台灣婦癌醫學會 Taiwan Association of Gynecologic Oncologists

                                                        本期編輯 陳子健 醫師   

壹、 會務報告

一、近期學會活動

二、「第十四屆台灣癌症聯合學術年會」重要公告

【一】大會時間

時間：2009年5月2日、3日（星期六、日）

地點：國防醫學院

主題：Molecular Oncology－Pushing Cancer Management A Step Forward

【二】壁報論文甄選

截稿日期：2009年2月15日（星期日）24：00止，逾時不予受理

獎勵內容：基礎、臨床類各10名，發表口頭報告、頒發獎狀、獎金（獎金部份：前3名每名3萬元，第4到第10名每名1萬元）

投稿方式：2008年11月16日起，至下列網站查詢及下載

          www.hancan.com.tw

※特別注意事項：本次壁報論文以網路上傳方式投稿，將會設定截止時間，請各會員務必配合，在截止時間之前完成上傳動作。

【三】台灣癌症聯合學術年會Logo徵稿

緣由：台灣癌症聯合學術年會是國內重要的癌症學術討論年會，定期舉辦已經有連續13年的歷史。經2008年8月23日第14屆第一次籌備會議討論後決議，聯合年會應有代表其精神的Logo，並向各學會會員徵稿。

設計內容：

1、代表台灣癌症聯合年會精神（例如：8隻小螃蟹合成一隻大螃蟹，或是一隻螃蟹殼上有8個小點等等………）

2、中文標題：「台灣癌症聯合學術年會」

3、英文標題：「Taiwan Joint Cancer Conference」

4、如經採用致贈獎金8000元

5、投稿請寄：14tjcc@gmail.com

     6、截稿日期：2008年12月15日

三、學會網站誠徵衛教文章

歡迎各位會員踴躍賜稿，以充實學會的網站內容。來稿請e-mail至tago.gyn@gmail.com

貳、 會員動態及意見與回應

(歡迎提供會員動態、意見，以及衛教文章（學會E-mail address: tago.gyn@gmail.com)

参、 前月文獻選錄

@ EORTC 重定radical hysterectomy 之分類

Int J Gynecol Cancer. 2008 Sep-Oct;18(5):1136-8.

Classification of radical hysterectomy adopted by the Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer.
Mota F, Vergote I, Trimbos JB, Amant F, Siddiqui N, Del Rio A, Verheijen R, Zola P.
Department of Gynecology, University Hospital of Coimbra, Coimbra, Portugal. fmota@huc.min-saude.pt
The Piver classification of radical hysterectomy for the treatment of cervical cancer is outdated and misused. The Surgery Committee of the Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer (EORTC) produced, approved, and adopted a revised classification. It is hoped that at least within the EORTC participating centers, a standardization of procedures is achieved. The clinical indications of the new classification are discussed.

@ recurrent cervical and uterine cancer 之超限手術

Int J Gynecol Cancer. 2008 Sep-Oct;18(5):1139-44.

Extended pelvic resections for recurrent uterine and cervical cancer: out-of-the-box surgery.
Caceres A, Mourton SM, Bochner BH, Gerst SR, Liu L, Alektiar KM, Kardos SV, Barakat RR, Boland PJ, Chi DS.
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Patients with recurrent uterine and cervical cancer have poor prognoses. The objective of this study was to analyze the outcomes of patients with recurrent uterine and cervical cancer who had undergone attempted curative resection of pelvic bone, sidewall muscle, major blood vessels, and/or nerves. We reviewed the records of all 14 patients with recurrent uterine and cervical cancer who had extended pelvic resections at our institution between June 2000 and November 2006. Primary sites of disease were the uterus (11 patients) and cervix (3 patients). Tumor histology was as follows: adenocarcinoma, seven; squamous cell carcinoma, three; leiomyosarcoma, three; and adenosarcoma, one. Previous treatment included hysterectomy, 11; pelvic radiation, 9; chemotherapy, 9; and total pelvic exenteration, 2. Extended pelvic resections included removal of pelvic sidewall muscle, five; bone, five; common and/or external iliac vessel, five; femoral nerve, two; lumbosacral nerve root, one; and obturator nerve, one. Other procedures included total pelvic exenteration, three; posterior exenteration, two; and anterior exenteration, one. Complete resection with negative margins was obtained in 11 (78%) of 14 patients. Seven patients (50%) received high-dose rate intraoperative radiation therapy. Reconstructive procedures included continent or incontinent urinary diversion, four; femoral-femoral arterial bypass, two; myocutaneous flap, two; and urinary ileal interposition, one. Median total operating time was 628 min (range, 345-935 min) and median estimated blood loss was 900 mL (range, 300-16,000 mL). Seven patients (50%) had one or more major complication(s), including pelvic abscess, three; colonic fistula, two; massive intraoperative hemorrhage, one; postoperative bladder perforation, one; thrombosed femoral-femoral graft, one; and disruption of appendicocutaneous urinary anastomosis, one. At a median follow-up of 26 months (range, 5-84 months), ten patients (71%) are alive and four patients (29%) have died of disease at 8, 13, 33, and 42 months postoperatively.

