CANCER EPIDEMIOLOGY IN CROATIA

1
CANCER EPIDEMIOLOGY IN CROATIA
5th Meeting of the Mediterranean Task Force for
Cancer Control Split, March 8, 2008
Marija Strnad Croatian National Institute of
Public Health, Croatia
2
Source of Cancer Statistics for Croatia
www.hzjz.hr/cancer/

• Croatian National Cancer Registry, founded in
  1959 at Croatian National Institute of Public
  Health.
• Since 1994, the Registry has been member of the
  International Association of Cancer Registries
  (IACR), in Lyon, France, and the European Network
  of Cancer Registries.
• Registry data are also included in Automated
  Childhood Cancer Information System (ACCIS),
  database of European childhood cancer incidence
  and survival data.
• Problems
• 1. Incomplete data from some hospitals and
  primary health care, in particular due to skin
  cancer
• 2. How to monitor the effects of prevention and
  screening.

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
3
CROATIA

• Cancer is the second most common cause of death,
  exceeded only by CVD.
• Accounts for 1 of every 4 deaths
• Incidence and mortality are increasing
• INCIDENCE FROM 1978 TO 2005 BY 58
• MORTALITY FROM 1878 TO 2005 BY 59

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
4
CROATIA

• New cancer cases
• (except skin cancer)
• in 2005 20 714 (crude rate 466,8/100 000)
• Deaths
• in 2005 12 640 (crude rate 284,8/100 000)
• 130 000 people alive today ever had cancer
• Lost potential years of life 1-75 years due to
  carcinoma is
• 3 091 /100 000 for M and
• 1 854 /100 000 for F

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
5
Cancer incidence and mortality rates in Croatia
for the period 1968-2006
Source CNIPH, Cancer Registry
Prof. Marija Strnad, M.D., Ph.D.
6
10 most common cancer sites in Croatia in 2005
(absolute number and crude incidence rate per 100
000)
Source CNIPH, Cancer Registry
Prof. Marija Strnad, M.D., Ph.D.
7
Cancer incidence and mortality rates in Croatia
for the period 1968-2005
Source CNIPH, Cancer Registry
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
8
10 most common cancer sites in Croatia in 2005
(absolute number and crude incidence rate per 100
000)
Source CNIPH, Cancer Registry
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
9
The most common cancer sites
Prof. Marija Strnad, M.D., Ph.D.
10
The most common cancer sites
Prof. Marija Strnad, M.D., Ph.D.
11
MOST COMMON CANCER SITES INCIDENCE BY SEX,
CROATIA 1978-2005, MALE
21 6 14 13 6 3
Source CNIPH, Cancer Registry
Prof. Marija Strnad, M.D., Ph.D.
12
MOST COMMON CANCER SITES INCIDENCE BY SEX,
CROATIA 1978-2005, FEMALE
24 14 4 5 5 7 3
Source CNIPH, Cancer Registry
Prof. Marija Strnad, M.D., Ph.D.
13
INCIDENCIJA NAJCECIH SIJELA RAKA 2005. GODINE U
HRVATSKOJ PREMA DOBI, MUKI
Prof. Marija Strnad, M.D., Ph.D.
14
2007 Estimated US Cancer Cases (1,444,920)

• MEN
• PROSTATE 29
• LUNG 15
• COLON RECTUM 10
• URINARY BLADDER 7
• NON-HDGK LYMPHOMA 4
• MELANOMA OF SKIN 4
• KIDNEY 4
• LEUKEMIA 3
• ORAL CAVITY 3
• PANCREAS 2
• OTHER 19

• WOMEN
• BREAST 26
• LUNG 15
• COLONRECTUM 11
• UTERINE CORPUS 6
• NON-HDGK LYMPHOMA 4
• MELANOMA OF SKIN 4
• THYROID 4
• OVARY 3
• KIDNEY 3
• LEUKEMIA 3
• OTHER 21

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
15
MOST COMMON CANCER SITES INCIDENCE BY SEX,
CROATIA 1978-2004, MALE
21 7 14 13 6 3
Source CNIPH, Cancer Registry
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
16
MOST COMMON CANCER SITES INCIDENCE BY SEX,
CROATIA 1978-2004, FEMALE
25 13 5 5 5 6 3
Source CNIPH, Cancer Registry
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
17
The most common cancer sites

• MEN
• in all age groups , except in the oldest age
  group, are lung and bronchus and large intestine
  (colon and rectum) cancer.
• In aged 75 and older, is prostate cancer.

