Temporal studies of cancer occurrence and applications of the age-period-cohort method to trends in Europe

This thesis examines the utility of temporal studies of cancer in practice, particularly from the perspective of analyses of the three underlying time components, age, period of event and birth cohort. This enquiry encompasses a review of temporal studies and routine data sources, as well as a more critical appraisal of the strategies available for APC analysis and presentation. Specific methods are then applied to trends in cancer incidence and mortality in Europe. The central aims of the thesis are: 1) to comprehensively review the graphical and analytical approaches available, particularly in relation to APC modelling and their usage in current practice; 2) on the basis of 1), to provide broad but sensible guidelines for the analyses of time trends; 3) on the basis of 2), to practically demonstrate the utility of time trends and the APC model; 4) to consider the benefits and limitations of systematic approaches applied to time trend studies. The recommended strategies are used as guiding principles for a detailed analysis of trends in incidence and mortality rates of three cancers (cervix, endometrium and testis) in European populations. The analyses of these neoplasms - purposely selected given their differing temporal and aetiological profile as well as their means of prevention - provides a platform to demonstrate the utility of APC analyses and the specified recommendations in practice. This motivates a discussion of the difficulties inherent in such studies and the consequences of introducing systematic approaches to the analyses of cancer trends.