Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study.

BACKGROUND: Despite the relatively low breast cancer incidence in Estonia, mortality remains high, and participation in mammography screening is below the recommended 70%. The objective of this register-based study was to evaluate incidence-based (IB) breast cancer mortality before and after the introduction of organized mammography screening in 2004. METHODS: Breast cancer deaths individually linked to breast cancer diagnosis were obtained from the Estonian Cancer Registry and used for calculating IB mortality. We compared age-specific IB mortality rates across 5-year birth cohorts and 5-year periods. Poisson regression was used to compare IB mortality for one age group invited to screening (50-63) and three age groups not invited to screening (30-49, 65-69, and 70+) during two periods before and after screening initiation (1993-2003 and 2004-2014). Joinpoint regression was used for age-standardized incidence and IB mortality trends. RESULTS: Age-standardized IB mortality has been decreasing since 1997. Age-specific IB mortality for birth cohorts never exposed to screening showed a continuous increase with age, while in cohorts exposed to organized screening the mortality curve flattened or declined after the age of first invitation. Significant decreases in mortality from 1993-2003 to 2004-2014 were seen in the 30-49 (age-adjusted rate ratio 0.51, 95% CI 90.42-0.63) and 50-63 (0.65, 95% CI 0.56-0.74) age groups, while no decline was seen in the 65-69 and 70+ age groups. CONCLUSIONS: The age specific IB mortality curves in birth cohorts exposed to screening and the significant mortality decline in the target age group after the initiation of the organized program suggest a beneficial effect of screening. Improved treatment without screening has not reduced mortality in older age groups. Our results support raising the upper screening age limit to 74 years.

Sociodemographic inequalities in mortality from drowning in the Baltic countries and Finland in 2000-2015: a register-based study.

BACKGROUND: Drowning is an important public health problem. Some evidence suggests that the risk of drowning is not distributed evenly across the general population. However, there has been comparatively little research on inequalities in drowning mortality. To address this deficit, this study examined trends and sociodemographic inequalities in mortality from unintentional drowning in the Baltic countries and Finland in 2000-2015. METHODS: Data for Estonia, Latvia and Lithuania came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, while corresponding data for Finland were obtained from the longitudinal register-based population data file of Statistics Finland. Deaths from drowning (ICD-10 codes W65-W74) were obtained from national mortality registries. Information was also obtained on socioeconomic status (educational level) and urban-rural residence. Age-standardised mortality rates (ASMRs) per 100 000 person years and mortality rate ratios were calculated for adults aged 30-74 years old. Poisson regression analysis was performed to assess the independent effects of sex, urban-rural residence and education on drowning mortality. RESULTS: Drowning ASMRs were significantly higher in the Baltic countries than in Finland but declined by nearly 30% in all countries across the study period. There were large inequalities by sex, urban-rural residence and educational level in all countries during 2000-2015. Men, rural residents and low educated individuals had substantially higher drowning ASMRs compared to their counterparts. Absolute and relative inequalities were significantly larger in the Baltic countries than in Finland. Absolute inequalities in drowning mortality declined in all countries across the study period except between urban and rural residents in Finland. Changes in relative inequalities were more variable during 2000-2015. CONCLUSION: Despite a sharp reduction in deaths from drowning in the Baltic countries and Finland in 2000-2015, drowning mortality was still high in these countries at the end of the study period with a substantially larger risk of death seen among men, rural residents and low educated individuals. A concerted effort to prevent drowning mortality among those most at risk may reduce drownings considerably in the general population.

Educational inequalities in hypothermia mortality in the Baltic countries and Finland in 2000-15.

BACKGROUND: Despite an increased focus on cold-related mortality in recent years, there has been comparatively little research specifically on hypothermia mortality and its associated factors. METHODS: Educational inequalities in hypothermia mortality among individuals aged 30-74 in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in 2000-15 were examined using data from longitudinal mortality follow-up studies of population censuses (the Baltics) and from a longitudinal register-based population data file (Finland). RESULTS: Age-standardized mortality rates (ASMRs) were much higher in the Baltic countries than in Finland across the study period. From 2000-07 to 2008-15, overall ASMRs declined in all countries except among Finnish women. Although a strong educational gradient was observed in hypothermia mortality in all countries in 2000-07, inequalities were larger in the Baltic countries. Between 2000-07 and 2008-15, ASMRs declined in all educational groups except for high-educated women in Finland and low-educated women in Lithuania; the changes however were not always statistically significant. The absolute mortality decline was often larger among the low educated resulting in narrowing absolute inequalities (excepting Lithuania), whereas a larger relative decline among the high educated (excepting Finnish women) resulted in a considerable widening of relative inequalities in hypothermia mortality by 2008-15. CONCLUSION: Although some reduction was observed in absolute educational inequalities in hypothermia mortality in 2000-15, substantial and widening relative inequalities highlight the need for further action in combatting factors behind deaths from excessive cold in socioeconomically disadvantaged groups, including risky alcohol consumption and homelessness.