@ Neoadjuvant chemotherapy 之於 cervical carcinoma

Gynecol Oncol. 2008 Sep;110(3 Suppl 2):S36-40.

The current role of neoadjuvant chemotherapy in the management of cervical carcinoma.
González-Martín A, González-Cortijo L, Carballo N, Garcia JF, Lapuente F, Rojo A, Chiva LM.
Medical Oncology Department, MD Anderson International España, Madrid, Spain. agonzalezm@seom.org
The role of neoadjuvant chemotherapy (NACT) in cervical cancer has been a matter of investigation over the last 20 years. A systematic review and meta-analysis of individual patient data (IPD) demonstrated that NACT followed by surgery is superior to radiotherapy alone in terms of overall survival. However, in spite of the results of the meta-analysis, NACT has not been adopted as the new standard of care. In the present paper, we review the reasons why NACT is still considered an investigational approach in cervical cancer.

@ Cervical cancer 的Novel therapeutic agents

Gynecol Oncol. 2008 Sep;110(3 Suppl 2):S72-6.

Update on novel therapeutic agents for cervical cancer.
del Campo JM, Prat A, Gil-Moreno A, Pérez J, Parera M.
Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain. jmcampo@vhebron.net
Effective cytotoxic treatment options for advanced cervical cancer are exceedingly limited. Cisplatin-based combination chemotherapy, the most commonly used cytotoxic therapy, has produced response rates ranging from 20% to 30% and overall survival of less than 10 months. Because of the minimal degree of success with cytotoxic therapies and the poor prognosis of patients with this disease, interest has increased in targeted therapeutics for the treatment of cervical cancer. In recent years, significant improvements in our understanding of the altered molecular events in tumor cells have led to the discovery of new targets and agents for clinical testing. Two of these promising targets are epidermal growth factor receptor (EGFR) and the vascular endothelial growth factor (VEGF) signaling pathway, which play critical roles in tumor growth and angiogenesis. Two monoclonal antibodies, cetuximab, which targets EGFR, and bevacizumab, which target the VEGF signaling pathway, are being evaluated as monotherapy and in combination with other agents and/or radiotherapy for the treatment of cervical cancer. In addition, VEGF receptor tyrosine kinase inhibitors, such as sorafenib and pazopanib, are being studied in phase I/II clinical trials. In this review, we discuss potential molecular targets and novel therapeutic strategies that are being investigated for the treatment of cervical cancer.

@ 以3D volume 來預測endometrial cancer

Gynecol Oncol. 2008 Sep;110(3):390-5.