• WOMEN
• breast cancer in all age groups, except in the
  oldest age group, in which case two most common
  cancer sites are breast and large intestine.
• In younger age groups (30-49), in addition to
  breast cancer, there is cervical cancer.

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
18
Regional differences in carcinoma incidence in
Croatia The highest cancer incidence

• Women in
• Primorsko-Goranska and
• Istarska Counties.

• Men in
• Varadinska and
• Sisacko-Moslavacka Counties.

• Importance of further research!

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
19
INCIDENCE AND MORTALITYALL SITES BUT SKIN
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
20
EUROPE SDR - MALIGNANT NEOPLASMSMALE
Source HFA, January 2007.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
21
EUROPESDR - MALIGNANT NEOPLASMSFEMALE
Source HFA, January 2007.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
22
INCIDENCE AND MORTALITYLUNGASR (World) per 100
000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
23
EUROPESDR - MALIGNANT NEOPLASMSTRACHEA,
BRONCHUS AND LUNG CANCER
Source HFA, January 2007.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
24
INCIDENCE AND MORTALITYBREASTASR (World) per
100 000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
25
EUROPESDR - MALIGNANT NEOPLASMSFEMALE BREAST
Source HFA, January 2007.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
26
INCIDENCE AND MORTALITYCOLON AND RECTUMASR
(World) per 100 000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
27
INCIDENCE AND MORTALITYPROSTATEASR (World) per
100 000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
28
INCIDENCE AND MORTALITYSTOMACHASR (World) per
100 000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
29
INCIDENCE AND MORTALITYCORPUS UTERIASR (World)
per 100 000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
30
INCIDENCE AND MORTALITYCERVIX UTERIASR (World)
per 100 000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
31
INCIDENCE AND MORTALITYPANCREASASR (World) per
100 000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
32
INCIDENCE AND MORTALITYMELANOMA OF SKINASR
(World) per 100 000 (All ages)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
33
Croatia

• Incidence of malignant tumour in the 0-14 age
  group is low, but increasing.
• Most common sites being
• Leukemia (acute lymphocytic)
• Brain/ONS
• Although uncommon, cancer is second leading cause
  of death in children, exceeded only by accidents.

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
34
INCIDENCE AND MORTALITYALL SITES BUT SKIN
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
35
INCIDENCE AND MORTALITYBRAIN, NERVOUS SISTEMASR
(World) per 100 000 (age 0-14)
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
36
INCIDENCE AND MORTALITYLEUKAEMIA
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
37
INCIDENCE AND MORTALITYNON-HODGKIN LYMPHOMA
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
38
INCIDENCE AND MORTALITYHODGKIN LYMPHOMA
Source GLOBOCAN, 2002.
Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
39
For all cancer sites (except skin cancer),
relative 5-year survival rate

• Croatia in the period 1994-1998
• 40 for men and
• 57 for women
• In European countries that participated in
  EUROCARE -3 project in the period 1990-1994
• 40 for men and
• 51 for women
• In the US, for men and for women
• 64 for the period 1992-1994, and
• 66 for the period 1996-2002

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
40

• Scientific research has shown that one third of
  cancer cases can be prevented, primarily by
  giving up smoking and changing an unhealthy diet.

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
41
Prevalence of some risk factors in Croatia,
according to adult health survey 2003

• smoking 25 for men and 22 for women,
• inadequate nutrition 11 for men and 7 for
  women,
• high alcohol consumption - 20 for men and 3 for
  women,
• physical inactivity - 40 for men and 43 for
  women,
• obesity 17 for men and 21 for women.
• BMJ 2005331208-210, Kern J, Strnad M, Coric T,
  Vuletic S.
• Public health programmes should be targeted at
  reducing the prevalence of RISK FACTORS.