Educational inequalities in epilepsy mortality in the Baltic countries and Finland in 2000-2015.

Little is known about socioeconomic differences in epilepsy mortality. This study examined educational inequalities in epilepsy mortality in the general population in the Baltic countries and Finland in 2000-2015. Education-specific mortality estimates for individuals aged 30-74 in Estonia, Latvia and Lithuania were obtained from census-linked mortality datasets while data for Finland came from the register-based population and death data file of Statistics Finland. Trends and educational inequalities in epilepsy mortality were assessed using age-standardised mortality rates (ASMRs) per 100,000 person years and age-adjusted mortality rate ratios (RRs) calculated using Poisson regression. ASMRs were higher in men than women in all countries. ASMRs reduced in 2000-2015 among all men and women except for Finnish women. Among men, an inverse educational gradient in epilepsy mortality in 2000-2007 widened in 2008-2015 with ASMRs falling among high and mid educated men in all countries but increasing among low educated men in three countries. An inverse educational gradient in female mortality remained in all countries throughout 2000-2015. Although epilepsy mortality fell in the Baltic countries and Finland (men only) in 2000-2015, this masked a clear inverse educational gradient in mortality that became steeper across the period.

Short-term postoperative changes in temporomandibular joints and masticatory muscles of Angle class II patients after mandibular advancement surgery: Clinical findings.

BACKGROUND AND OBJECTIVE: The aim of the study was to detect postoperative changes in the temporomandibular joints (TMJs) and masticatory muscles of Angle class II malocclusion patients who underwent mandibular advancement surgery. MATERIAL AND METHODS: Twenty-three patients were selected for mandibular advancement by bilateral sagittal split ramus osteotomy (BSSO). Cephalograms and clinical evaluation were performed before the surgery as well as fourteen days and six months after surgery. Clinical examination included measurement of overjet, overbite and of the amplitude of mandibular movements, registration of deviation on mouth opening, of TMJ pain and pathological sounds and of tenderness of masticatory muscles on palpation. Mandibular position was determined by cephalometric analysis. Statistical analyses were performed using a mixed-level longitudinal random intercept model with a confidence level of 95% and a P-value of 0.05 to reveal significant differences. RESULTS: Statistical results showed a mean mandibular advancement of 4 mm (3.1-5.0). Cephalometric measurements, overjet and overbite remained stable six months after surgery. Postoperative amplitude of mandibular movements was limited and did not completely recover 6 months later. Mouth opening was the most affected, showing an average reduction of 7.5 mm six months after surgery. Deviation on mouth opening, pathological TMJ sounds, TMJ pain and masticatory muscle tenderness did not show significant changes. CONCLUSIONS: Moderate mandibular advancement surgery offers stable results, yet the amplitudes of mandibular movements, were significant smaller after surgery and did not completely recovered 6 months following surgery. TMJ and masticatory muscles symptoms did not change after the surgery, suggesting that mandibular advancement surgery does not change the course of TMD.

Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000-2015: a register-based study.

AIM: To estimate whether large macroeconomic fluctuations in the 2000s affected inequalities in alcohol-related mortality in the Baltic countries and Finland. DESIGN: Longitudinal register-based follow-up study. SETTING: Estonia, Latvia, Lithuania and Finland. PARTICIPANTS: General population in the 35-74 age group. MEASUREMENTS: Socioeconomic status was measured by the highest achieved educational level and was categorised using the International Standard Classification of Education 2011 as low (included categories 0-2), middle (3-4), and high (5-8). Educational inequalities in alcohol-related mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 were examined using census-linked longitudinal mortality data. We estimated age-standardised mortality rates and the relative and slope index of inequality. FINDINGS: Alcohol-related mortality increased in all countries in 2004-2007 except among Estonian women and decreased/remained the same from 2008 onward except among Latvian men. By 2012-2015 alcohol-related mortality was still higher than in 2000-2003 in Finland, Latvia and Lithuania (women only). Relative inequalities increased across the study period in all countries (significantly in Lithuania and Latvia). The 2004-2007 increase in relative inequalities was mostly driven by a larger mortality increase among the low educated, whereas in 2008-2011 and in 2012-2015 inequalities often increased because of a larger relative mortality decline among the high educated. However, these period changes in relative inequalities and between educational groups were often not statistically significant. Absolute inequalities were larger in 2012-2015 versus 2000-2003 in all countries except Estonia (decrease). CONCLUSION: In the Baltic countries and Finland, alcohol-related mortality tended to increase faster among the low educated during a period of economic expansion (2004-2007) and decrease more among the high educated during a period of economic recession (2008-2011).

