The aim of organized breast cancer screening is early detection and reduction in mortality. Organized screening should promote equal access and reduce socio-economic inequalities. In Slovenia, ...organized breast cancer screening achieved complete coverage in 11-years' time. We explored whether step-wise implementation reflects in prognostic factors (earlier diagnosis and treatment) and survival of breast cancer patients in our population.
Using population-based cancer registry and screening registry data on breast cancer cases from 2008-2018, we compared stage distribution and mean time to surgical treatment in (A) women who underwent at least one mammography in the organized screening programme, women who received at least one invitation but did not undergo mammography and women who did not receive any screening invitation, and in (B) women who were invited to organized screening and those who were not. We also compared net survival by stage in different groups of women according to their screening programme status.
Women who underwent at least one mammography in organized screening had lower disease stage at diagnosis. Time-to-treatment analysis showed mean time to surgery was shortest in women not included in organized screening (all stages = 36.0 days vs. 40.3 days in women included in organized screening). This could be due to quality assurance protocols with an obligatory multidisciplinary approach within the organized screening vs. standard treatment pathways which can vary in different (smaller) hospitals. Higher standard of care in screening is reflected in better survival in women included in organized screening (5-years net survival for regional stage: at least one mammography in the screening programme- 96%; invitation, but no mammography- 87.4%; no invitation or mammography in the screening programme- 82.6%).
Our study, which is one of the first in central European countries, shows that introduction of organized screening has temporary effects on population cancer burden indicators already during roll-out period, which should therefore be as short as possible.
Indoor radon is an important risk factor for lung cancer, as 3-14% of lung cancer cases can be attributed to radon. The aim of our study was to estimate the impact of indoor radon exposure on lung ...cancer incidence over the last 40 years in Slovenia. We analyzed the distribution of lung cancer incidence across 212 municipalities and 6032 settlements in Slovenia. The standardized incidence ratios were smoothed with the Besag-York-Mollie model and fitted with the integrated nested Laplace approximation. A categorical explanatory variable, the risk of indoor radon exposure with low, moderate and high risk values, was added to the models. We also calculated the population attributable fraction. Between 2.8% and 6.5% of the lung cancer cases in Slovenia were attributable to indoor radon exposure, with values varying by time period. The relative risk of developing lung cancer was significantly higher among the residents of areas with a moderate and high risk of radon exposure. Indoor radon exposure is an important risk factor for lung cancer in Slovenia in areas with high natural radon radiation (especially in the southern and south-eastern parts of the country).
Despite having an established systematic approach to population survival estimation in Slovenia, the influence of socioeconomic environment on cancer patients' survival has not yet been evaluated. ...Thus, the main aim of our study was to quantify the potential impact of socioeconomic environment on cancer patients' survival in our population in the 21st century. The net survival was calculated and stratified into quintiles of Slovenian version of the European Deprivation Index for all adult cancer patients diagnosed between 2004 and 2018 using the national cancer registry data. After accounting for basic demographic variables (age and gender), differences in stage at diagnosis, as well as the impact of the cancer treatment improvements over time, we found that cancer patients in Slovenia with lower socioeconomic status experience worse survival and have higher mortality. In particular, the odds of dying from oral, stomach, colorectal, liver, pancreatic, lung, breast, ovarian, corpus uteri, prostate, and bladder cancers, as well as for melanoma, leukemia, and non-Hodgkin lymphoma, are significantly higher in the socioeconomically most deprived group of patients compared to the most affluent group. The inequalities in cancer burden we found could help decision-makers to better understand the magnitude of this problem.
