Cancer In Slovenia Research Articles

Impact of Indoor Radon Exposure on Lung Cancer Incidence in Slovenia.

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).

Prognostic factors and outcomes in women with breast cancer in Slovenia in relation to step-wise implementation of organized screening.

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.

1615P Impact of the COVID-19 pandemic on diagnosing and treatment referrals of lung cancer patients: A single-centre experience

Due to the global pandemic of COVID-19 in 2020, a substantial drop in the rate of cancer diagnosis, treatment and prognosis is anticipated owing to limited health resources dealing with cancer. Here, we present single-centre data of University Clinic Golnik, which addresses more than 40% of all cases of diagnosis and treatment of lung cancer in Slovenia, but was also one of the main COVID-19 treatment centres in the country during the last year. Data for lung cancer diagnosis and treatment referrals through multidisciplinary tumour board (MDT) were prospectively collected through the clinical hospital registry and analysed in comparison with the year before. Descriptive statistical analysis was performed. There were 583 patients diagnosed with lung cancer in year 2019 and 614 in 2020. There was no major difference in symptom duration prior to diagnosis: no symptoms in 17% vs 22%, symptoms lasting less than 1 month in 12% vs 5%, 1-3 months in 43% vs 39% and more than 3 months in 25% vs 24% for years 2019 and 2020, respectively. Also, at the time of diagnosis patients did not present in worse ECOG performance status (PS): 90% vs. 89% had PS 0-2 and 10% vs. 8% had PS 3-4 in 2019 and 2020, respectively. Limited stage of disease was diagnosed in 31% and 37% of patients, loco-regionally advanced in 10% and 8% of patients and metastatic disease in 57% and 53% comparing the years 2019 and 2020. Referrals to the first oncological treatment by the MDT in years 2019 and 2020 were as follows: 31% and 37% proceeded to surgery, 9% and 9% to chemo-radiotherapy, 15% and 16% to palliative radiotherapy, 33% and 28% to systemic therapy and 11% and 10% to best supportive care alone. No major differences in any of these parameters was found comparing the two years. In our small single-centre experience, there seems to be no decline in newly diagnosed lung cancer cases, neither increase in later-stage diagnosis. Later analysis will show if this might be attributable to increased radiological investigations performed due to respiratory symptoms and fear of COVID-19 and surely due to timely performed diagnostic procedures and excellent organisation despite the pandemic.

Breast cancer risk based on adapted IBIS prediction model in Slovenian women aged 40-49 years - could it be better?

BackgroundThe aim of the study was to assess the proportion of women that would be classified as at above-average risk of breast cancer based on the 10 year-risk prediction of the Slovenian breast cancer incidence rate (S-IBIS) program in two presumably above-average breast cancer risk populations in age group 40-49 years: (i) women referred for any reason to diagnostic breast centres and (ii) women who were diagnosed with breast cancer aged 40–49 years. Breast cancer is the commonest female cancer in Slovenia, with an incidence rate below European average. The Tyrer-Cuzick breast cancer risk assessment algorithm was recently adapted to S-IBIS. In Slovenia a tailored mammographic screening for women at above average risk in age group 40–49 years is considered in the future. S-IBIS is a possible tool to select population at above-average risk of breast cancer for tailored screening.Patients and methodsIn 357 healthy women aged 40–49 years referred for any reason to diagnostic breast centres and in 367 female breast cancer patients aged 40–49 years at time of diagnosis 10-years breast cancer risk was calculated using the S-IBIS software. The proportion of women classified as above-average risk of breast cancer was calculated for each subgroup of the study population.Results48.7% of women in the Breast centre group and 39.2% of patients in the breast cancer group had above-average 10-year breast cancer risk. Positive family history of breast cancer was more prevalent in the Breast centre group (p < 0.05).ConclusionsInclusion of additional risk factors into the S-IBIS is warranted in the populations with breast cancer incidence below European average to reliably stratify women into breast cancer risk groups.

