Cancer Incidence in Sweden 2002

Transcription

1 TATITIC HEALTH AND DIEAE 2003:11 Cancr Incidnc in wdn 2002 Cntr for Epidmiology

2 tatistics - Halth and Disass Cancr Incidnc in wdn 2002 Th National Board of Halth and Wlfar Cntr for Epidmiology OFFICIAL TATITIC OF WEDEN For information: Lotti Barlow Th Cancr Rgistry, Cntr for Epidmiology Tlphon: Publishd at Intrnt: - Dcmbr 2003 Artiklnr IN ocialstyrlsn klassificrar från och md år 2001 sin utgivning i olika dokumnttypr. Dtta är statistik. Dt innbär att rapportn innhållr siffruppgiftr som ocialstyrlsn samlat in, rgistrrat, barbtat, sammanställt, analysrat och/llr kommntrat. Uppgiftrna bskrivr läg, tillstånd och/llr utvckling. 2

3 Prfac Th wdish Cancr Rgistry was stablishd in In this publication th Cntr for Epidmiology (EpC) at th National Board of Halth and Wlfar prsnts its 45th rport on th incidnc and prvalnc of cancr in wdn. It compriss th matrial for 2002 and a dscription of trnds covring th priod of In th prsnt rport th rats ar ag standardizd according to th population Dcmbr 31, A comparison btwn diffrnt ag standardization ar shown in Figur A. Th cumulativ probability to dvlop cancr is prsntd in chaptr 8.Th prvalnc of cancr in wdn is prsntd in chaptr 9. it and histopathology ("morphology") of th tumors has bn codd in th ICD-O-2/ICD-10 systms of topography and morphology as of January 1st With ths systms, a mor dtaild information is obtaind (spcially with rgard to th morphology) than was prviously possibl with th ICD-7/WHO/H/ CANC/24.1 coding principls; furthr, th coding systms in th Cancr Rgistry will in th futur b comparabl with ICD-10 whn usd in its clinical contxt. In th prsnt publication, ICD-O-2/ICD-10 figurs for coding sit hav bn translatd to comply with arlir ICD-7 praxis, and ar prsntd in th main tabls according to ICD-7. Tabl W1 and Tabl W2 show that, for all practical purposs, such a translation is fasibl. tockholm Dcmbr 2003 Krstin Wigzll Dirctor Gnral National Board of Halth and Wlfar Måns Rosén Profssor and Had Cntr for Epidmiology National Board of Halth and Wlfar 3

4 Profssional taff of th Cancr Rgistry Ptra Ottrblad Olausson, Dputy Had of Division Mdical consultativ staff: Jan Ericsson, MD Lars Holmbrg, MD Barbro Lundh-Rozll, MD tatistical and administrativ staff: hiva Ayoubi Lotti Barlow Vilhlm Gustafsson Mats Talbäck Ulla Trsmdn For information: Lotti Barlow wdish Cancr Rgistry Cntr for Epidmiology National Board of Halth and Wlfar E TOCKHOLM WEDEN Tlphon: Fax: cancrrgistrt@sos.s Wb sit: 4

5 Contnts Pag Matrial 7 Information availabl in th Cancr Rgistr 8 Rporting procdurs and controls of th matrial 9 Validity of th data 10 tatistical trms 12 Th population of wdn 13 Total cancr incidnc Cumulativ probability to dvlop cancr 20 Th prvalnc of cancr in wdn 22 Trnds in th cancr incidnc 24 Coding according to ICD-O-2/ICD-10, and translation to arlir ICD vrsions: 107 Tabl W1 Translation of sit cods from ICD-O-2/ICD-10 to ICD-7 and ICD Tabl W2 Translation of sit cods from ICD-O-2/ICD-10 to ICD-7 and ICD-9, 115 including rlvant morphology cods FIGURE Figur A Comparison btwn diffrnt mthods of calculating 15 incidnc rats pr , by sx, Figur B Th tn most frqunt spcifid cancr sits, by sx 16 Figur C Ag-spcific incidnc rats pr All sits, by sx 16 Figur D Groupd cancr sits, by sx 17 Figur E All sits. Nw cass, Figur F1 All sits. Ag standardizd, Figurs F2-28 Ag standardizd cancr incidnc rats pr , by sit and sx TABLE Tabl A1 Main cancr sits in not autopsid cass in th Caus of Dath Rgistr but not in th Cancr Rgistr Tabl A2 Main cancr sits in autopsid cass in th Caus of Dath Rgistr but not in th Cancr Rgistr Tabl B lctd population data for wdn 2002, by sx 13 Tabl C Th man population of wdn 2002, by sx and ag 13 Tabl D Th man population of wdn 2002, by sx and domicil 14 Tabl E Total numbrs and total rats pr , by sx 15 Tabl F Prcntag distribution of th nw cass of cancr, by sit and sx 18 5