Abstract Objectives Our aim was to explore the association between cold-knife conisation and large loop excision of transformation zone (LLETZ) with spontaneous preterm birth in a large 10-year ...national sample. We wanted to explore further the association of these procedures with preterm birth according to gestation. Study Design We conducted a population based retrospective cohort study, using data from national Medical Birth Registry. The study population consisted of all women giving birth to singletons in the period 2003–2012 in Slovenia, excluding all induced labours and elective cesarean sections before 37 weeks of gestation (N = 192 730). We compared the prevalence of spontaneous preterm births (before 28 weeks, before 32 weeks, before 34 weeks and before 37 weeks of gestation) in women with cold-knife conisation or LLETZ compared to women without history of conisation, calculating odds ratios (OR), adjusted for potential confounders. Chi-square test was used for descriptive analysis. Logistic regression analyses were performed to estimate crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals (95% CI) with two-sided probability ( p ) values. Results A total of 8420 (4.4%) women had a preterm birth before 37 weeks of gestation, 2250 (1.2%) before 34 weeks of gestation, 1333 (0.7%) before 32 weeks of gestation and 603 (0.3%) before 28 weeks of gestation. A total of 4580 (2.4%) women had some type of conisation in their medical history: 2083 (1.1%) had cold-knife conisation and 2498 (1.3%) had LLETZ. In women with history of cold-knife conisation, the adjusted OR for preterm birth before 37 weeks of gestation was 3.13 (95% CI; 2.74–3.57) and for preterm birth before 28 weeks of gestation 5.96 (95% CI; 4.3–8.3). In women with history of LLETZ, the adjusted OR was 1.95 (95% CI; 1.68–2.25) and 2.88 (95% CI; 1.87–4.43), respectively. Conclusions Women with cervical excision procedure of any kind have significantly increased odds for preterm birth, especially for preterm birth before 28 weeks and before 32 weeks of gestation.
The aim of our study was to explore the risk factors for very preterm (gestation under 32 weeks) and moderate preterm birth (gestation weeks 32-36 6/7) in singleton pregnancies in a national ...retrospective cohort study. We also wanted to establish whether IVF/ICSI is an independent risk factor for preterm birth after adjusting for already known confounders. We used data for 267 718 singleton births from 2002-2015 from the National Perinatal Information System of Slovenia, containing data on woman, pregnancy, birth, the postpartum period, and the neonate for each mother–infant pair. Mode of conception, maternal age, education, BMI, parity, smoking, history of cervical excision procedure, history of hysteroscopic resection of uterine septum, presence of other congenital uterine malformations, bleeding in pregnancy, preeclampsia or HELLP and maternal heart, and pulmonary or renal illness were included in the analyses. Unadjusted OR for very preterm birth after IVF-ICSI was 2.8 and for moderate preterm birth was 1.7. After adjusting for known confounders, the OR was still significantly elevated (1.6 and 1.3, respectively). Risk factors for very preterm birth with OR higher than 2.4 were history of cervical excision procedure, resection of uterine septum, operation or having other congenital uterine malformations, and bleeding in pregnancy. Risk factors for very preterm birth with OR between 1.4 and 2.1 were age >35 years, being underweight or obese, not having professional education, smoking, first birth, preeclampsia/HELLP, and IVF/ICSI. Risk factors for moderate preterm birth with OR higher than 2.4 were history of cold knife conization and other congenital uterine malformations. We found that even after adjustment, IVF/ICSI represents a single risk factor for early and late preterm birth even after adjustment with other risks such as maternal age, smoking, or a history of invasive procedures for either cervical intraepithelial neoplasia or infertility treatment.