The role of three-dimensional volume measurement in diagnosing endometrial cancer in patients with postmenopausal bleeding.
Yaman C, Habelsberger A, Tews G, Pölz W, Ebner T.
Department of Obstetrics and Gynecology, AKH-Linz, Linz, Austria. yaman@aon.at
OBJECTIVE: To evaluate the role of three-dimensional transvaginal ultrasound in diagnosing endometrial cancer in patients with history of postmenopausal bleeding and compare its effectiveness with two-dimensional ultrasound. METHODS: Transvaginal ultrasound examinations, diagnostic hysteroscopy with subsequent curettage, and/or hysterectomy were performed in 213 consecutive patients with a history of postmenopausal bleeding. The results of the ultrasonographic examinations were compared with the diagnoses on the basis of histologic examination. In addition to an explorative data analysis, receiver operating characteristic curves were shown and areas under curves were calculated. Minimal endometrial volume (2.7 ml) and minimal endometrial thickness (7 mm) of endometrial carcinoma were defined as optimal cutoff values. RESULTS: In 42 patients, endometrial carcinoma was diagnosed. The mean endometrial volume of patients with endometrial cancer, measured by three-dimensional ultrasound, was 11.78 ml. The sensitivity of the endometrial volume at the optimal cutoff (2.7 ml) was 100.00%, the specificity was 69.00%, the positive predictive value was 44.20%, and the negative predictive value was 100.00%. On two-dimensional ultrasound, the mean endometrial thickness of patients with endometrial cancer was 16.6 mm. The sensitivity endometrial thickness measurements at the optimal cutoff (7 mm) was 100.00%, the specificity was 43.3%, the positive predictive value was 30.2%, and the negative predictive value was 100.00%. The area under curve of volume measured by three-dimensional ultrasound was 0.89 (95% CI 0.85-0.93). The area under curve of endometrial thickness was 0.85 (95% CI 0.80-0.91). The comparison of the area under curve of receiver operating curves between endometrial volume and endometrial thickness revealed a significant difference (p=0.023). CONCLUSION: Volume measurement by three-dimensional transvaginal ultrasound has a higher specificity, which means that it has the ability to better identify the negative cases compared to conventional ultrasound. Three-dimensional transvaginal ultrasound is a helpful tool for diagnosing endometrial cancer in patients with postmenopausal bleeding.

@ Sonohystography 與 endometrial cancer spillage

Am J Obstet Gynecol. 2008 Sep;199(3):240.e1-8.

Sonohysterography and endometrial cancer: incidence and functional viability of disseminated malignant cells.
Berry E, Lindheim SR, Connor JP, Hartenbach EM, Schink JC, Harter J, Eickhoff JC, Kushner DM.
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
OBJECTIVE: The purpose of this study was to evaluate sonohysterography in patients with endometrial cancer and to determine whether (1) transtubal fluid spill occurs during routine sonohysterography, (2) a critical infusion volume for spill exists, or (3) disseminated cancer cells demonstrate viability. STUDY DESIGN: At laparotomy, sonohysterography was performed on 16 patients with endometrial adenocarcinoma. Volumes at which tubal spill occurred were recorded. Collected specimens were processed and incubated. After evaluation for viable cells, cytologic analysis was undertaken. RESULTS: The median volume that was required for adequate sonohysterography was 8.5 mL. Five patients (31%) had transtubal spill. With an additional saline solution flush, the median total volume for a spill was 20.5 mL. Two patients (12.5%) had viable benign cells that were cultured after routine sonohysterography. One patient (6%) had nonviable carcinoma cells that were identified. CONCLUSION: Transtubal spill occurs during sonohysterography. No critical spill volume was identified. A highly diagnostic tool when abnormal bleeding is evaluated, sonohysterography has a low probability of cancer cell dissemination.

@ Raloxifene 預防 endometrial cancer

J Clin Oncol. 2008 Sep 1;26(25):4151-9.

Impact of raloxifene or tamoxifen use on endometrial cancer risk: a population-based case-control study.
DeMichele A, Troxel AB, Berlin JA, Weber AL, Bunin GR, Turzo E, Schinnar R, Burgh D, Berlin M, Rubin SC, Rebbeck TR, Strom BL.
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA. angela.demichele@uphs.upenn.edu
PURPOSE: Raloxifene reduces breast cancer risk in women with osteoporosis, and both tamoxifen and raloxifene prevent breast cancer in high-risk women. However, in vitro, raloxifene does not share the pro-estrogenic effects of tamoxifen on the endometrium. Randomized trials of these agents have provided limited information about endometrial cancer risk in the general population. We sought to compare endometrial cancer risks associated with raloxifene, tamoxifen, and nonusers of a selective estrogen receptor modulator (SERM) in the general population and characterize the endometrial tumors occurring in these groups. METHODS: We performed a case-control study of white and African American women age 50 to 79 years in the Philadelphia area. Patients were diagnosed with endometrial cancer between July 1999 and June 2002. Controls were identified through random-digit dialing. RESULTS: We analyzed 547 cases and 1,410 controls. Among cases, 3.3% had taken raloxifene; 6.2% had taken tamoxifen. Among controls, 6.6% had taken raloxifene; 2.4% had taken tamoxifen. After adjustment for other risk factors, the odds of endometrial cancer among raloxifene users was 50% that of nonusers (odds ratio [OR] = 0.50; 95% CI, 0.29 to 0.85), whereas tamoxifen users had three times the odds of developing endometrial cancer compared with raloxifene users (OR = 3.0; 95% CI, 1.3 to 6.9). Endometrial tumors in raloxifene users had a more favorable histologic profile and were predominantly International Federation of Gynecology and Obstetrics stage I and low grade. CONCLUSION: Raloxifene users had significantly lower odds of endometrial cancer compared with both tamoxifen users and SERM nonusers, suggesting a role for raloxifene in endometrial cancer prevention and individualization of SERM therapy.

