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Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study.

Driver JA, Djoussé L, Logroscino G, Gaziano JM, Kurth T - BMJ (2008)

Bottom Line: The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening.This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age.Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. jdriver@partners.org

ABSTRACT

Objective: To investigate the influence of increasing age on the incidence and remaining lifetime risk of cardiovascular disease and cancer in a cohort of older men.

Design: Prospective cohort study.

Setting: United States.

Participants: 22,048 male doctors aged 40-84 who were free of major disease in 1982.

Main outcome measures: Incidence and remaining lifetime risk of major cardiovascular disease (myocardial infarction, stroke, and death from cardiovascular disease) and cancer.

Results: 3252 major cardiovascular events and 5400 incident cancers were confirmed over 23 years of follow-up. The incidence of major cardiovascular disease continued to increase to age 100. Beginning at age 80, however, major cardiovascular disease was more likely to be diagnosed at death. The incidence of cancer peaked in those aged 80-89 and then declined. Cancers detected by screening accounted for most of the decline, whereas most cancers for which there was no screening continued to increase to age 100. Unadjusted cumulative incidence overestimated the risk of cardiovascular disease by 16% and cancer by 8.5%. The remaining lifetime risk of cancer at age 40 was 45.1% (95% confidence interval 43.8% to 46.3%) and at age 90 was 9.6% (7.2% to 11.9%). The remaining lifetime risk of major cardiovascular disease at age 40 was 34.8% (33.1% to 36.5%) and at age 90 was 16.7% (12.9% to 20.6%).

Conclusions: In this prospective cohort of men, the incidence of new cardiovascular disease continued to increase after age 80 but was most often diagnosed at death. The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening. These findings suggest that people aged 80 and older have a substantial amount of undiagnosed disease. The remaining lifetime risk of both diseases approached a plateau in the 10th decade. This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age. Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.

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Fig 4 Age specific crude incidence of overall cancer compared with subgroups of cancers detected by screening (prostate, colorectal, melanoma) and cancers for which there is no routine screening
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fig4: Fig 4 Age specific crude incidence of overall cancer compared with subgroups of cancers detected by screening (prostate, colorectal, melanoma) and cancers for which there is no routine screening

Mentions: Table 3 displays the age specific incidence of cancer by subtypes. The most common cancers were prostate (47.2%), colorectal (10.3%), lymphoma (6.6%), lung (6.6%), and melanoma (5.7%). Most of the cancers that declined before age 100 were those detected by screening, whereas the incidence of cancers for which there was no routine screening continued to increase up to age 99 (fig 4). The cancer rate among ever smokers peaked in those aged 80-89, at 2883 per 100 000 person years, and then declined, whereas the rate among never smokers peaked at 2205 per 100 000 person years in the ninth decade and then remained stable. In contrast, the incidence of major cardiovascular disease increased through the 10th decade in both smokers and non-smokers (data not shown).


Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study.

Driver JA, Djoussé L, Logroscino G, Gaziano JM, Kurth T - BMJ (2008)

Fig 4 Age specific crude incidence of overall cancer compared with subgroups of cancers detected by screening (prostate, colorectal, melanoma) and cancers for which there is no routine screening
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2600919&req=5

fig4: Fig 4 Age specific crude incidence of overall cancer compared with subgroups of cancers detected by screening (prostate, colorectal, melanoma) and cancers for which there is no routine screening
Mentions: Table 3 displays the age specific incidence of cancer by subtypes. The most common cancers were prostate (47.2%), colorectal (10.3%), lymphoma (6.6%), lung (6.6%), and melanoma (5.7%). Most of the cancers that declined before age 100 were those detected by screening, whereas the incidence of cancers for which there was no routine screening continued to increase up to age 99 (fig 4). The cancer rate among ever smokers peaked in those aged 80-89, at 2883 per 100 000 person years, and then declined, whereas the rate among never smokers peaked at 2205 per 100 000 person years in the ninth decade and then remained stable. In contrast, the incidence of major cardiovascular disease increased through the 10th decade in both smokers and non-smokers (data not shown).

Bottom Line: The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening.This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age.Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. jdriver@partners.org

ABSTRACT

Objective: To investigate the influence of increasing age on the incidence and remaining lifetime risk of cardiovascular disease and cancer in a cohort of older men.

Design: Prospective cohort study.

Setting: United States.

Participants: 22,048 male doctors aged 40-84 who were free of major disease in 1982.

Main outcome measures: Incidence and remaining lifetime risk of major cardiovascular disease (myocardial infarction, stroke, and death from cardiovascular disease) and cancer.

Results: 3252 major cardiovascular events and 5400 incident cancers were confirmed over 23 years of follow-up. The incidence of major cardiovascular disease continued to increase to age 100. Beginning at age 80, however, major cardiovascular disease was more likely to be diagnosed at death. The incidence of cancer peaked in those aged 80-89 and then declined. Cancers detected by screening accounted for most of the decline, whereas most cancers for which there was no screening continued to increase to age 100. Unadjusted cumulative incidence overestimated the risk of cardiovascular disease by 16% and cancer by 8.5%. The remaining lifetime risk of cancer at age 40 was 45.1% (95% confidence interval 43.8% to 46.3%) and at age 90 was 9.6% (7.2% to 11.9%). The remaining lifetime risk of major cardiovascular disease at age 40 was 34.8% (33.1% to 36.5%) and at age 90 was 16.7% (12.9% to 20.6%).

Conclusions: In this prospective cohort of men, the incidence of new cardiovascular disease continued to increase after age 80 but was most often diagnosed at death. The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening. These findings suggest that people aged 80 and older have a substantial amount of undiagnosed disease. The remaining lifetime risk of both diseases approached a plateau in the 10th decade. This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age. Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.

Show MeSH
Related in: MedlinePlus