Margit Mägi

Trends in cervical cancer incidence and mortality in the Baltic countries, Bulgaria and Romania

The burden of cervical cancer varies considerably in the European Union (EU). In this article, we describe trends in incidence of and mortality from this cancer in the two most affected areas: the Baltic countries (Estonia, Latvia and Lithuania) and Southeast Europe (Bulgaria and Romania). Incidence data were obtained from the national cancer registries. Data on population and number of deaths from uterine cancers were extracted from the World Health Organization mortality database. Mortality rates were corrected for inaccuracies in the death certification of not otherwise specified uterine cancer. Joinpoint regression was used to study the annual variation of corrected and standardized incidence and mortality rates. Changes were assessed by calendar period and age group, whereas the evolution by birth cohort was synthesized by computing standardized cohort incidence/mortality ratios. Joinpoint regression revealed rising trends of incidence (in Lithuania, Bulgaria and Romania) and of mortality (in Latvia, Lithuania, Bulgaria and Romania). In Estonia, rates were rather stable. Women born between 1940 and 1960 were at continuously increasing risk of both incidence of and mortality from cervical cancer. Although some quality issues in the registration of cancer and causes of death cannot be ignored, the trends indicate increased exposure to human papillomavirus infection and absence of effective screening programs. Rising trends of cervical cancer in the most affected EU member states reveal a worrying pattern that warrants urgent preventive actions.

Trends in cervical cancer incidence and mortality in Bulgaria, Estonia, Latvia, Lithuania and Romania.

Objective The burden of cervical cancer varies considerably in the European Union. In this paper, we describe trends in incidence of and mortality from this cancer in the five most affected member states. Methods Data on number of deaths from uterine cancers and the size of the female population of Estonia, Latvia, Lithuania, Bulgaria and Romania were extracted from the WHO mortality database. Mortality rates were corrected for inaccuracies in the death certification of not otherwise specified uterine cancer. Incidence data were obtained from the national cancer registries. Joinpoint regression was used to study the annual variation of corrected and standardized incidence and mortality rates. Changes by birth cohort were assessed for specific age groups and subsequently synthesized by computing standardized cohort incidence/mortality ratios. Results Joinpoint regression revealed rising trends of incidence (in Lithuania, Bulgaria and Romania) and of mortality (in Latvia, Lithuania, Bulgaria and Romania). In Estonia, rates were rather stable. Women born between 1940 and 1960 were at continuously increasing risk of both incidence of and mortality from cervical cancer. Conclusions Rising trends of cervical cancer in the most affected EU member states reveal a worrying pattern that warrants urgent introduction of effective preventive actions as described in the European guidelines.

Place of residence predicts breast cancer stage at diagnosis in Estonia

BACKGROUND Stage at diagnosis is one of the most important predictors of breast cancer survival. The objective of this population-based study was to examine the impact of age, period of diagnosis and place of residence on breast cancer stage at diagnosis in Estonia. METHODS Female breast cancer cases reported to the Estonian Cancer Registry in 1995-2006 with a known extent of disease were included. Logistic regression was used to estimate the risk of advanced stage (non-localized) disease. RESULTS Overall, 56% of the 6936 women included in the analysis were diagnosed at advanced stage. The risk of advanced disease at diagnosis decreased over the study period in all age groups, but the change was much larger among women aged 50-69 years than among women in younger and older age groups. Multivariate analysis indicated that the strongest predictor of advanced stage disease was the place of residence. Compared with Tallinn (the capital of Estonia), living in Tartu (a small town with a university hospital) was associated with a significant 36% reduction in risk while the odds ratio associated with living in a marginal industrial county (Ida-Viru) was 1.52 (95% confidence interval 1.29-1.79). CONCLUSIONS The observed regional variations are most likely due to differences in education, unemployment and health care access. Younger and elderly women, those living in remote areas and of lower socio-economic status should be addressed with specific measures to promote earlier detection of breast cancer, particularly in view of current economic difficulties and a sharply rising unemployment rate.

Testicular cancer survival in Estonia: Improving but still relatively low

Abstract Background. International comparisons have pointed to very low survival of patients diagnosed with testicular cancer (TC) in Estonia. Methods. Using population based data from the Estonian Cancer Registry and period analysis, we examined trends in TC survival between 1985 and 2004. Additional results from a review of clinical records to ascertain patterns of disease management (1990–2003) were used to explain the changes and identify the areas for potential improvement. Results. Age-adjusted 5-year period relative survival increased from 47.9% in 1985–1989 to 74.5% in 2000–2004 (p for trend <0.01). A marked improvement was seen for the patients younger than 30, with the 5-year survival reaching 93.3%, while the improvement remained modest among patients aged 30 and above. Although substantial advances occurred in staging and treatment techniques since 1990, deficiencies remained evident in disease management, including not referring patients to an oncologist after their orchiectomy and less careful diagnostic workup for patients above 30 years of age. Low use of radiotherapy suggests poor access to contemporary equipment. Delays in seeking medical consultation, but also in starting adjuvant therapy, could have contributed to poorer outcomes. Conclusions. Survival in TC increased markedly in Estonia by the 21st century, but is still notably lower than in the more developed countries. Multidisciplinary efforts may help to achieve further improvement. The provision of TC care should be coordinated by specialised cancer centres.

Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations

Objective Resection can potentially cure resectable pancreatic cancer (PaC) and significantly prolong survival in some patients. This large-scale international study aimed to investigate variations in resection for PaC in Europe and USA and determinants for its utilisation. Design Data from six European population-based cancer registries and the US Surveillance, Epidemiology, and End Results Program database during 2003–2016 were analysed. Age-standardised resection rates for overall and stage I–II PaCs were computed. Associations between resection and demographic and clinical parameters were assessed using multivariable logistic regression models. Results A total of 153 698 records were analysed. In population-based registries in 2012–2014, resection rates ranged from 13.2% (Estonia) to 21.2% (Slovenia) overall and from 34.8% (Norway) to 68.7% (Denmark) for stage I–II tumours, with great international variations. During 2003–2014, resection rates only increased in USA, the Netherlands and Denmark. Resection was significantly less frequently performed with more advanced tumour stage (ORs for stage III and IV versus stage I–II tumours: 0.05–0.18 and 0.01–0.06 across countries) and increasing age (ORs for patients 70–79 and ≥80 versus those <60 years: 0.37–0.63 and 0.03–0.16 across countries). Patients with advanced-stage tumours (stage III–IV: 63.8%–81.2%) and at older ages (≥70 years: 52.6%–59.5%) receiving less frequently resection comprised the majority of diagnosed cases. Patient performance status, tumour location and size were also associated with resection application. Conclusion Rates of PaC resection remain low in Europe and USA with great international variations. Further studies are warranted to explore reasons for these variations.

Nonsurgical therapies for resected and unresected pancreatic cancer in Europe and USA in 2003-2014: a large international population-based study: Nonsurgical therapies for PaC in Europe and USA

The role of chemotherapy in the treatment of pancreatic cancer (PaC) has been well‐established, while radiation plays ambiguous roles. This international large‐scale population‐based study aimed to investigate the real‐world application of chemotherapy and radiotherapy for resected and unresected PaC in Europe and USA. Population‐based data from multiple European national cancer registries and the US Surveillance, Epidemiology and End Results (SEER)‐18 database during 2003–2014 were analyzed. Temporal trends and geographical variations in the application rates of chemotherapy and radiotherapy were quantified using age standardization. Associations of treatment with demographic and clinical characteristics were assessed using multivariable logistic regression. A total of 141,533 PaC patients were analyzed. From 2003–2005 to 2012–2014, chemotherapy administration rates increased in most countries and more strongly among resected patients, while radiation rates were generally low with a slight decline or no obvious trend. In 2012–2014, 12.5% (Estonia) to 61.7% (Belgium) of resected and 17.1% (Slovenia) to 56.9% (Belgium) of unresected patients received chemotherapy. Radiation was administered in 2.6% (Netherlands) to 32.6% (USA) of resected and 1.0% (USA) to 6.0% (Belgium) of unresected patients. Strong temporal and geographical variations were observed. Patterns and strengths of associations of treatment administration with various demographic and clinical factors differed substantially between resected and unresected cancers and varied greatly across countries. Conclusively, administration of chemotherapy but not radiotherapy for PaC increased during the last decade in Europe and USA. Treatment rates were low and the uptake strongly varied across countries, highlighting the need for standardization in PaC treatment to improve patient care.

Vähihaigestumus 2009–2013 ja 20 aasta trendid Eestis

Eesmark. Anda varske ulevaade vahihaigestumusest Eestis ning analuusida pikaajalisi trende vahihaigestumuses ja -suremuses. Metoodika. Eesti vahiregistri andmete pohjal arvutati tavaline ja vanuse jargi standarditud haigestumuskordaja 100 000 inimaasta kohta (HK) mees- ja naisrahvastikus 27 paikme/paikmeruhma kohta aastatel 2009−2013. Vanuse jargi standarditud haigestumus- (1994–2013) ja suremustrende (1994–2014) analuusiti valitud paikmete puhul muutuspunkti regressiooni abil. Tulemused. Aastatel 2009–2013 diagnoositi aastas keskmiselt 7899 vahi esmasjuhtu (4008 meestel, 3891 naistel). Vanuse jargi standarditud HK oli meestel 395,8 ja naistel 259,0. Sagedamad paikmed olid meestel eesnaare, kops ning kaar- ja parasool; naistel rind, naha mittemelanoom ning kaar- ja parasool. Nii meestel kui ka naistel suurenes koguvahihaigestumus 20 aasta jooksul, kuid suremus vahenes. Sagedamatest paikmetest suurenes eesnaarme-, rinna- ning kaar- ja parasoolevahi haigestumus ning vahenes meeste kopsuvahihaigestumus. Suremuse pusiv langustrend ilmnes rinnavahi ning meeste kopsuvahi puhul. Emakakaelavahi haigestumus suurenes jatkuvalt ja suremus ei vahenenud. Jareldused. Vahihaigestumuse kasv Eestis jatkus. Ennetatavate pahaloomuliste kasvajate seas taheldati positiivseid muutusi uksnes meeste kopsuvahi puhul. Vahitorje koigi aspektide tohustamiseks vajab Eesti hoolikalt kavandatud jatkustrateegiat. Vahitorje tulemuste usaldusvaarseks hindamiseks tuleb ka edaspidi suurt rohku panna kvaliteetsete registriandmete kogumisele.