Incidence and Survival for Head and Neck Cancers in Estonia, 1996-2016: A Population-Based Study.

BACKGROUND: Changing patterns of alcohol and tobacco consumption and human papillomavirus (HPV) infection have affected the epidemiology of head and neck cancers. The aim of this study was to examine 20-year trends in the incidence and survival of head and neck cancers in Estonia by site, sex, morphology, and stage. METHODS: Data on all adult cases of invasive head and neck cancers diagnosed in Estonia in 1996-2016 were obtained from a population-based cancer registry. TNM stage was available for 2010-2016. Incidence trends were modeled with join-point regression, and five-year relative survival ratios (RSRs) were calculated. RESULTS: A total of 6,769 cases were included, 64% men. We observed declining incidence of lip and laryngeal cancer and substantial increases in the incidence of hypopharyngeal and oropharyngeal cancers. Over 60% of mouth and pharyngeal cancers were diagnosed at stage IV. Age-standardized 5-year RSR for mouth and pharyngeal cancer increased substantially over the study period, from 21% (95% CI 16%-25%) in 1996-2002 to 33% (29%-38%) in 2010-2016. The largest survival increases were seen for cancers of the oral cavity (reaching 44% in 2010-2016), tongue (41%), and larynx (63%), while modest changes were seen for the oropharynx (24%) and hypopharynx (17%). The latest 5-year RSR was 90% for thyroid cancers (99% for papillary carcinoma). Large female survival advantage was seen for most sites. CONCLUSION: The observed trends suggest an emerging role of HPV infection in combination with traditional risk factors in the development of head and neck cancers in Estonia. Efforts targeting health behavior, HPV vaccination, and earlier diagnosis are crucial for reducing mortality from these cancers.

Macroeconomic changes and educational inequalities in traffic fatalities in the Baltic countries and Finland in 2000-2015: a register-based study.

This study examined trends and inequalities in road traffic accident (RTA) mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in relation to large-scale macroeconomic changes in the 2000s. Educational inequalities in RTA mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 among 30-74 year olds were examined using census-linked longitudinal mortality data and by estimating the relative and slope index of inequality. Overall RTA mortality decreased substantially between 2000-2003 and 2012-2015. From 2004-2007 to 2008-2011, the RTA mortality decline accelerated but was larger in the Baltic countries. Among men the RTA mortality decline was mostly driven by a larger fall among the high and middle educated. Among women, the changes in RTA mortality by educational level had no clear pattern. From 2000-2003 to 2012-2015 relative educational inequalities in RTA mortality increased among men, although more in the Baltic countries. Among women the pattern was mixed across countries. Absolute inequalities fell in all countries among both sexes. Educational inequalities in male RTA mortality may be growing because of increasingly less access to safer cars and a more hazardous driving culture among the lower educated.

Age, Period and Cohort Effects On Alcohol Consumption In Estonia, 1996-2018.

AIMS: To analyse the independent effects of age, period and cohort on estimated daily alcohol consumption in Estonia. METHODS: This study used data from nationally representative repeated cross-sectional surveys from 1996 to 2018 and included 11,717 men and 16,513 women aged 16-64 years in total. The dependent variables were consumption of total alcohol and consumption by types of beverages (beer, wine and strong liquor) presented as average daily consumption in grams of absolute alcohol. Mixed-effects negative binomial models stratified by sex were used for age-period-cohort analysis. RESULTS: Alcohol consumption was highest at ages 20-29 years for both men and women and declined in older ages. Significant period effects were found indicating that total alcohol consumption and consumption of different types of beverages had increased significantly since the 1990s for both men and women. Cohort trends differed for men and women. Men born in the 1990-2000s had significantly lower daily consumption compared to earlier cohorts, whereas the opposite was found for women. CONCLUSION: While age-related patterns of alcohol consumption are aligned with life course stages, alcohol use has increased over the study period. Although the total daily consumption among men is nearly four times higher than among women, the cohort trends suggest convergence of alcohol consumption patterns for men and women.

