RESEARCH – June 2016

The increase in cancer patient survival in Estonia continued in 2010–2014

Authors: Kaire Innos, Tiiu Aareleid

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Aim. The aim of this paper was to proovide an overview of cancer survival in Estonia in 2010–2014 and to examine changes in relative survival since 2005–2009.

Material and methods. We used Estonian Cancer Registry`s data on all incident cases of malignant neoplasms diagnosed in adults (age ≥15 years) in Estonia during 2005–2012. Five year relative survival ratios (RSR) were calculated with period-hybrid analysis using population life tables stratified by age, sex and calendar year. Crude 5-year RSRs were presented for all sites combined, as well as for 27 sites/site groups. For 16 common cancers, age-adjusted 5-year RSRs for 2010–2014 were calculated and compared with previously published estimates for 2005–2009.

Results. Among all incident cases of cancer in 2005–2012 (n=59234), 88% were microscopically confirmed. Overall, 1.8% of the cases were death certificate only (DCO) cases and 1.5% were diagnosed at autopsy. Mean age at diagnosis was 68 years for men and 67 years for women. Quality indicators and mean age at diagnosis varied across the cancer sites.

The 5-year RSR for all sites was 59% (56% for men and 63% for women). The highest 5-year RSRs were observed for non-melanoma skin cancer (over 100%), testicular cancer (93%), prostate cancer (90%), thyroid cancer (88%), Hodgkin’s disease (85%), skin melanoma (79%), breast cancer (79%) and corpus uteri cancer (78%). The lowest 5-year RSRs were seen for cancers of the oesophagus (9%), liver (4%) and pancreas (5%).

We observed a statistically significant increase in the age-adjusted 5-year RSRs from 2005–2009 to 2010–2014 for prostate cancer (from 76% to 87%), skin melanoma (from 71% to 81%), colon cancer (from 51% to 58%) and stomach cancer (from 22% to 27%); borderline significance was seen for cancers of corpus uteri (from 70% to 77%), breast (from 73% to 77%), lung (from 11% to 14%) and pancreas (from 4% to 7%).

Conclusions. Five-year relative survival estimates have increased considerably in Estonia, and for some cancers they have reached or even exceeded the corresponding estimates for the Western and Northern European countries. However, marked deficit persists for cancers in the case of which early diagnosis combined with adequate treatment may lead to high survival rates (particularly skin melanoma, breast cancer and colorectal cancer). In the upcoming years, the cancer control strategies in Estonia should increasingly focus on early diagnosis (including improvement in the current screening programmes), patient pathways, treatment centralisation and surveillance of outcomes.