@ 用anastrozole 來治療recurrent endometrial ca

Am J Obstet Gynecol. 2008 Sep;199(3):e7-e10.

Recurrent endometrial carcinoma regression with the use of the aromatase inhibitor anastrozole.
Bellone S, Shah HR, McKenney JK, Stone PJ, Santin AD.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology Yale University School of Medicine, New Haven, CT 06520-8063, USA.
Recurrent/metastatic endometrial adenocarcinoma that is not amenable to cure with local or regional therapy and/or chemotherapy represents a discouraging clinical entity for the clinician. We report the case of 58-year-old woman with recurrent endometrial carcinoma that was resistant to chemotherapy that was treated successfully with the aromatase inhibitor anastrozole

@ 對於uterine carcinosarcoma (advanced or recurrent)使用carboplatin + paclitaxel + liposomal doxorubicin

Gynecol Oncol. 2008 Sep;110(3):299-303.

Combination chemotherapy with carboplatin, paclitaxel and pegylated liposomal doxorubicin for advanced or recurrent carcinosarcoma of the uterus: clinical experience of a single institution.
Pectasides D, Pectasides E, Papaxoinis G, Xiros N, Sykiotis C, Papachristodoulou A, Tountas N, Panayiotides J, Economopoulos T.
2nd Department of Internal Medicine, Propaedeutic, Oncology Section, University of Athens, Attikon University Hospital, Haidari, Athens, Greece. pectasid@otenet.gr
OBJECTIVES: The purpose of this study was to evaluate the activity and toxicity of carboplatin, paclitaxel and pegylated liposomal doxorubicin combination in advanced or recurrent of the uterine carcinosarcoma. METHODS: Twenty-nine eligible patients with measurable disease were treated with carboplatin [area under the curve (AUC) 5], paclitaxel 175 mg/m(2) and pegylated liposomal doxorubicin 25 mg/m(2) every 3 weeks for 6-8 cycles. RESULTS: There were 10 complete responses (CRs) (34%) and 8 partial responses (PRs) (28%) for an overall response rate (RR) of 62% (95% confidence interval [CI], 43-81%). The median progression-free survival (PFS) was 8.2 months (95% CI, 4.1-12.2 months) and the median overall survival (OS) was 16.4 months (95% CI, 14.7-18.0 months). There was no statistically significant difference between histology and response to therapy. Patients with PS of 0 or 1 had a higher RR than those with worst PS. Toxicity was generally mild except for myelotoxicity. Neutropenia grade 3/4 was recorded in 52% of patients and 10% experienced febrile neutropenia. Anemia grade 3 or 4 developed in 27% of patients and thrombocytopenia grade 3 or 4 in 31% of patients. Three patients (10%) developed grade 3 sensory neuropathy and only 2 patients (8%) grade 3 palmar-plantar erythrodysesthesias. No treatment-related deaths were recorded in our series. CONCLUSION: The combination of carboplatin, paclitaxel and pegylated liposomal doxorubicin appears to have activity in advanced, persistent or recurrent endometrial carcinosarcoma with an acceptable toxicity profile.

@ 以proteomics找出早期ovarian cancer

Am J Obstet Gynecol. 2008 Sep;199(3):215-23.