6 Tabl G Numbr of tumors considrd not to b infiltrating and mtastasizing, but 19 includd in th total cancr incidnc, by diagnosis and sx Tabl H Numbr of bnign tumors and prcancrous lsions rgistrd, but 19 not includd in th total cancr incidnc, by diagnosis and sx Tabl I Cumulativ probability of dvloping a cancr bfor a crtain ag in 21 wdn, by sit and sx Tabl J Prvalnc of cancr in wdn, by sit and sx, and Tabl K Estimats of th annual linar trnd of slctd sits, and Tabl 1 Numbr of nw cass, by sit, sx and ag at diagnosis 33 Tabl 2 Numbr of nw cass, by sit, sx and county 47 Tabl 3A Numbr of nw cass, by sit, sx, mdical rgion and th municipalitis 51 of tockholm, Malmö and Götborg Tabl 3B Numbr of nw cass found incidntally at autopsy, by sit, sx, mdical 55 rgion and th municipalitis of tockholm, Malmö and Götborg Tabl 3C Numbr of scond and multipl primaris, by sit, sx, mdical rgion 59 and th municipalitis of tockholm, Malmö and Götborg Tabl 4 Rats pr , by sit, sx and ag at diagnosis and rats ag adjustd 63 to th wdish population 2000 and th world standard population Tabl 5 Rats pr ag standardizd to th wdish population 2000, 76 by sit, sx and county Tabl 6 Rats pr ag standardizd to th wdish population 2000, by sit, 80 sx, mdical rgion and th municipalitis of tockholm, Malmö and Götborg Tabl 7 Rats pr ag adjustd to th world standard population, by sit, 84 sx and yar of diagnosis Tabl 8 Prcntag of cytologically or histologically vrifid cass, by sit, 88 sx and ag at diagnosis Tabl 9 Prcntag of cass found incidntally at autopsy, by sit, sx and 92 ag at diagnosis Tabl 10 Prcntag of cass found incidntally at autopsy, by sit, sx and county 96 and th municipalitis of tockholm, Malmö and Götborg APPENDICE Appndix 1 Major xcptions from th cods in th 7th WHO rvision 100 (WHO/H/CANC/24.1 for Anatomical Location) Appndix 2 Dfinitions of statistical trms 101 Appndix 3 Form usd for clinical rport 104 Appndix 4 Map of wdn 105 6

7 Matrial According to Rgulations by th National Board of Halth and Wlfar (OF(M) 1984:32) all physicians in hospitals and othr stablishmnts for mdical tratmnt undr public or privat administration in wdn must rport all cass of cancr ("Clinical rport", Appndix 3) to th Cancr Rgistry. Furthrmor, pathologists and cytologists sparatly rport vry cancr diagnosis on surgically rmovd tissus, biopsis, cytological spcimns, bon marrow aspirats and autopsis. Thus, th majority of cass ar notifid twic, in sparat rports. Only prsons that hav official rsidncy in wdn ar includd in th Cancr rgistr. Th rgistration of nw cancr rports and th major chck-up and corrction work is prformd by six rgional cancr rgistris covring th whol country. Ths rgistris ar associatd with th oncological cntr in ach mdical rgion of wdn (tockholm-gotland, Uppsala-Örbro, Linköping, Lund-Malmö, Götborg and Umå). Th rgionalization implis a clos contact btwn th rgistry and th rporting physician which in turn allviats th task of corrcting and chcking th matrial. Annualy th rgional rgistris snd information of nwly rgistrd cass and corrctions concrning thos prviously rportd to th National Cancr Rgistry. Th prsnt publication compriss statistics on cass of cancr diagnosd in Th following disass ar to b rportd to th National Cancr Rgistry. A B C D All dfinitly malignant noplasms (.g. carcinoma, sarcoma, malignant lymphoma, lukmia and malignant tratoma). Carcinoid tumors of digstiv and othr organs, granulosa cll tumors of th ovary, thymomas, adamantinomas and chordomas. Histologically bnign tumors of th cntral nrvous systm and mnings, transitional cll papillomas of th urinary tract, all hormonally activ tumors of th ndocrin glands (xcpt th thyroid) and th ntro-chromaffin and nurondocrin systms. Prcancrous lsions of lip, mouth, larynx, bronchus, tracha, crvix utri, skin, vulva and vagina, gastro-intstinal polyps with suspctd malignancy, "bronchial adnomas", atypical pithlial prolifrations of th brast (carcinoma in situ typ) and adnoma phyllods, prcancrous ndomtrial lsions, hydatidiform mols of placntal tissu, and ovarian cystadnomas of bordrlin typ. Disass mntiond undr A - C ar includd in th total cancr incidnc (Tabls F, G, I, J and 1-10), although a numbr of th tumors listd undr C ar considrd not to b "infiltrating and mtastasizing" (Tabl G). Th bnign tumors and prcancrous lsions mntiond undr D ar listd in Tabl H. 7