Faecal immunochemical test-based colorectal cancer screening programme SVIT in Slovenia

Colorectal cancer (CRC) is the second most common cancer in Slovenia. The 5-year survival of patients depends on the clinical stage at presentation. More than 70% of patients with CRC are diagnosed as being in stage III or IV, with a 5-year survival rate of 52.7%. To improve the detection rate of CRC and to detect CRC in its early and more curable stage, a national screening programme is needed. In the year 2008, we started a pilot phase of the National CRC screening programme. We invited 9091 Slovene residents aged 64-68 years from Ljubljana, Kranj, and Celje regions, of whom 3807 responded to our invitation (41.9%). Two kits of the faecal immune test were sent to 3117 participants who met the inclusion criteria, and 2829 (90.7%) tests were returned. The compliance rate in our pilot programme was 32.9%. Among the patients who responded positively, 7.5% were positive. Until February 2009, 193 colonoscopies had been performed at DC Bled, DC Lipa and AM DC Rogaška. Intubation to the caecum was carried out in 99.4% of colonoscopies. Histology specimens were taken from 135 patients (70%). The adenoma detection rate was 53.8% (59.8% for men and 47.9% for women; P<0.05). We detected 1-17 adenomas per patient (2.4 on average). Advanced adenomas were detected in 60 patients (31%; 35.1% of men and 27.1% of women; P<0.05). Invasive carcinoma was detected in 15 patients (7.7%; 12.4% of men and 3.1% of women; P<0.05). Ten of them (73.3%) were in clinical stage I or II. In the pilot phase of the CRC screening programme the majority of CRCs were detected at early clinical stages. Invasive cancers were detected in 7.7% of patients. In almost all patients adenomas were resected at screening colonoscopy, thus reducing the possibility of later development of CRC in those patients.

Enhanced recovery after surgery in patients with colorectal cancer in Slovenia 2012

Background : Enhanced recovery after surgery (ERAS) protocol is a model of perioperative patient management where process optimisation helps to shorten patients’ recovery time. Application of ERAS protocol in colorectal cancer surgery is a demanding process, challenging our professional and organisational measures. Methods : A questionnaire regarding ERAS was sent to all thirteen heads of departments performing surgical treatment of colorectal cancer patients in Slovenia. The questionnaire was analyzed using Microsoft Excel Program. Results : There is a strong agreement among all the respondents that ERAS is a relevant clinical concept. Only seven clinical departments have developed a clinical pathway consistent with ERAS protocol, but principles of ERAS are followed at least partly or completely in twelve clinical departments. The most obvious is lack of activity before surgery, and particularly the educational interview with a dietitian and a physiotherapist. Less than half of the patients drink the glucose drink before surgery, and the same applies to the prophylaxis of nausea and vomiting. More than two thirds of patients are still subjected to mechanical bowel preparation before surgery. More than half of them have a central line and are admitted to intensive care unit (ICU) after surgery. More than 75 % of the patients do not sit up in bed or stand up on day 1 after surgery. More than half of them still have the nasogastric tube. Laparoscopy is used more frequently for colon and less for rectal surgery. Conclusions : Comparing this analysis with the one done in 2004, we can conclude that there is an important shortening of average planned hospital stay. Nevertheless, still the majority of patients are not managed according to the ERAS protocol. The implementation of ERAS concept in Slovenia is rather poor, contrary to what we would expect considering evidence-based positive effects, but nevertheless comparable to other’s experience.

Late somatic sequelae after treatment of childhood cancer in Slovenia

BackgroundThis is a long-term follow-up clinical study of adolescents and adults, survivors of childhood cancer. We evaluate and analyze the late somatic sequelae of childhood cancer treatment. Many such studies are susceptible to a strong selection bias, i.e., they employ a limited non-systematic sample of patients, based on a clinical hospital that provided the cancer treatment or performed the follow-up. To address the issue of selection bias, we perform here an analysis of late sequelae on a systematic database of the entire population of the children treated for cancer in Slovenia. Due to the specifics of cancer treatment procedures in Slovenia, they have all been treated and followed-up in the same clinic.MethodsThe data are based on the centralized registry of cancer patients in Slovenia and present a controlled and homogeneous collection. Late sequelae are evaluated following a modified CTCAE, i.e., the National Cancer Institute’s Common Terminology Criteria for Adverse Events version 3.0. We use survival analysis method to estimate the incidence of and risk for late sequelae, where the time variable is measured in years from the diagnosis date, while we follow the event of incidence of late sequelae scored other than none. Survival analysis is performed using KaplanMeier estimator and Cox regression model.ResultsThe incidence of mild, moderate, or severe late sequelae of childhood cancer treatment significantly decreased from 75% in the group of patients diagnosed before 1975 to 55% for those diagnosed after 1995. The Cox regression analysis of the risk factors for the incidence of late sequelae identifies three significant factors: treatment modalities, age at diagnosis, and primary diagnosis.ConclusionsThe change of treatment modalities in terms of replacement of surgery and radiotherapy with chemotherapy is the main reason for the decrease of the incidence and the risk for late sequelae of childhood cancer treatment; treatment modalities including surgery significantly increase the risk ratio of late sequelae, while those based on chemotherapy only significantly decreases the risk. Risk of late sequelae increases with the diagnosis age: younger children are more susceptible to late effects of treatment. Finally, primary diagnosis significantly influences the risk for late sequelae, but mostly due to the dependency of the treatment modality on the primary diagnosis.