Croatian National Institute of Public Health
Prof. Marija
Strnad, M.D., Ph.D.
42
NATIONAL PROGRAMME FOR EARLY DETECTION OF BREAST
CANCER IN CROATIA

• Prof. Marija Strnad

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CROATIA
POPULATION 4,4 million DIVIDED IN
21 counties FEMALE BREAST CA CASES - 2300
yearly FEMALE BREAST CA DEATHS - 850 yearly
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BREAST CANCER

• MOST FREQUENT CANCER SITE IN WOMEN IN CROATIA
• INCIDENCE AND MORTALITY ARE INCREASING
• IN 2005, 2 303 NEW PATIENTS (INCREASE OF 2.5
  TIMES COMPARED TO 1968,)
• SHIFT TOWARDS YOUNGER AGE GROUPS

45
Age standardised (ASRW) female breast cancer
incidence and mortality rates in Croatia,
1985-2006
46
SDR, malignant neoplasms female breast, all ages
per 100000
Source HFA, January 2007.
47
SURVIVAL
The 5-year relative survival rate for breast
cancer accounts for 75, with 36.2 of the cases
diagnosed at the localized stage.
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NATIONAL SCREENING PROGRAM MAMMA

• STARTED October 2006
• INTRODUCED BY THE GOVERNMENT
• IT IS CONSISTENT WITH THE EU COUNCIL
  RECOMMENDATIONS (OJ L 327/34-38)
• TARGET POPULATION women aged 50-69,
• which is about 560,000 women
• GOALS
• to reduce breast cancer mortality by 25 within 5
  years of the beginning of the programme
• to increase the proportion of breast cancers
  detected in EARLY stage and to increase
  successful treatment and survival
• to improve the patients quality of life
• to reduce high costs for advanced stages
• SCREENING TEST mammography (double-reading)
• SCREENING INTERVAL 2 years, and minimum 70
  coverage

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MAMMOGRAPHY SCREENING PROGRAMME MAMMA

• 21 county institutes of public health are in
  charge of collaboration with mammographic units,
  distributing invitations and coordination at the
  county level
• Programme is centrally coordinated by the
  Ministry of Health and Social Welfare and
  Croatian National Institute of Public Health,
  where the National Cancer Registry is located
• For the purpose of implementation and monitoring,
  a separate database has been formed for each
  county
• The central unit can access each of these
  databases through a common server located at the
  Ministry of Health and Social Welfare
• There are 101 mammography units participating in
  the programme

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• In 2002 we realized the pilot-project Mobile
  Diagnostic Mammographic Unite- mobile Mammography
  - the first one in Croatia, together with Europa
  Donna, Croatian Medical Association-Croatian
  Senologic Society and purchased 2 mobile
  mammography units.
• Good collaboration with the Croatian Medical
  Association, the Croatian Senologic Society, the
  Croatian Oncologic Society, the Croatian League
  against Cancer, the Croatian Psychosocial
  Oncology Association, the Croatian Association
  for Hospice / Palliative Care, and the University
  Hospital for Tumors.

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MAMMOGRAPHY SCREENING PROGRAMME MAMMA - RESULTS

• By the end of February 2008, over 350 000 women
  were summoned for screening mammography.
• According to preliminary results, the overall
  compliance was 53.6, or, however, even greater
  than 70 in some counties.
• Younger age groups participated better compared
  to older ones. There were 598 cancers detected
  (4.9/1000 mammograms).
• Almost 6 of the invated had a mammogram a year
  before the start of the National Program, mostly
  through Europa Donnas and other NGO efforts in
  some Croatian counties.

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Participation rates by year of birth
53
Our next goal is the National Programme for
breast cancer treatment and care and setting up
multidisciplinary breast units according to EU
criteria.