8 Basal cll carcinoma (basalioma) hav not bn rgistrd. If a prson has mor than on primary tumor, ach tumor is rgistrd sparatly. This also applis for tumors apparing in th sam parnchymal organ, providd th noplastic tissus and histogntic proprtis diffr among th tumors (for instanc, if on noplasm is a carcinoma and anothr a sarcoma). Each nw primary tumor in th skin, intstin and urinary tract is rgistrd. Information from dath crtificats is availabl to th Rgistry, supplying dat and caus of dath. Dath crtificats until Dcmbr 31, 2001 hav bn mrgd with th fils of th Cancr Rgistry Du to th fact that th Caus of Dath Rgistry has not bn updatd to 2002, 2001 is th last yar availabl. Cancr diagnoss basd on dath crtficats ar not rgistrd. Th prsons in th Cancr Rgistry hav also bn followd up rgarding to migration through tatistics wdn. Information availabl in th Cancr Rgistry Data in cancr rports - Uniqu prsonal idntification numbr composd of 8 digits basd on cntury, yar, month and day of birth, supplmntd with th so-calld rgistration numbr (3 digits) and a chck digit - x - Domicil (county, municipality, parish) - Hospital - Hospital dpartmnt - Pathology/cytology dpartmnt - pcimn numbr, and yar whn spcimn was takn - it of tumor. Th Rgistry has vr sinc 1958 and still, mainly followd a cod basd on th 7th WHO rvision (WHO/H/CANC/24.1 for Anatomical Location). For xcptions cf. Appndix 1. For th yars , th ICD-9 coding systm hav bn usd and 1993-w th ICD-O-2/ ICD-10 (Intrnational Classification of Disass for Oncology. cond Edition. WHO Gnva 1990) - Tumor srial numbr - Malignancy (ys/no) - Histological typ (WHO/H/CANC/24.1 Histology ) and from 1993 according to NOMED (Intrnational Classification of Disass for Oncology. cond Edition. WHO Gnva 1990) - Basis of diagnosis: 1 Clinical diagnosis only 2 X-ray 3 Histological xamination of surgical or biopsy matrial (patho-anatomic diagnosis, "PAD") 4 Autopsy with histopathological xamination of surgical or biopsy matrial 5 Cytological diagnosis 6 Gross xamination at surgry 7 Autopsy without histopathological xamination - Dat of diagnosis (cntury, yar, month, day) 8

9 - Diagnosis mad incidntally at autopsy (ys/no) 2.2 Data from dath crtificats - Dat of dath (cntury, yar, month, day) - Caus of dath. Main undrlying caus, according to: ICD , ICD , ICD , ICD w Rporting procdurs and controls of th matrial Th rports ar rgistrd continuously at th rgional cancr rgistris. Usually a notification from th pathology/cytology lab arrivs first, followd by a clinical notification. Whnvr rports arriv sparatly, thy ar rgistrd with a flag to show that on rport is lacking. If th missing rport dos not arriv within thr to nin months, a rmindr is snt out. In pr cnt of th cass, rports hav to b tracd according to this schm. If th missing rport dos not arriv, th rquird information can b takn from th hospital cas rcord, if availabl. If this sourc of information is also lacking, rgistration is don on th basis of th information that is availabl at hand. Th prcntag of cass with such an incomplt rgistration is lss than two pr cnt. A small numbr of cass (annually som hundrd) ar rportd too lat to b includd in th publication. Ths cass ar addd to th rgistry whnvr thy arriv. An stimation of th drop-out rat of cancrs can b don by comparing th Cancr Rgistry data with th Caus of Dath Rgistry (s nxt chaptr). Th matrial passs through th following controls: - th idntification numbr is chckd against th rgistr covring th total population of wdn - duplicats ar subjct to spcial chcking - th validity and logical contnts of th cods ar chckd whn th matrial is procssd. 9

10 Validity of th data Approximatly 98 pr cnt of th cass ar morphologically vrifid (Tabl 8). Th rliability of th diagnosis may vary with th hospital, dpartmnt and/or physician concrnd; this may add to a gographical variability, though th structur of th country's public halth systm is homognous. Th availability of facilitis for pathology srvic likwis varis. Th rliability of th diagnosis also varis with ag and typ of disas. Th figurs on incidnc from th Cancr Rgistry includ data on cass of cancr found incidntally at autopsy. Th contribution from this additional sourc varis with sit and typ of tumor. Variations in th incidnc of a particular typ of tumor in a crtain gographical rgion may partly b du to diffrncs in frquncy and thoroughnss of th autopsy xamination and th histologic xamination of th autopsy spcimns. Cancr of bronchus/lung, pancras, colon, livr and prostat ar oftn ovrlookd at clinical xaminations but ar found incidntally at autopsy. Tabl 3B givs th numbr of all cass found incidntally at autopsy by sit, sx and mdical rgion. Th wdish Cancr Rgistry dos not us information on cancrs basd on dath crtificats, th rason bing that th data on th dath crtificats in many instancs ar uncrtain - spcially rgarding old prsons - as shown in a sparat analysis (1). In 2001, thr wr prsons in th Caus of Dath Rgistry with cancr statd as undrlying caus of dath which wr not on fil in th Cancr Rgistry Th most common cancr sits wr - as notd prviously - bronchus/lung, pancras and prostat. Th distribution by sx, ag, and autopsy is shown in Tabl A1 and Tabl A2. Th figurs show that most of th cass ar 75 yars of ag, or oldr, and not autopsid. Du to th fact that th Caus of Dath Rgistry has not bn updatd to 2002, 2001 is th last yar availabl. REFERENCE 1. Britta Mattsson, Cancr Rgistration in wdn, acadmic thsis, Karolinska Institut, tockholm

