFR3, TERT and OTX1 as a Urinary Biomarker Combination for Surveillance of Patients with Bladder Cancer in a Large Prospective Multicen-ter Study. J Urol, 197(6):1410-1418.
43. Na Y, Ye Z, Sun G, et al (2014). Guidelines for the Diagnosis and Treatment of Urological Diseases in China. People’s Medical Publishing House Beijing, 340-361.
2. Global Burden of Disease Cancer Collab-oration, Fitzmaurice C, Abate D, et al (2019). Global, regional, and National cancer incidence, mortality, years of life lost, years lived with disability, and dis-ability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analy-sis for the global burden of disease study. JAMA Oncol, 5:1749–68.
3. Roth GA, Abate D, Kalkidan HA, et al (2018). Global, regional, and national age-sex- specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the global burden of disease study 2017. Lancet, 392:1736–88.
4. Wong MCS, Fung FDH, Leung C, et al (2018). The global epidemiology of bladder cancer: a joinpoint regression analysis of its incidence and mortality trends and projection. Sci Rep, 8(1): 1129.
5. Cumberbatch MG, Rota M, Catto JW, et al (2016). The role of tobacco smoke in bladder and kidney carcinogenesis: a comparison of exposures and meta-analysis of incidence and mortality risks. Eur Urol, 70(4):458–66.
6. Joshi HN, Makaju R, Karmacharya R, et al (2013). Urinary bladder carcinoma: im-pact of smoking, age and its clinico-pathological spectrum. Kathmandu Univ Med J (KUMJ), 11(44):292–5.
7. Xu Y, Huo R, Chen X, et al (2017). Diabetes mellitus and the risk of bladder cancer: a PRISMA-compliant meta-analysis of cohort studies. Medicine (Baltimore), 96 (46): e8588.
8. Zhu Z, Wang X, Shen Z, et al (2013). Risk of bladder cancer in patients with dia-betes mellitus: an updated meta-analysis of 36 observational studies. BMC Cancer, 13:310.
9. Cumberbatch MG, Cox A, Teare D, et al (2015). Contemporary occupational car-cinogen exposure and bladder cancer: a systematic review and meta-analysis. JAMA Oncol, 1(9): 1282–90.
10. Schmitz-Drager BJ, Droller M, Lokeshwar VB, et al (2015). Molecular markers for bladder cancer screening, early diagno-sis, and surveillance: the WHO/ICUD consensus. Urol Int, 94(1):1–24.
11. Apolo AB, Vogelzang NJ, Theodorescu D. (2015). New and promising strategies in the management of bladder cancer. Am Soc Clin Oncol Educ Book, 2015:105–112.
12. Bladder Cancer Screening, available from: https://www.cancer.gov/types/bladder/screening
13. Larré S, Catto JW, Cookson MS, et al (2013). Screening for bladder cancer: rationale, limitations, whom to target, and per-spectives. Eur Urol, 63(6):1049-58.
14. Lotan Y, Elias K, Svatek RS, et al (2009): Bladder cancer screening in a high risk asymptomatic population using a point of care urine based protein tumor marker. J Urol, 182:52-57.
15. Lotan Y, Elias K, Svatek RS, et al (2022). Eu-ropean Association of Urology Guide-lines on Non-muscle-invasive Bladder Cancer (Ta, T1, and Carcinoma in Situ). Eur Urol, 81(1):75-94.
16. Damjanov I, Golubovic M. (2011). Histo-pathology of Urinary Bladder Carcino-ma: Less Common Variants. Srp Arh Celok Lek, 139(9-10):693-699.
17. Leivo MZ, Elson PJ, Tacha DE, et al (2016). A combination of p40, GATA-3 and uroplakin II shows utility in the diagno-sis and prognosis of muscle-invasive urothelial carcinoma. Pathology, 48(6):543-9.
18. Zhang Y, Wu J, Zhao C, et al (2023). Recent Advancement of PD-L1 Detection Technologies and Clinical Applications in the Era of Precision Cancer Therapy. J Cancer, 14(5):850–73.
19. World Health Organization. International Classification of Diseases, 10th Revision (ICD-10). Available from: https://icd.who.int/browse10/2019/en
20. Public Health Institute Podgorica. Statistical Yearbook for 2009 on Population Health and Healthcare in Montenegro [in Montenegrin]. Podgorica; 2010.
21. Institut za javno zdravlje. Umrli prema uz-roku smrti po grupama oboljenja, polu i starosti u Crnoj Gori, 2010-2019. https://www.ijzcg.me/me/izvjestaji/umrli-prema-uzroku-smrti-po-grupama-oboljenja-polu-i-starosti-u-crnoj-gori-2010-2019
22. Statistical office of Motenegro. Population estimations. Available from: https://www.monstat.org/cg/page.php?id=48&pageid=48. Accessed: Jun 22, 2024.