The early detection of ovarian cancer: from traditional methods to proteomics. Can we really do better than serum CA-125?
Nossov V, Amneus M, Su F, Lang J, Janco JM, Reddy ST, Farias-Eisner R.
Department of Obstetrics and Gynecology, University of California, Los Angeles, Medical Center, Los Angeles, CA 90095-1740, USA.
Ovarian cancer is the leading cause of death from gynecologic malignancy in the United States. More than 80% of patients present with advanced disease, with 5 year survival rates between 15% and 45%. In contrast, the survival rate for stage I disease, with malignancy confined to the ovary, is approximately 95%. Given the discrepancy in survival outcomes between early- and late-stage disease, strategies that would allow for the detection of ovarian cancer in its early stages would hold promise to significantly improve the mortality rate from ovarian cancer. Unfortunately, current screening methods for the detection of early stage ovarian cancer are inadequate. However, several recent proteomics-based biomarker discovery projects show promise for the development of highly sensitive and specific markers for gynecological malignancies, including ovarian cancer. In this review, we hope to provide an overview of the early detection ovarian cancer from traditional methods to recent promises in the proteomics pipeline

@ 停經婦女CA125 上升的epidemiology

Gynecol Oncol. 2008 Sep;110(3):383-9.

The epidemiology of CA-125 in women without evidence of ovarian cancer in the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial.
Johnson CC, Kessel B, Riley TL, Ragard LR, Williams CR, Xu JL, Buys SS; Prostate, Lung, Colorectal and Ovarian Cancer Project Team.
Josephine Ford Cancer Center, Henry Ford Hospital, Detroit, MI, USA. cjohnso1@hfhs.org
OBJECTIVE: To determine the epidemiology of CA-125 in women without ovarian cancer. METHODS: We analyzed demographic, medical and lifestyle characteristics related to CA-125, measured using the Centocor CA-125II RIA assay, among 25,608 multi-ethnic U.S. women aged 55-74 years enrolled in a cancer screening trial and found to have no evidence of ovarian cancer. RESULTS: Mean CA-125 level was 11.9 U/ml (SD 8.3); median 10.0 U/ml, interquartile range 8.0-14.0. High levels, using the clinical cut point of >or=35 U/ml, were associated with increased age (p<0.001) and former smoking (p<0.021), while hysterectomy and obesity were protective (p<0.001). Mean levels were higher with increasing age (p<0.001), ever use of hormone therapy (p<0.001), former smoking (p<0.017) and history of breast cancer (p<0.002), but lower (p<0.001) with non-White status, previous hysterectomy, current smoking, and obesity. Current hormone therapy use was not associated with CA-125 in women without a uterus. CONCLUSION: In post-menopausal women without ovarian cancer, CA-125 level is influenced by a number of factors, including race/ethnicity, age, hysterectomy, smoking history and obesity.

@ 組合式biomarkers for ovarian cancer

Gynecol Oncol. 2008 Sep;110(3):374-82.

Evaluation of biomarker panels for early stage ovarian cancer detection and monitoring for disease recurrence.
Havrilesky LJ, Whitehead CM, Rubatt JM, Cheek RL, Groelke J, He Q, Malinowski DP, Fischer TJ, Berchuck A.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA. havri001@mc.duke.edu
OBJECTIVE: To determine the utility of novel combinations of biomarkers, using both a one-step and two-step assay format, to distinguish serum of early ovarian cancer patients from that of healthy controls and to discern the utility of these biomarkers in a monitoring capacity. METHODS: For ovarian cancer detection, HE4, Glycodelin, MMP7, SLPI, Plau-R, MUC1, Inhibin A, PAI-1, and CA125 were evaluated in a cohort of 200 women with ovarian cancer and 396 healthy age-matched controls. Each biomarker was assessed by serum-based immunoassays utilizing novel monoclonal antibody pairs or commercial kits. For detection of disease recurrence, HE4, Glycodelin, MMP7 and CA125 were evaluated in 260 samples from 30 patients with OC monitored longitudinally after diagnosis. RESULTS: Based upon ROC curve analysis, the sensitivity/specificity of specific biomarker combination algorithms ranged from 59.0%/99.7% to 80.5%/96.5% for detection of early stage ovarian cancer and 76.9%/99.7% to 89.2%/97.2% for detection of late stage cancer. In monitoring evaluation of 27 patients who experienced recurrence of OC, sensitivity for predicting recurrence was 100% for the biomarker panel and 96% for CA125. At least one of the panel biomarkers was elevated earlier (range 6-69 weeks) than CA125 and prior to clinical evidence of recurrence in 14/27 (52%) patients. CONCLUSIONS: We have developed and demonstrated the utility of several one- and two-step multi-marker combinations with acceptable test characteristics for possible use in an ovarian cancer screening population. A subset of this panel may also provide adjunctive information to rising CA125 levels in disease monitoring.

