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CANCER EPIDEMIOLOGY IN CROATIA

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. Source of Cancer Statistics for Croatia – www.hzjz.hr/cancer/.

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CANCER EPIDEMIOLOGY IN CROATIA

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  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 NAJČEŠĆIH SIJELA RAKA 2005. GODINE U HRVATSKOJ PREMA DOBI, MUŠKI Prof. Marija Strnad, M.D., Ph.D.

  14. 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% COLON&RECTUM 11% UTERINE CORPUS 6% NON-HDGK LYMPHOMA 4% MELANOMA OF SKIN 4% THYROID 4% OVARY 3% KIDNEY 3% LEUKEMIA 3% OTHER 21% 2007 Estimated US Cancer Cases (1,444,920) 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. 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. The most common cancer sites 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 Men in: • Varaždinska and • Sisačko-Moslavačka Counties. Women in: • Primorsko-Goranskaand • Istarska 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 2005;331:208-210, 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

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

  44. 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 cancerincidenceand 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.

  48. 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 by25% 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

  49. 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 mammographyunits participating in the programme

  50. 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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