11 Tabl A1: Main cancr sits in not autopsid cass in th Caus of Dath Rgistry 2001, but not in th Cancr Rgistry Ag at dath ICD-10 it x All ags C00-C97 All sits M F C16 tomach M F C18-C21 Colon and rctum M F C22 Livr and intrahpatic bil ducts M F C23-C24 Gallbladdr, othr and unspcifid parts of M biliary tract F C25 Pancras M F C26 Othr and ill-dfind digstiv organs M F C34 Bronchus and lung M F C50 Brast M F C51-C58 Fmal gnital organs F C61 Prostat M C64-C68 Urinary tract M F C69-C72 Cntral nrvous systm M F C76-C80 Ill-dfind, scondary and unspcifid sits M F C81-C96 Lymphoid, hamatopoitic and rlatd tissu M F Othr sits M F Tabl A2: Main cancr sits in autopsid cass in th Caus of Dath Rgistry 2001, but not in th Cancr Rgistry Ag at dath ICD-10 it x All ags C00-C97 All sits M F C16 tomach M F C18-C21 Colon and rctum M F C22 Livr and intrahpatic bil ducts M F C23-C24 Gallbladdr, othr and unspcifid parts of M biliary tract F C25 Pancras M F C26 Othr and ill-dfind digstiv organs M F C34 Bronchus and lung M F C50 Brast M F C51-C58 Fmal gnital organs F C61 Prostat M C64-C68 Urinary tract M F C69-C72 Cntral nrvous systm M F C76-C80 Ill-dfind, scondary and unspcifid sits M F C81-C96 Lymphoid, hamatopoitic and rlatd tissu M F Othr sits M F

12 tatistical trms Ag Th ag of th patint at th dat of diagnosis. Crud incidnc rat Th total numbr of cass dividd by th corrsponding man population pr Rats for mals and fmals ar calculatd sparatly. Ag spcific incidnc rat Numbr of cass for ach fiv yar ag-group dividd by th corrsponding man population pr Rats for mals and fmals ar calculatd sparatly. Ag standardizd incidnc rat In Tabls E, K and 4-6, th figurs hav bn adjustd for ag distribution to th wdish population Dcmbr 31, In ordr to facilitat intrnational comparisons, th incidnc rats hav also bn adjustd to th world standard population (Tabls E, 4 and 7). In th lattr tabl th sits (lukmia, polycythæmia vra and mylofibrosis) ar aggrgatd. Th standard populations and mor dtails on dfinitions of statistical trms ar givn in Appndix 2. Cumulativ probability of dvloping cancr In Tabl I th cumulativ probability to dvlop a cancr bfor a crtain ag has bn stimatd from th ag spcific incidnc rats in Tabl 4. Prvalnc In Tabl J th numbr of rsidnt prsons in wdn Dcmbr 31, 2002 with a diagnosd cancr wr countd as th prvalnc. Th calculations wr don for two rcruiting priods: th whol rgistry , and to nabl comparisons btwn yars, th last fiv yar priod Trnd Th trnds ovr tim ar calculatd from th ag adjustd figurs on tumor rats in th 18 diffrnt ag groups. In Tabl K th trnd figurs for both th last 10 and 20 yars ar prsntd. Th tim sris of ag standardizd rats plottd in Figurs F1-F28 covr th priod from 1960 to Comparisons btwn trnds covring diffrnt tim priods should b mad with caution sinc diagnostic mthods may vary, and coding practics chang. Furthrmor, in th trnd priods shown in th prsnt publication, th ag structur of th population, th autopsy frquncy (rcnt figur 15 pr cnt, compard to 50 pr cnt in th svntis), and typ and forms of scrning activitis vary. 12

13 Th population of wdn Th lif xpctancy at birth in wdn for 2002 was 77.7 yars for mals and 82.1 for fmals. om dmographic data for th population ar givn in Tabls B - D. Tabl B: lctd population data for wdn 2002, by sx Mals Fmals Total Man population Numbr of liv births Numbr of lat fotal daths (still births) Numbr of daths Numbr of daths from cancr* Crud dath rats** Infant mortality rats*** * Last avalibal data from 2001 ** Numbr of daths pr of th man population *** Numbr of daths during th first yar of lif pr liv births ourc: tatistics wdn and Th National Board of Halth and Wlfar Tabl C: Th man population of wdn 2002, by sx and ag Ag Mals % Fmals % Total % All ags ourc: tatistics wdn 13

14 Tabl D: Th man population of wdn 2002, by sx and domicil Mals % Fmals % Total % wdn County 01 tockholms län Uppsala län ödrmanlands län Östrgötlands län Jönköpings län Kronobrgs län Kalmar län Gotlands län Blking län kån län Hallands län Västra Götalands län Värmlands län Örbro län Västmanlands län Dalarnas län Gävlborgs län Västrnorrlands län Jämtlands län Västrbottns län Norrbottns län Municipality 0180 tockholm Malmö Götborg Mdical rgion R1 tockholm/gotland R2 Uppsala/Örbro R3 Linköping R4 Lund/Malmö R5 Götborg R6 Umå ourc: tatistics wdn 14

15 Total cancr incidnc 2002 Th incidnc is basd on a total of cancrs rportd to th wdish Cancr Rgistry in 2002, 817 cass of thm wr found incidntally at autopsy. Th numbr of prsons with cancr diagnosd for th first tim in 2002 was ( mals and fmals); thus cancrs wr diagnosd in prsons with at last on prvious cancr diagnosis. Th distribution of all rportd cancrs is givn by sx in Tabl E blow. CANCER INCIDENCE IN WEDEN 2002 Tabl E: Total numbrs and total rats pr , by sx Rats pr x Nw cass Crud rat wdn* World** All tumors M F M+F Numbr of prsons (first primaris) M F M+F cond primaris M F M+F Tumors found incidntally at autopsy M F M+F 817 *Ag adjustd to th wdish population 2000 **Ag adjustd to th World population CANCER INCIDENCE IN WEDEN 2002 Figur A: Comparison btwn diffrnt mthods of calculating incidnc rats pr , by sx 700 Pr Mals 600 Pr Fmals Ag stand. wdn 2000 Ag standard World Crud rats Yar of diagnosis Ag stand. wdn 2000 Ag standard World Crud rats Yar of diagnosis 15

