Epidemiology of gynecological cancer in Estonia
Date
2019-12-11
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Abstract
Günekoloogiliste pahaloomuliste kasvajate koormus ühiskonnale on suur, sest nad moodustavad 15% kõigist naistel diagnoositavatest pahaloomulistest kasvajatest Euroopas.
Töö eesmärk oli saada põhjalik ülevaade günekoloogiliste pahaloomuliste kasvajate pikaajalistest haigestumus-, suremus- ja elulemustrendidest Eestis. Uurimistöö tulemused aitavad kaasa vähiennetuse ja sõeluuringute ning tervishoiukorralduslike muutuste läbiviimisele.
Andmed vähijuhtude kohta saadi Eesti Vähiregistrist ja surmajuhtude kohta Surma põhjuste registrist. Emakakeha-, emakakaela-, munasarja- ning häbeme- ja tupevähi trendide analüüsimiseks kasutati erinevaid statistilisi meetodeid.
Uuringus leiti emakakeha- ja emakakaelavähi haigestumuse tõus, samal ajal kui munasarjavähi ning häbeme- ja tupevähi haigestumus on olnud stabiilne. Emakakehavähi haigestumuse tõusu saab seostada peamiselt ülekaalulisuse suurenemisega. Emakakaelavähi puhul ei täheldatud ennetustegevuse mõju haigestumusele, mis näitab riikliku sõeluuringu ebaefektiivsust. Kiiresti on vähenenud munasarjavähi suremus ja paranenud elulemus. Samuti on paranenud emakakehavähi elulemus ning see on tõenäoliselt seotud kirurgilise ravi sagenemisega nii vanemas eas kui hilisemate staadiumite puhul. Vähiravi parem kättesaadavus ja kvaliteet, tehnoloogia areng ning tõhusam kaasuvate haiguste käsitlus ja ravi on tõenäoliselt aidanud kaasa munasarja- ja emakakehavähi elulemuse paranemisele. Vanemate naiste osakaal on uuringuperioodil peaaegu kahekordistunud. Nihe varasemas staadiumis diagnoosimise suunas ilmnes vaid emakakehavähi puhul.
Et vältida naiste enneaegseid surmasid tulevikus, on vaja parandada emakakaelavähi sõeluuringu kvaliteeti ja tõsta osalemismäära ning saavutada optimaalne hõlmatus HPV vaktsineerimisega. Võitlus rasvumisega tuleb seada prioriteediks. Ühtlasi tuleb rõhutada regulaarsete günekoloogiliste läbivaatuste olulisust, esmajoones eakate naiste seas, et aidata kaasa kasvajate ennetamisele ja varajasele avastamisele.
The burden of gynecological cancers is considerable as they comprise 15% of all cancers among women in Europe. The aim of the study was to obtain a better understanding of the long term epidemiological trends of the incidence, mortality and survival of gynecological cancers in Estonia, to support policy decisions in cancer prevention, screening and cancer care. Data were obtained from the Estonian Cancer Registry and Estonian Causes of Death Registry. Long term incidence, mortality and survival trends of corpus uteri, cervical, ovarian and vulvovaginal cancer were analyzed using a variety of statistical methods. The incidence of corpus uteri and cervical cancer increased over the study period while no changes were observed for ovarian and vulvovaginal cancer. The growing prevalence of obesity is the most likely underlying cause of the corpus uteri incidence trend. No impact of health care related interventions on cervical cancer incidence was detected, showing the lack of effectiveness of nation-wide screening program. The mortality of ovarian cancer declined rapidly and was accompanied by a large survival gain. The survival improvement seen for corpus uteri cancer was associated with more frequent surgical treatment, even at older ages and later stages. Better access to and increased quality of cancer care, the use of advanced technology and improved management of comorbidities are likely contributors to survival improvement. The proportion of elderly patients almost doubled over the study period, whereas a shift towards earlier stages was seen only in corpus uteri cancer. In order to avoid premature deaths in the future, the quality and the participation rate of cervical cancer screening should be improved, and efforts must be made to obtain optimal HPV vaccination coverage. Tackling obesity should be prioritized. The importance of regular gynecological check-ups should be emphasized, particularly in older age, to prevent gynecological cancers or detect them early.
The burden of gynecological cancers is considerable as they comprise 15% of all cancers among women in Europe. The aim of the study was to obtain a better understanding of the long term epidemiological trends of the incidence, mortality and survival of gynecological cancers in Estonia, to support policy decisions in cancer prevention, screening and cancer care. Data were obtained from the Estonian Cancer Registry and Estonian Causes of Death Registry. Long term incidence, mortality and survival trends of corpus uteri, cervical, ovarian and vulvovaginal cancer were analyzed using a variety of statistical methods. The incidence of corpus uteri and cervical cancer increased over the study period while no changes were observed for ovarian and vulvovaginal cancer. The growing prevalence of obesity is the most likely underlying cause of the corpus uteri incidence trend. No impact of health care related interventions on cervical cancer incidence was detected, showing the lack of effectiveness of nation-wide screening program. The mortality of ovarian cancer declined rapidly and was accompanied by a large survival gain. The survival improvement seen for corpus uteri cancer was associated with more frequent surgical treatment, even at older ages and later stages. Better access to and increased quality of cancer care, the use of advanced technology and improved management of comorbidities are likely contributors to survival improvement. The proportion of elderly patients almost doubled over the study period, whereas a shift towards earlier stages was seen only in corpus uteri cancer. In order to avoid premature deaths in the future, the quality and the participation rate of cervical cancer screening should be improved, and efforts must be made to obtain optimal HPV vaccination coverage. Tackling obesity should be prioritized. The importance of regular gynecological check-ups should be emphasized, particularly in older age, to prevent gynecological cancers or detect them early.
Description
Väitekirja elektrooniline versioon ei sisalda publikatsioone
Keywords
gynecological oncology, gynecologic diseases, female genital organs, malignant neoplasms, cancer (medicine), epidemiology, Estonia