23. Ahmad OB, Boschi-Pinto C, Lopez AD, et al (2001). Age standardization of rates: a new WHO standard. GPE Discussion Paper Series: No.31. Geneva: World Health Organization.
24. National Cancer Institute. Joinpoint Re-gression Program, Version 5.0.2-May, 2023. https://surveillance.cancer.gov/joinpoint/
25. Kim HJ, Fay MP, Feuer EJ, et al (2000). Permutation tests for joinpoint regres-sion with applications to cancer rates. Stat Med, 19:335-351.
26. Antoni S, Ferlay J, Soerjomataram I, et al (2017). Bladder Cancer Incidence and Mortality: A Global Overview and Re-cent Trends. Eur Urol, 71(1):96-108.
27. Liu X, Jiang J, Yu C, et al (2019). Secular trends in incidence and mortality of bladder cancer in China, 1990-2017: A joinpoint and age period-cohort analy-sis. Cancer Epidemiol, 61:95-103.
28. Bitiņa-Barlote Ē, Plonis J, Cauce V, et al (2021). Bladder cancer trends in Latvia during 1990–2017: incidence, mortality, and survival rates. Cent European J Urol, 74(1):14-23.
29. Shariat SF, Sfakianos JP, Droller MJ, et al (2010). The effect of age and gender on bladder cancer: a critical review of the literature. BJU Int, 105(3):300-308.
30. Noon A, Albertsen P, Thomas F, et al (2013). Competing mortality in patients diagnosed with bladder cancer: evi-dence of undertreatment in the elderly and female patients. Br J Cancer, 108(7):1534-1540.
31. World Health Organization. Prevalence of tobacco smoking Internet Geneva (CH): World Health Organization; 2016. Age-standardized prevalence of current to-bacco smoking among persons aged 15 years and older.
32. World Bank Group. Montenegro Overview of Tobacco Use, Tobacco Control Leg-islation, and Taxation A Country Brief. Available from: https://openknowledge.worldbank.org/server/api/core/bitstreams/d4e8f659-5cb4-549a-bde2-def712d89e14/content
33. Nedović-Vuković M, Laušević D, Ljaljević A, et al (2019). Lung cancer mortality in Montenegro, 1990 to 2015. Croat Med J, 60(1):26-32.
34. General population survey on substance use in Montenegro 2017: http://www.emcdda.europa.eu/attachements.cfm/att_261864_EN_2-%20Final%20Report%20GPS%20Montenegro%202017.pdf
35. Likić D. Izvještaj o obolijevanju od šećerne bolesti u 2015. godini. Institut za javno zdravlje Crne Gore. Available at: https://www.ijzcg.me/me/izvjestaji/godisnji-izvjestaji-o-obolijevalju-od-secerne-bolesti-u-crnoj-gori
36. Ferlay J, Colombet M, Soerjomataram I, et al (2018). Global and Regional Estimates of the Incidence and Mortality for 38 Cancers: GLOBOCAN 2018. Lyon: In-ternational Agency for Research on Cancer/World Health Organization; Available from: https://gco.iarc.fr/
37. Vlada Crne Gore, Ministarstvo zdravlja, rada i socijalnog staranja. Strategija za prevenciju i kontrolu hroničnih nezaraznih bolesti, 2008.
38. Ministarstvo zdravlja, Vlada Republike Crne Gore. Zdravstvena politika u Re-publici Crnoj Gori do 2020 (2001).
39. Ministarstvo zdravlja Crne Gore. Nacio-nalni program za kontrolu raka, 2011. Available at: https://www.gov.me/en/documents/ae7dd230-22e0-48ef-8095-16cf176f9b9b
40. Hall MC, Chang SS, Dalbagni G, et al (2007): Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol, 178(6):2314-2330.
41. Jain K, Datta C, Sengupta M, et al (2023). Quest to develop a standard screening method for urothelial carcinoma using liquid-based cytology (The Paris System) and CK20. Indian J Pathol Microbiol, 66(4):720-726.
42. Beukers W, van der Keur KA, Kandimalla R, et al (2017). FGFR3, TERT and OTX1 as a Urinary Biomarker Combination for Surveillance of Patients with Bladder Cancer in a Large Prospective Multicen-ter Study. J Urol, 197(6):1410-1418.
43. Na Y, Ye Z, Sun G, et al (2014). Guidelines for the Diagnosis and Treatment of Urological Diseases in China. People’s Medical Publishing House Beijing, 340-361.
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| Section | Original Article(s) | |
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How to Cite
1.
Nedovic Vukovic M, Terzic Z, Golubovic M, Bojic M, Vukovic M. Bladder Cancer Mortality Trend in Montenegro: 1990-2021. Iran J Public Health. 2025;54(2):414-423.