16 Th prcntag distribution of th tn most frqunt forms of cancr is givn in Figur B blow. Th cass covr 79.1 pr cnt of all mal cancr. Th corrsponding figur for fmals is 73.2 pr cnt. CANCER INCIDENCE IN WEDEN 2002 Figur B: Th tn most frqunt spcifid cancr sits, by sx MALE FEMALE Prostat kin (mlanoma xcludd) 7,4 Tracha, bronchus, lung 7,1 Colon 7,0 Urinary organs (xcluding kidny) 6,9 Rctum and anus 4,7 Malignant mlanoma of skin 4,0 Malignant lymphoma 3,7 Othr and unspcifid sits 3,2 Nrvous systm 2, ,6 % Brast 29,3 Colon 8,0 Corpus utri 5,8 Tracha, bronchus, lung 5,6 kin (mlanoma xcludd) 5,3 Othr and unspcifid sits 4,4 Malignant mlanoma of skin 4,1 Rctum and anus 3,8 Ovary 3,6 Malignant lymphoma 3, % Th ag-spcific incidnc rats for all cancr ar shown in Figur C. Th graph illustrats that cancr mainly is a disas of th oldr ag groups. In th ag groups from to yars, th incidnc is highr among fmals, mostly bcaus of th dominanc of brast and gnital cancr. CANCER INCIDENCE IN WEDEN 2002 Figur C: Ag-spcific incidnc rats pr All sits, by sx Pr Mals Fmals Ag at diagnosis In Figur D, closly rlatd cancr sits hav bn groupd and prsntd by sx. Th distribution by individual sit and sx, is shown in Tabl F.

17 CANCER INCIDENCE IN WEDEN 2002 Figur D: Groupd cancr sits, by sx MALE NERVOU YTEM 2.5 GENITAL ORGAN 1.5 KIN 11.4 LEUKEMIA & LYMPHOMA 7.7 PROTATE 32.6 REPIRATORY YTEM 8.0 URINARY YTEM 9.1 OTHER 5.6 DIGETIVE YTEM 21.3 FEMALE KIN 9.4 NERVOU YTEM 2.7 LEUKEMIA & LYMPHOMA 7.1 GENITAL ORGAN 12.8 REPIRATORY YTEM 5.9 URINARY YTEM 4.5 BREAT 29.3 OTHER 8.3 DIGETIVE YTEM

18 CANCER INCIDENCE IN WEDEN 2002 Tabl F: Prcntag distribution of th nw cass of cancr, by sit and sx ICD-7 it Mals % Fmals % Total % All sits Lip Tongu alivary glands Floor of mouth Mouth, othr parts and unspcifid Msopharynx Nasopharynx Hypopharynx Pharynx, parts unspcifid Osophagus tomach mall intstin Colon Rctum and anus Biliary passags and livr, primary Livr, primary Livr not spcifid as primary Pancras Pritonum Nos and nasal sinuss Larynx Tracha, bronchus, lung and plura, primary Bronchus and lung, primary Lung, unspcifid Mdiastinum Brast Crvix utri Corpus utri Chorionpithlioma of utrus Utrus parts unspcifid Ovary, tub and broad ligamnt Ovary Othr fmal gnital organs Prostat Tstis Othr mal gnital organs Kidny Rnal parnchyma Urinary organs (xcluding kidny) Malignant mlanoma of skin kin (mlanoma xcludd) Ey Nrvous systm Thyroid gland Endocrin glands Bon Connctiv tissu, muscl Othr and unspcifid sits Malignant non-hodgkin lymphoma Hodgkin disas Rticulosis and rlatd forms Multipl myloma, plasmocytoma Lymphatic lukmia Myloid lukmia Monocytic lukmia Othr and unspcifid lukmia Polycythamia vra Mylofibrosis Malignant lymphoma Lukmia

19 CANCER INCIDENCE IN WEDEN 2002 Tabl G: Numbr of tumors considrd not to b infiltrating and mtastasizing, but includd in th total cancr incidnc, by diagnosis and sx it / histopathologic diagnosis Mals Fmals Total Papilloma, urinary tract Angiosarcoma of kaposi Histologically bnign tumors of th cntral nrvous systm Histologically bnign tumors of ndocrin glands (xcluding thyroid adnoma) Low grad fibrosarcoma (including Drmatofibro-sarcoma protubrans) CANCER INCIDENCE IN WEDEN 2002 Tabl H: Numbr of bnign tumors and prcancrous lsions rgistrd, but not includd in th total cancr incidnc, by diagnosis and sx it / histopathologic diagnosis Mals Fmals Total Prcancrous lsions of lip and mouth Prcancrous lsions of larynx, tracha and bronchus Prcancrous pithlial lsions of skin Malignant mlanoma in situ of th skin Prcancrous lsions of vulva and vagina Gastro-intstinal polyp with prcancrous chang Prcancrous chang of brast and adnoma phyllods Carcinoma in situ ("stag 0") of utrin crvix (squamous cll typ) Hydatidiform mol Prcancrous ndomtrial chang Ovarian cystadnoma with bordrlin malignancy Prlukmia