Macroeconomic fluctuations and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in 2000-2015: A register-based study.

INTRODUCTION: In the 2000s, the Baltic countries experienced unprecedented economic growth followed by a deep recession. This study aimed to examine changes and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in relation to macroeconomic fluctuations. METHODS: We analysed changes in overall suicide mortality and by educational level between the 2000-2003, 2004-2007, 2008-2011 and 2012-2015 periods among men aged 30-64 years using census-linked longitudinal mortality data. We estimated age-standardised mortality rates, mortality rate ratios (Poisson regression), the relative index of inequality and slope index of inequality. RESULTS: Overall suicide mortality fell markedly from 2000-2003 to 2004-2007. The decline was largest among high educated men in the Baltic countries and among middle and low educated men in Finland. From 2004-2007 to 2008-2011, the positive trend slowed and while suicide mortality continued to fall among middle and low educated men, it increased somewhat among high educated men in all Baltic countries. In Finland, suicide mortality decreased among the high educated and increased slightly among low educated men. CONCLUSIONS: In the Baltic countries, lower educated men had a smaller decline in suicide mortality than higher educated men during a period of rapid economic expansion, however, they were not more disadvantaged during the recession, possibly because of being less exposed to financial loss. Consequently, relative inequalities in suicide mortality may increase during economic booms and decrease during recessions.

Long-term trends in the body mass index and obesity risk in Estonia: an age-period-cohort approach.

OBJECTIVES: To analyse the age, period and cohort effects on the mean body mass index (BMI) and obesity over the past two decades in Estonia. METHODS: Study used data from nationally representative repeated cross-sectional surveys on 11,547 men and 16,298 women from 1996 to 2018. The independent effects of age, period and cohort on predicted mean BMI and probability of obesity (BMI ≥ 30 kg/m2) were modelled using hierarchical age-period-cohort analysis. RESULTS: Curvilinear association between age and mean BMI was found for men, whereas the increase in mean BMI was almost linear for women. The predicted mean BMI for 40-year-old men had increased by 6% and probability of obesity by 1.8 times over 1996-2018; the period effects were slightly smaller for women. Men from the 1970s birth cohort had higher mean BMI compared to the average, whereas no significant cohort effects were found for obesity outcome. CONCLUSIONS: Population-level BMI changes in Estonia during 1996-2018 were mostly driven by period rather than cohort-specific changes.

Childhood cancer incidence and survival trends in Estonia (1970-2016): a nationwide population-based study.

BACKGROUND: Childhood cancers represent a small proportion of all cancers but are still a major public health problem. The study analysed long-term trends in childhood cancer incidence and survival in Estonia in relation to societal and health care transition. METHODS: Data on all malignant tumours, diagnosed in children aged 0-14 during 1970-2016, were derived from the Estonian Cancer Registry. Age-standardised (World standard) incidence rates were calculated by ICCC-3 site groups and joinpoint regression was used to estimate annual percentage change (APC) for incidence trends. Cohort and period approach were used to estimate 5-year survival. Internal age standardisation was applied. RESULTS: A total of 1628 incident cancer cases were diagnosed during the study period and overall incidence increased significantly at a rate of 0.5% per year. Significant increases were seen for neuroblastoma and germ cell tumours, for lymphoid leukemias and some CNS sub-sites. At the same time, decline in incidence was seen in almost all subgroups of unspecified neoplasms. The overall 5-year survival improved from 24% in 1970-1979 to 73% in 2010-2016, with the largest changes occurring in the 1990s and 2000s. For many sites, survival increase thereafter has been marginal. CONCLUSION: In this first comprehensive population-based study of childhood cancer incidence and survival in Estonia, long-term trends are shown in the context of societal and health care changes. Even though the increasing incidence of some sites may, at least partially, be explained by improved diagnostics reflected in the decreased incidence of unspecified neoplasms, the overall cancer incidence in children seems to be rising. Rapid progress in diagnosis and care have improved childhood cancer survival immensely, but deficit in Estonia persists compared to other European countries. Results of the study accentuate the need for a more in-depth analysis of clinical data, but also for the prioritization of childhood cancer in Estonia, to ensure access to standard care and innovative treatments.