Due to the potential negative consequences of cancer screening programmes and the substantial resources invested in them, it is important to monitor their effectiveness. Mortality in the target ...population is one indicator that can be used to demonstrate the long-term effectiveness of organized, population-based screening programmes—after 10 to 20 years, mortality in the target population is expected to decrease by 20–30%. One of the main limitations of the mortality indicator is that, particularly for cancers with good survival rates, it only shows the effectiveness of screening over a long period of time. Therefore, survival analysis, where results are available earlier, is often used to evaluate the effectiveness of population- based cancer screening programmes. It is recognized that a number of biases can creep into the results of survival analysis (e.g. lead, length and overdiagnosis bias). Recently, Slovenian researchers have proposed a new analytical approach that allows a comparison of survival rates for cancers detected and undetected in the screening programme, taking into account all relevant biases. The calculated survival rates form the basis for the calculation of life years gained, a measure that expresses the additional number of years of life that people live as a result of participating in the screening programme. In the test case, we assessed the impact of the introduction of the National Breast Cancer Screening Programme DORA, which was first offered to residents in 2008 and expanded to the entire population in 2018. Women invited to the DORA programme in the period 2008–2022 gained a total of 90.6 life years. If all women had been included in the DORA programme since 2008, they would have gained 552.7 years of life. The total number of life years gained increases with each additional year of observation that individual women survive after enrolment in the DORA programme. The new method will help in the management of existing cancer screening programmes, their promotion and the evaluation of the impact of changes in screening policy.
An increasing proportion of colorectal cancers (CRCs) are detected through screening due to the availability of organised population-based programmes. We aimed to analyse survival probabilities of ...patients with screen-detected CRC in European countries.
Data from CRC patients were obtained from 16 population-based cancer registries in nine European countries. We included patients with cancer diagnosed from the year organised CRC screening programmes were introduced until the most recent year with available data at the time of analysis, whose ages at diagnosis fell into the age groups targeted by screening. Patients were followed up with regards to vital status until 2016-2020 across the various countries. Overall and CRC-specific survival were analysed by mode of detection and stage at diagnosis for all countries combined and for each country separately using the Kaplan-Meier method.
We included data from 228 134 patients, of whom 134 597 (aged 60-69 years at diagnosis targeted by screening in all countries) were considered in analyses for all countries combined. 22·3% (38 080/134 597) of patients had cancer detected through screening. Most screen-detected cancers were found at stages I-II (65·6% 12 772/19 469 included in stage-specific analyses), while the majority of non-screen-detected cancers were found at stages III-IV (56·4% 31 882/56 543 included in stage-specific analyses). Five-year overall and CRC-specific survival rates for patients with screen-detected cancer were 83·4% (95% CI 82·9-83·9) and 89·2% (88·8-89·7), respectively; for patients with non-screen-detected cancer, they were much lower (57·5% 57·2-57·8 and 65·7% 65·4-66·1, respectively). The favourable survival of patients with screen-detected cancer was also seen within each stage – five-year overall survival rates for patients with screen-detected stage I, II, III, and IV cancers were 92.4% (95% CI 91·6-93·1), 87·9% (86·6-89·1), 80·7% (79·3-82·0), and 32·3 (29·4-35·2), respectively. These patterns were also consistently seen for each individual country.
Patients with cancer diagnosed at screening have a very favourable prognosis. In the rare case of detection of advanced stage cancer, survival probabilities are still much higher than those commonly reported for all patients regardless of mode of detection. Although these results cannot be taken to quantify screening effects, they provide useful and encouraging information for patients with screen-detected CRC and their physicians.
This study was supported in part by grants from the German Federal Ministry of Education and Research and the German Cancer Aid.
Around 70 children and adolescents under the age of 20 are diagnosed with cancer in Slovenia every year. Incidence is rising over time, but survival is improving significantly, resulting in a ...decrease in mortality and an increase in the number of survivors who need lifelong follow-up because of the risk of late effects. The Slovenian Cancer Registry's standard dataset contains data that is too scarce for some in-depth studies on childhood and adolescent cancers and late effects in survivors. At the Cancer Registry, we have therefore started activities in 2020 to establish a clinical registry of childhood cancer and late effects of childhood cancer treatment, which acts as a population-based registry with a highly expanded dataset. Its primary purpose is to systematically record the late effects of cancer treatment. It consists of two modules. The first is managed by the Cancer Registry and, using an active registration approach through access to the electronic patient records of the Ljubljana Paediatric Clinic and other institutions, it allows for a detailed inventory of the disease (in line with international rules), primary treatment (operations, cumulative doses of individual therapeutics, cumulative radiation doses, haematopoietic stem cell transplantation and other treatments, side effects of treatment) and recurrences, where the treatment is registered to the same level of detail as the primary treatment. The first module already contains data for the incidence year 2019, with accelerated registration of subsequent years to follow. The second module will be operated by the Late effects unit of the Institute of Oncology Ljubljana, where all collected data will be accessible during the patient's visit, and where visits, tests performed, questionnaires completed and late effects identified can be prospectively recorded. The second module is undergoing testing for user-friendliness, and we are developing automation of the treatment summary (survivorship passport) and follow-up recommendations.