20 Cumulativ probability of dvloping cancr Th risk of dvloping cancr varis strongly with ag and by sit. Tabl I shows th probability to dvlop a spcific cancr up to a crtain ag for slctd sits. Only sits with a lif-tim probability (up to ag 85) of at last on pr cnt ar prsntd in th tabl. 20

21 CANCER INCIDENCE IN WEDEN 2002 Tabl I : Cumulativ probability of dvloping a cancr bfor a crtain ag in wdn, by sit and sx ICD-7 it x < 25 < 35 < 45 < 55 < 65 < 75 < All sits M Ag F tomach M F Colon M F Rctum and anus M F Biliary passags and livr, primary M F Pancras M F Tracha, bronchus, lung and plura, primary M F Brast M F Corpus utri F Ovary, tub and broad ligamnt F Prostat M Kidny M F Urinary organs (xcl. kidny) M F Malignant mlanoma of skin M F kin (mlanoma xcludd) M F Nrvous systm M F Endocrin glands M F Unspcifid sits M F Malignant non-hodgkin lymphoma M F Lukmia M F Othr sits * M F * All individual sit includd in othr sit has a probability blow on pr cnt at 84 yars of ag. Not: Th probability has bn stimatd from th ag spcific rats in Tabl 4. 21

22 Th prvalnc of cancr in wdn Th numbr of prsons rsidnt in wdn Dcmbr 31, 2002 and diagnosd with a cancr in th priods and ar shown in Tabl J. For simplicity all prsons ar considrd as prvalnt cass, although som might b curd from thir disas. om individuals may hav mor than on primary diagnosis. In all sits ach prson is countd only onc. For th singl sits thy ar countd onc for ach diagnostic group. Th prvalnc of a disas is affctd by dmographic, diagnostic and tratmnt factors that all may chang ovr tim: th incidnc of th disas th ag distribution arly diagnosis lngth of survival This fact maks prvalnc tim trnd analyss complx. 22

23 CANCER INCIDENCE IN WEDEN 2002 Tabl J: Prvalnc of cancr in wdn as of Dcmbr 31, 2002 for cass diagnosd and , and as a comparison th numbr of prsons diagnosd 2002, by sit and sx Prvalnc of cass Prvalnc of cass Incidnt cass diagnosd diagnosd diagnosd 2002 ICD-7* it Mals Fmals Total Mals Fmals Total Mals Fmals Total All sits Lip Tongu alivary glands Floor of mouth Mouth, othr parts and unspcifid Msopharynx Nasopharynx Hypopharynx Pharynx, part unspcifid Osophagus tomach mall intstin Colon Rctum and anus Biliary passags and livr, primary Livr, not spcifid as primary Pancras Pritonum Nos and nasal sinuss Larynx Tracha, bronchus, lung Lung, not spcifid as primary Mdiastinum Brast Crvix utri Corpus utri Chorionpithlioma of utrus Utrus, part unspcifid Ovary, tub and broad ligamnt Othr fmal gnital organs Prostat Tstis Othr mal gnital organs Kidny Urinary organs (xcl. kidny) Malignant mlanoma of skin kin (mlanoma xcludd) Ey Nrvous systm Thyroid gland Endocrin glands Bon Connctiv tissu, muscl Othr and unspcifid sits Malignant non-hodgkin lymphoma Hodgkin disas Rticulosis and rlatd forms Multipl myloma, plasmocytoma Lymphatic lukmia Myloid lukmia Monocytic lukmia Othr and unspcifid lukmia Polycythamia vra Mylofibrosis * In all sits ach prson is countd only onc. For singl sits th prsons ar countd onc for ach diagnostic group. 23

24 Trnds in th cancr incidnc Factors that affct trnds includ changs in coding practics, ag structur of th population at risk, and th autopsy frquncy, as wll as th introduction of scrning activitis and improvmnts in diagnostic practics. For this rason, conclusions may b difficult to draw from trnd figurs covring long tim priods. In th prsntation of th trnds, w prsnt figurs both for a 20-yar priod and th latst dcad (Tabl K). Th annual numbr of cancr cass in wdn has incrasd constantly sinc Th avrag annual incras is 2.0 pr cnt for mn and 1.8 for womn. About half of this incras is xplaind by th continuous aging of th population. This is sn in th graphs in Figur A (pag 15) whr th crud rats ar compard with ag standardizd rats. Whn th numbr of cancr cass is considrd ovr th priod , th avrag annual incras is 1.2 pr cnt for mn and 1.1 for womn. Th avrag annual changs in tim trnds ar calculatd according to an xponntial modl (th nd of Appndix 2) with th ag standardizd incidnc rats as point stimats. Th avrag annual incras in th ag standardizd rats for all cancr is 0.4 pr cnt for both mn and womn during th complt priod. Th figur for th priod is 0.7 for mals and 0.4 for fmals. An incras in th trnd for th yars is sn. g. for th following sits: Malignant mlanoma of skin. n ovr a 20-yar priod, this is on of th most rapidly incrasing malignant tumors in wdn. For mn, th avrag incras pr yar is 2.2 pr cnt and for womn slightly lss (2.0 pr cnt). Non-mlanoma skin cancr (mainly squamous carcinomas). An avrag annual incras of 3.4 pr cnt is obsrvd for mn and 3.8 for womn for th 20-yar priod. During th latst 10-yar priod studid th figurs ar 3.0 pr cnt for mn and 3.7 pr cnt for womn. Bronchus and lung, primary. Womn show a rathr strong avrag incras pr yar, 2.6 pr cnt, whil th prviously notd incrasing trnd in mals has turnd to a dcras of 1.5 pr cnt calculatd for th whol 20 yar priod. Th gap btwn th incidnc curvs for both sxs is, howvr, still considrabl. 24