Increasing incidence and survival of corpus uteri cancer in Estonia over the past two decades.

BACKGROUND: Corpus uteri cancer has become the fourth most common female cancer in Europe. In Estonia, the prevalence of obesity is increasing, and corpus uteri cancer survival has been relatively low. The aim of the study was to evaluate incidence, mortality and survival trends of corpus uteri cancer in Estonia by age, stage and histological subtypes with an emphasis on surgical treatment. METHODS: Estonian Cancer Registry data on incident cases of corpus uteri cancer were used to examine incidence trends (1995-2016) and calculate relative survival ratios (RSR) (1996-2016). Cases were classified by morphology and FIGO stage. Causes of Death Registry data were used to analyse corrected mortality (1995-2017). RESULTS: A total of 4281 cases were diagnosed in 1996-2016. A significant increase was seen in age-standardized incidence from 2009, while mortality remained stable throughout the study period. Significant increases were observed for type I cancers and age groups ≥65 years. Overall age-standardized 5-year RSR improved from 70% in 1996-2002 to 78% in 2010-2016. Survival increased for type I cancers, all age groups and all stages (significantly for stage IV). The proportion of surgically treated cases increased significantly from 85% to 89%, with the largest increases seen in older age groups and later stages. DISCUSSION: The rising corpus uteri cancer incidence in Estonia is driven by the type I cancer trend. Survival gain for later stages and older age groups likely reflected more frequent surgical treatment. To reduce mortality, further efforts are necessary to ensure appropriate care for all patients.

Gastric cancer trends in Estonia 1995-2014 by age, subsite, morphology and stage.

BACKGROUND: Gastric cancer (GC) is among the most common cancers and one of the leading causes of cancer deaths globally. In general, the incidence of GC has declined and survival improved in Europe. Nevertheless, previous analysis has shown that survival of GC patients in Estonia is still significantly lower compared to some European countries. Therefore, to improve patient outcomes, better overview of GC epidemiology is needed. The aim of this study was to describe the incidence and survival of GC in Estonia 1995-2014 in relation to age, subsite, morphology, and the extent of disease. MATERIAL AND METHODS: We used data from the population-based Estonian Cancer Registry on all incident cases of GC diagnosed in 1995-2014. Incidence rates and relative survival were calculated. Joinpoint regression modeling was used to estimate annual percentage change for incidence trends. Data were analyzed by age, sex, subsite, morphology, and the extent of disease. Changes between 1995-1999 and 2010-2014 were assessed. RESULTS: The overall incidence of GC in Estonia decreased in 1995-2014. The age-standardized (world) incidence declined significantly for both sexes, for patients below 70 years of age, adenocarcinomas, NOS and other morphologies, non-cardia and unspecified cases, and for all known stages. Approximately 40% of GC cases were diagnosed with distant metastasis. Overall age-standardized 5-year relative survival of GC patients increased from 20% to 28%. Survival improved the most in age group 50-69 years. A large survival gain was also seen for localized (from 55% to 70%) and locally/regionally spread disease (from 23% to 37%). CONCLUSIONS: In Estonia, the incidence of GC has declined and relative survival increased. However, special emphasis needs to be put on improving survival among men, elderly and in patients with metastatic disease.

Increasing kidney cancer incidence and survival in Estonia: role of age and stage.

BACKGROUND: Kidney cancer rates in Estonia are high. The study aimed to examine long-term trends in kidney cancer incidence, mortality and survival in Estonia, with special focus on age, birth cohorts, morphology and TNM stage. MATERIAL AND METHODS: Estonian Cancer Registry provided data on all incident cases of kidney cancer (ICD-10 C64), diagnosed in adults (age ≥15 years) in Estonia during 1995 - 2014. Relative survival ratios (RSR) were calculated and excess hazard ratios of dying were estimated with gender, age, period of diagnosis and TNM stage as independent variables. Joinpoint regression modeling was used to calculate estimated annual percentage change for incidence (1970-2014) and mortality (1995-2016) trends. Age-specific incidence rates were presented by birth cohort and period of diagnosis. RESULTS: Incidence increased significantly in both sexes, with the steepest rise seen for localized cancer. Cohort effects were pronounced particularly in men, while period effects were seen from the mid-1980s to mid-1990s in both sexes. Age-standardized five-year RSR for total kidney cancer increased by 13 percentage units (from 53% to 65%) over the study period; the increase was larger for renal cell carcinoma (from 63% to 78%). Survival increases of about five percentage units were seen for stages I/II and III. Age and gender were not associated with excess risk of dying from renal cell carcinoma after adjusting for stage. CONCLUSION: Estonia is currently among countries with the highest incidence of kidney cancer. The results suggest a combined effect of changing risk profiles in successive birth cohorts and increasing diagnostic activity around 1990. Large survival increase can mostly be attributed to earlier detection, but improved diagnosis and treatment have probably influenced stage-specific survival. High proportion of tumors with unspecified morphology and those with unknown stage among the elderly warrants further investigation of diagnostic and treatment practices.