Introduction: During the past decade in Slovenia, the number of new cancer diagnoses (incidence) has risen by 1.6% annually. In 2020, the first year of the COVID-19 epidemic, a 3–8% decrease in new ...cancer diagnoses was projected by the OnCOvid platform. Our aim is to present the official cancer incidence for 2020 for Slovenia and to communicate the actual lack of new cancer diagnose. Methods: In the Slovenian Cancer Registry, all Slovene inhabitants diagnosed with cancer in 2020 were registered following the international rules. The results were compared to the official incidence for 2019, modelled incidence for 2020, OnCOvidˊs preliminary results and available data from other population-based cancer registries. Results: In 2020, 15,096 inhabitants were diagnosed with cancer in Slovenia (7,034 women, 8,002 men). Compared to the modelled incidence for 2020, there was a decrease of 1,854 persons (10.9%; 11.6% in women, 10.4 % in men). The decrease is highest in the localized stage and in patients aged 50–69 years (13.2%). The decrease for Slovenia is comparable to decreases in England, the United States and Canada, but somewhat higher than in Scotland and Sweden. The largest decrease in new cancer cases was found for non-melanoma skin cancer (23%, mostly after age 50), prostate (15.9%, localized stage), lung (8.9%, 60–64 years, regional stage) and breast cancer (8.3%, 45–64 years), non-Hodgkin lymphoma (9%) and leukaemia (11.6%), with no decrease in melanoma and colorectal cancer cases. Conclusions: The decrease in cancer incidence for 2020 is likely due to containment measures, healthcare reorganisation and health-seeking behaviour during the COVID-19 epidemic, which is also reported by other countries. Uninterrupted provision of cancer care during epidemics is needed.
Backgound: Radon in the living environment is classified by the World Health Organization as one of 19 environmental carcinogens, and is, along with tobacco smoke, one of the most important risk ...factors for the development of lung cancer, accounting for approximately 10% of all lung cancer cases. In our research, we examined for the first time the impact of radon on the occurrence of lung cancer in Slovenia. Methods: For the 40-year period from 1978 to 2017, three data sources were linked at the level of settlements: lung cancer patients (Cancer Registry of the Republic of Slovenia), residents (Statistical Office of the Republic of Slovenia) and radon map of Slovenia. In spatial smoothing models with Bayesian hierarchical models, radon in the living environment was included as an explanatory variable, and population attributable fraction was calculated. The relative risk was estimated using the standardized incidence rate. Results: In Slovenia, about 60 people get lung cancer every year due to exposure to radon in the living environment (analysis at the level of settlements), which represents 5% of all people who get this disease. Analysis of the relative risk by gender shows that in Slovenia, mainly men have an increased risk of lung cancer due to exposure to radon in the living environment. Women who live in areas with higher radon exposure do not have an increased relative risk of developing lung cancer. Conclusion: Along with smoking, exposure to radon in the living environment is one of the most important risk factors for lung cancer in the Slovenian population. In areas where radon concentration is high in the living environment (mainly southern and south-eastern Slovenia), it is crucial from a public health point of view to implement preventive measures, and first and foremost to raise awareness and educate the population about the danger and the possibilities for preventing it..
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