25 CANCER INCIDENCE IN WEDEN 2002 Tabl K: Estimats of th annual linar trnd of slctd sits, and Annual chang in prcnt Rats ag adjustd to for trnd priod th population 2000 E of th latst pr ICD-7 it x 20 Yars 10 Yars All sits M.4 *.7 * (ag standardisd) F.4 *.4 * Lip M -3.4 * -4.0 * F Osophagus M F tomach M -4.2 * -4.2 * F -4.3 * -3.2 * Colon M F Rctum M F Biliary passags M -3.2 * -2.5 * and livr primary F -4.7 * -5.1 * Livr, primary M -2.4 * F -3.6 * -5.2 * Pancras M -3.7 * -4.1 * F -2.9 * -3.8 * Larynx M -1.9 * F Bronchus and lung M -1.5 * -1.2 * primary F 2.6 * 2.4 * Brast F 1.6 * 1.7 * Crvix utri F -1.5 * Corpus utri F 1.4 * 1.1 * Ovary, tub and broad ligamnt F -1.8 * -2.2 * Prostat M 2.2 * 3.2 * Tstis M 1.9 * Rnal parnchyma M -2.8 * -2.6 * F -2.6 * -2.7 * Urinary organs (xcluding kidny) M.5 * F.8 * 1.3 * Malignant mlanoma of skin M 2.2 * 1.9 * F 2.0 * kin (mlanoma xcludd) M 3.4 * 3.0 * F 3.8 * 3.7 * Nrvous systm M -1.1 * F Thyroid gland M -1.8 * F -1.5 * Malignant non-hodgkin lymphoma M F 1.0 * Hodgkin disas M -2.3 * -2.4 * F Multipl myloma, plasmocytoma M -1.0 * F -.7 * Lukmia M F ALL ITE M 1.2 * 1.5 * (NUMBER OF CAE) F 1.1 *.9 * * Implis that th trnd is considrd to b strictly incrasing or dcrasing at th 98% confidnc lvl 25

26 Brast cancr in womn. Th annual incras is 1.6 pr cnt for th 20 yar priod and 1.7 for th 10-yar priod. Prostat. This is th most common cancr sit in mn with an avrag annual incras of 2.2 pr cnt. For th last 10-yar priod th incras is 3.2 pr cnt. Tstis. An avrag annual incras of 1.9 pr cnt is sn for th 20 yar priod and vn highr during th last dcad (2.7 pr cnt). Urinary organs (xcluding kidny). Th incras for mn during th whol priod is 0.5 for mn and for womn 0.8 pr cnt a yar. For th last 10-yar priod, thr has bn no chang at all for mn, whil th womn has an incras (1.3 pr cnt). Malignant non-hodgkin lymphoma. Th avrag annual incras for th whol priod is 0.5 pr cnt for mn and 1.0 pr cnt for womn. Ths figurs ar partly "balancd" by a dcras in Hodgkin disas. Th calculations of th annual changs in trnds and th graphs in Figurs F8 and F9 show that th prvious trnds towards an incras in th incidnc of cancr in th biliary passags and primary livr cancr (in both mals and fmals) hav bn brokn during th 1980s and arly 1990s. This also applis for cancr of th ovary (Figur F16) and for cancrs of pancras (Figur F10), and lung (Figur F12a and 12b) in mals. A dcras in trnd is obsrvd.g. for Hodgkin disas, cancr of lip in mn, and for cancrs of Crvix utri. Th ag standardizd rat has dcrasd with 1.5 pr cnt a yar for th 20-yar priod. This is vidntly in grat masur an ffct of scrning activitis. Th incidnc sms to b lvling out at a rat of approximatly 10 pr during th lat 1990s. tomach. Thr is a rmarkabl dcras in incidnc for both mn and womn during th whol priod (4.2 pr cnt for mn and 4.3 pr cnt for womn annually). Corrsponding figurs for th last 10-yar priod is 4.2 for mn and 3.2 for womn. Th rats in th incidnc of cancr in various sits during th priod ar plottd and prsntd in Figurs F1-F28. For many sits, th numbr of cass ar fw and random variations play an important rol for th configuration of th graphs. Plas not that diffrnt scals ar usd among th figurs. Th rats ar ag standardizd according to th wdish population Dcmbr 31,

27 30000 Numbr of cass Figur E. All its. Nw cass Mals Fmals Yar of diagnosis 700 Pr Figur F1. All its. Ag standardizd Mals Fmals Yar of diagnosis 27