Trends in cervical cancer incidence and survival in Estonia from 1995 to 2014.

BACKGROUND: Cervical cancer (CC) incidence in Estonia is the third highest in Europe, even though an organised nation-wide screening program has been in place since 2006. The aim of the study was to analyse the incidence and survival of CC in Estonia, focusing on age, morphology and stage at diagnosis. METHODS: Data from Estonian Cancer Registry were used to analyse age-standardized (world) and age-specific incidence for 1968-2014 rates. Joinpoint regression was used to estimate the annual percentage change (APC) for incidence trends. Age-period-cohort model was used to summarise time trends in terms of cohort and period effects. Relative survival ratios (RSR) were calculated for cases diagnosed in 1995-2014. Union for International Cancer Control version 7 of the TNM classification for malignant tumours was used to categorise stage. RESULTS: The age-standardized incidence of CC increased since 1980s at a rate of 0.8% per year. A significant increase was seen for all age groups except for 70+. The incidence of squamous cell carcinoma mimicked the overall trend, while adenocarcinoma showed increase since mid-1990s (APC 6.7). Age-period-cohort modelling showed strong cohort effects with the lowest risk for birth-cohorts born around 1940 and significantly increasing risks for successive cohorts born thereafter. No period effects were seen. The proportion of stage IV cases increased from 13% in 2005-2009 to 18% in 2010-2014. A significant increase was seen in the overall 5-year RSR from 1995 to 1999 to 2010-2014 (58% vs 66%). In 2010-2014, the 5-year RSRs ranged from 89% in women aged 15-39 to 41% in age group 70+. For stages I to IV, the respective RSRs were 98, 74, 57 and 22%. CONCLUSIONS: The inadequate uptake and insufficient quality of the Pap-smear based screening program has not brought along a decline in the incidence of CC in Estonia. Stage distribution has shifted towards later stages. New approaches are needed to prevent CC in Estonia.

Subsite- and stage-specific colorectal cancer trends in Estonia prior to implementation of screening.

BACKGROUND: The occurrence of colorectal cancer (CRC) in Estonia has been characterised by increasing incidence, low survival and no screening. The study aimed to examine long-term incidence and survival trends of CRC in Estonia with specific focus on subsite and stage. METHODS: We analysed CRC incidence and relative survival using Estonian Cancer Registry data on all cases of colorectal cancer (ICD-10 C18-21) diagnosed in 1995-2014. TNM classification was used to categorise stage. RESULTS: Age-standardized incidence of colon cancer increased both in men and women at a rate of approximately 1% per year. Significant increase was seen for right-sided tumours, but not for left-sided tumours. Rectal cancer incidence increased significantly only in men and anal cancer incidence only in women. Age-standardized five-year relative survival for colon cancer increased from 50% in 1995-1999 to 59% in 2010-2014; for rectal cancer, from 38% to 56%. Colon cancer survival improved significantly for left-sided tumours (from 51% to 62%) and stage IV disease (from 6% to 15%). For rectal cancer, significant survival gain was seen for stage II (from 58% to 75%), stage III (from 34% to 70%) and stage IV (from 1% to 12%). CONCLUSION: In the pre-screening era in Estonia, increase in colon cancer incidence was limited to right-sided tumours. Large stage-specific survival gain, particularly for rectal cancer, was probably due to better staging and advances in multimodality treatment. Nonetheless, more than one quarter of new CRC cases are diagnosed at stage IV, emphasising the need for an efficient screening program.

Prostate cancer incidence, mortality and survival trends in Estonia, 1995-2014.

