On 27 January at 15:00 Kristiina Ojamaa will defend her doctoral thesis „Epidemiology of gynecological cancer in Estonia“.
Professor Emeritus Hele Everaus (dr. med., Faculty of Medicine)
Senior Research Fellow Piret Veerus (PhD, Department of Epidemiology and Biostatistics, National Institute for Health Development)
Head of the Department of Epidemiology and Biostatistics, National Institute for Health Development Kaire Innos (dr. med.)
Professor Johanna Mäenpää (PhD), Department of Obstetrics and Gynecology, Tampere University Hospital, University of Tampere, Tampere, Soome.
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.