28 Figur F2: Lip (icd-7:140) Pr Mals 6 Fmals Yar of diagnosis Figur F3: Osophagus (icd-7:150) Pr Mals 4 Fmals Yar of diagnosis Pr Figur F4: tomach (icd-7:151) Mals Fmals 5 4 Figur F5: mall intstin (icd-7:152) Pr Mals Fmals Yar of diagnosis Yar of diagnosis 50 Pr Figur F6: Colon (icd-7:153) 30 Figur F7: Rctum and anus (icd-7:154) Pr Mals Fmals 10 5 Mals Fmals Yar of diagnosis Yar of diagnosis 28

29 20 Figur F8: Biliary passags and livr, primary (icd-7:155) Pr Mals 15 Figur F9: Livr, primary (icd-7:155.0) Pr Mals 15 Fmals 10 Fmals Yar of diagnosis Yar of diagnosis Pr Figur F10: Pancras (icd-7:157) Mals Fmals Pr Figur F11: Larynx (icd-7:161) Mals Fmals Yar of diagnosis Yar of diagnosis Figur F12a: Bronchus and lung, primary (icd-7:162.1) Pr Mals Fmals Yar of diagnosis Figur F12b: Bronchus and lung, primary (icd-7:162.1) Ag group 0-54 yars Pr Mals Fmals Yar of diagnosis 29

30 160 Pr Figur F13: Brast (icd-7:170) 30 Pr Figur F14: Crvix utri (icd-7:171) Fmals Fmals Yar of diagnosis Yar of diagnosis 30 Pr Figur F15: Corpus utri (icd-7:172) 30 Pr Figur F16: Ovary (icd-7:175.0) Fmals Fmals Yar of diagnosis Yar of diagnosis 250 Pr Figur F17: Prostat (icd-7:177) 7 Pr Figur F18: Tstis (icd-7:178) Mals Yar of diagnosis Mals Yar of diagnosis 30

31 25 Figur F19: Kidny, rnal parnchyma (icd-7:180.0) Pr Mals 50 Figur F20: Urinary organs, xcl. kidny (icd-7:181) Pr Mals 20 Fmals 40 Fmals Yar of diagnosis Yar of diagnosis 25 Figur F21: Malignant mlanoma of skin (icd-7:190) Pr Figur F22: kin, xcl. mlanoma (icd-7:191) Pr Mals Fmals Mals Fmals Yar of diagnosis Yar of diagnosis Figur F23: Brain and nrvous systm (icd-7:193) Pr Mals Fmals Figur F24: Thyroid gland (icd-7:194) Pr Mals Fmals Yar of diagnosis Yar of diagnosis 31

32 25 20 Figur F25: Malignant non-hodgkin lymphoma (icd-7:200) Pr Mals Fmals 8 6 Figur F26: Hodgkin disas (icd-7:201) Pr Mals Fmals Yar of diagnosis Yar of diagnosis Figur F27: Multipl myloma plasmocytoma (icd-7:203) Pr Mals Fmals Yar of diagnosis Figur F28: Lukmia (icd-7: ) Pr Mals 2 Fmals Yar of diagnosis 32

33 CANCER INCIDENCE IN WEDEN 2002 PART 1 ( 14) Tabl 1 : Numbr of nw cass by sit, sx and ag at diagnosis ICD-7 it x All ags Ag at diagnosis All sits M F Lip M F Uppr lip M F Lowr lip M F Multipl parts M - F Lip unspcifid M F Tongu M F Bas of tongu M F Othr spcifid part M F Multipl parts M F Part unspcifid M F alivary glands M F Parotid M F ublingual M F ubmandibular M F

34 CANCER INCIDENCE IN WEDEN 2002 PART 2 ( 14) Tabl 1 : Numbr of nw cass by sit, sx and ag at diagnosis ICD-7 it x All ags Ag at diagnosis Multipl glands M - F Gland unspcifid M F Floor of mouth M F Mouth, othr parts and M unspcifid F Msopharynx M F Nasopharynx M F Hypopharynx M F Pharynx, part unspcifid M F Osophagus M F Osophagus, spcifid part M F Multipl parts M F Part unspcifid M F tomach M F Cardia M F Part unspcifid M F

35 CANCER INCIDENCE IN WEDEN 2002 PART 3 ( 14) Tabl 1 : Numbr of nw cass by sit, sx and ag at diagnosis ICD-7 it x All ags Ag at diagnosis mall intstin M F Duodnum M F Othr spcifid part M F Multipl parts M F Part unspcifid M F Colon M F Cocum and ascndns M F Transvrs and flxurs M F Dscndns M F igmoid M F Appndix M F Multipl parts M - F Part unspcifid M F Rctum and anus M F Rctum inkl. rcto-sigmoidal junction M F

36 CANCER INCIDENCE IN WEDEN 2002 PART 4 ( 14) Tabl 1 : Numbr of nw cass by sit, sx and ag at diagnosis ICD-7 it x All ags Ag at diagnosis Anus M F Multipl parts M F Biliary passags and M livr, primary F Livr, primary M F Gall bladdr M F Extrahpatic bil ducts M F Ampulla of vatr M F Multipl parts M F Unspcifid bil passags M F Livr, not spcifid M as primary F Pancras M F Pritonum M F Nos and nasal sinuss M F Nos (intrnal) and nasal M cavitis F Eustachian tub and M middl ar F -