OBJECTIVE: The aim of this study was to analyze long-term trends in prostate cancer (PCa) incidence, mortality and survival in Estonia, with specific focus on age and stage. MATERIALS AND METHODS: Data on PCa incident cases and deaths in 1995-2014 were obtained from the Estonian Cancer Registry and the Causes of Death Registry, respectively. Joinpoint regression was used to estimate the annual percentage change for incidence and mortality trends. Relative survival ratios (RSRs) were calculated for four 5 year periods. Incidence and survival were analyzed by age and stage. RESULTS: The average annual number of new PCa cases in Estonia increased more than three-fold from 1995-1999 to 2010-2014. The age-standardized overall incidence and the incidence of localized cancer increased steeply until 2011, then leveled off. The incidence of locally/regionally spread or distant PCa remained stable. A significant increase in PCa mortality was seen only in men aged 65 years and older. The overall 5 year RSR increased from 58% to 90% over the study period. Survival increased considerably for all stages. CONCLUSIONS: The dramatic rise in the incidence of PCa in Estonia since the late 1990s was limited to localized cancers. This, together with rapid increases in survival, is probably due predominantly to extensive opportunistic prostate-specific antigen testing of middle-aged and elderly men. The ongoing increase in PCa mortality among older men warrants validation of causes of death to avoid possible overestimation. Evaluation of diagnostic and treatment strategies could identify possibilities for improving outcomes of non-localized PCa.

Divergent trends in lung cancer incidence by gender, age and histological type in Estonia: a nationwide population-based study.

BACKGROUND: Lung cancer (LC) is the leading cause of cancer deaths in men and the second most frequent cause of cancer deaths in women in Estonia. The study aimed to analyze time trends in LC incidence and mortality in Estonia over the 30-year period, which included major social, economic and health care transition. The results are discussed in the context of changes in tobacco control and smoking prevalence. Long-term predictions of incidence and mortality are provided. METHODS: Data for calculating the incidence and mortality rates in 1985-2014 were obtained from the nationwide population-based Estonian Cancer Registry and the Causes of Death Registry. Joinpoint regression was used to analyze trends and estimate annual percentage change (APC) with 95% confidence interval (CI). Nordpred model was used to project future incidence and mortality trends for 2015-2034. RESULTS: Incidence peaked among men in 1991 and decreased thereafter (APC: -1.5, 95% CI: -1.8; -1.3). A decline was seen for all age groups, except age ≥ 75 years, and for all histological types, except adenocarcinoma and large cell carcinoma. Incidence among women increased overall (APC: 1.6, 95% CI: 1.1; 2.0) and in all age groups and histological types, except small cell carcinoma. Age-standardized incidence rate (world) per 100,000 was 54.2 in men and 12.9 in women in 2014. Changes in mortality closely followed those in incidence. According to our predictions, the age-standardized incidence and mortality rates will continue to decrease in men and reach a plateau in women. CONCLUSIONS: The study revealed divergent LC trends by gender, age and histological type, which were generally consistent with main international findings. Growing public awareness and stricter tobacco control have stimulated overall favorable changes in men, but not yet in women. Large increase in incidence was observed for adenocarcinoma, which in men showed a trend opposite to the overall decline. LC will remain a serious public health issue in Estonia due to a high number of cases during the next decades, related to aging population, and previous and current smoking patterns. National tobacco control policy in Estonia should prioritize preventing smoking initiation and promoting smoking cessation, particularly among women.

Age, period and cohort effects on suicide mortality in Russia, 1956-2005.

BACKGROUND: Russian suicide mortality rates changed rapidly over the second half of the twentieth century. This study attempts to differentiate between underlying period and cohort effects in relation to the changes in suicide mortality in Russia between 1956 and 2005. METHODS: Sex- and age-specific suicide mortality data were analyzed using an age-period-cohort (APC) approach. Descriptive analyses and APC modeling with log-linear Poisson regression were performed. RESULTS: Strong period effects were observed for the years during and after Gorbachev's political reforms (including the anti-alcohol campaign) and for those following the break-up of the Soviet Union. After mutual adjustment, the cohort- and period-specific relative risk estimates for suicide revealed differing underlying processes. While the estimated period effects had an overall positive trend, cohort-specific developments indicated a positive trend for the male cohorts born between 1891 and 1931 and for the female cohorts born between 1891 and 1911, but a negative trend for subsequent cohorts. CONCLUSIONS: Our results indicate that the specific life experiences of cohorts may be important for variations in suicide mortality across time, in addition to more immediate effects of changes in the social environment.