@ 輸卵管可能是primary peritoneal serous carcinoma 之源頭

J Clin Oncol. 2008 Sep 1;26(25):4160-5.

Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention.
Carlson JW, Miron A, Jarboe EA, Parast MM, Hirsch MS, Lee Y, Muto MG, Kindelberger D, Crum CP.
Department of Pathology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
PURPOSE: A diagnosis of primary peritoneal serous carcinoma (PPSC) requires exclusion of a source in other reproductive organs. Serous tubal intraepithelial carcinoma (STIC; stage 0) has been described in asymptomatic women with BRCA mutations and linked to a serous cancer precursor in the fimbria. This study examined the frequency of STIC in PPSC and its clinical outcome in BRCA-positive women. PATIENTS AND METHODS: Presence or absence of STIC was recorded in consecutive cases meeting the 2001 WHO criteria for PPSC, including 26 patients with nonuniform sampling of the fallopian tubes (group 1) and 19 patients with complete tubal examination (group 2; sectioning and extensively examining the fimbriated end, or SEE-FIM protocol). In selected cases, STIC or its putative precursor and the peritoneal tumor were analyzed for p53 mutations (exons 1 to 11). Outcome of STIC was ascertained by literature review. RESULT: Thirteen (50%) of 26 PPSCs in group 1 involved the endosalpinx, with nine STICs (35%). Fifteen (79%) of 19 cases in group 2 contained endosalpingeal involvement, with nine STICs (47%). STIC was typically fimbrial and unifocal, with variable invasion of the tubal wall. In five of five cases, the peritoneal and tubal lesion shared an identical p53 mutation. Of 10 reported STICs in BRCA-positive women, all patients were without disease on follow-up. CONCLUSION: The fimbria is the source of nearly one half of PPSCs, suggesting serous malignancy originates in the tubal mucosa but grows preferentially at a remote peritoneal site. The generally low risk of recurrence in stage 0 (STIC) disease further underscores STIC as a possible target for early serous cancer detection and prevention.

@ 人生而不平等

Eur J Cancer. 2008 Sep;44(14):2074-85.

Social inequality in incidence of and survival from cancer in a population-based study in Denmark, 1994-2003: Summary of findings.
Dalton SO, Schüz J, Engholm G, Johansen C, Kjaer SK, Steding-Jessen M, Storm HH, Olsen JH.
Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark. sanne@cancer.dk
The purpose of this nationwide, population register-based study was to describe variations in cancer incidence and survival by social position in a social welfare state, Denmark, on the basis of a range of socioeconomic, demographic and health-related indicators. Our study population comprised all 3.22 million Danish residents born in 1925-1973 and aged >or=30 years, who were followed up for cancer incidence in 1994-2003 and for survival in 1994-2006, yielding 147,973 cancers. The incidence increased with lower education and income, especially for tobacco- and other lifestyle-related cancers, although for cancers of the breast and prostate and malignant melanoma the association was inverse. Conversely there was a general increase in incidence among early retirement pensioners, persons living in rented housing and those living in the smallest dwellings. Also incidence rates were generally higher in persons living alone compared to those living with a partner and in the capital area compared to the rural areas. Social inequality in the prognosis of most cancers was observed, despite the equal access to health care in Denmark, with poorer relative survival related to fewer advantages, regardless of how they were measured, often most pronounced in the first year after diagnosis. Also living alone and having somatic or psychiatric comorbidity negatively impacted the relative survival after most cancers. Our study shows that inequalities in cancer incidence and survival must be addressed in all aspects of public health, with interventions both to reduce incidence and to prolong survival