Genomic variants of human papillomavirus genotypes 16, 18, and 33 in women with cervical cancer in Slovenia

Our aim was to analyze genomic variants of the three most common human papillomavirus (HPV) genotypes found in Slovenian women with cervical cancer (CC). A total of 40 isolates of HPV 16, 20 isolates of HPV 18 and 11 isolates of HPV 33 were included in the study. The genomic diversity of HPV 16, HPV 18 and HPV 33 isolates was investigated within the long control region (LCR), and E6 and E7 genomic regions using direct polymerase chain reaction-sequencing. A total of 26 genomic variants of HPV 16, consisting of 22 LCR, 10 E6 and 5 E7 variants were identified. Thirty-eight (95%) HPV 16 isolates belonged to the European branch, one (2.5%) to the African 2 branch and one (2.5%) to the Asian-American branch. A total of 18 genomic variants of HPV 18 consisting of 18 LCR, two E6 and four E7 variants were identified: 19 (95%) HPV 18 isolates belonged to the European branch and one (5%) to the African branch. A total of seven genomic variants of HPV 33 consisting of seven LCR, two E6 and three E7 variants were identified: five (45.5%) HPV 33 isolates belonged to prototypic and six (54.5%) to non-prototypic HPV 33 genomic variants. The majority of HPV 16 and HPV 18 isolates from Slovenian patients with CC analyzed in this study belonged to European branches. Prototypic and non-prototypic HPV 33 genomic variants were equally distributed among Slovenian patients with CC. Several novel mutations were identified in all three genotypes examined.

Gastric cancer, screening possibilities and proposals for endoscopic and histologic follow-up of premalignant gastric lesions.

Gastric cancer is the second largest cause of cancer related deaths worldwide. Gastric cancer is the sixth most common cancer in Slovenia. The known risk factors for gastric cancer are: Helicobacter pylori infection ( H. pylori ), E–catherin mutation, proinflammatory cytokine polymorphisms, certain foods (salt, nitrosamine, antioxidants), pernicious anemia, 20 years post gastric partial resection, gastric adenoma and hamartoma, male sex and smoking. From 65 % to 80 % of noncardia gastric cancer are late consequences of H. pylori infection. Half of the World population is infected with H. pylori, but only 1 % will develop gastric cancer . Last year, Asian Pacific Cancer Concensus Conference recommended population – based screening and treatment of H. pylori infection in countries with gastric cancer incidence more than 20/100 000. Untill this approach becomes a part of daily clinical practice, endoscopic and histologic surveillance should be done in all patients with premalignant gastric lesions ( atrophy, intestinal metaplasia and dysplasia ). Histologic caracteristics and recommendations for endoscopic and histologic surveillance are presented.

Distribution of human papillomavirus genotypes in women with cervical cancer in Slovenia

Objective The purpose of the present study was to establish the distribution of human papillomavirus (HPV) genotypes in a representative population of women with cervical cancer in Slovenia in order to contribute to the lacking data on HPV in cervical cancer and to assess the potential local benefit of future prophylactic HPV vaccination. Study design A total of 284 samples of cervical cancer were analyzed including archival samples, cervical scrapes and fresh tissue samples. Polymerase chain reaction with GP5+/GP6+ primers was performed in all samples for HPV deoxyribonucleic acid (DNA) detection. All GP5+/GP6+ negative samples were additionally tested using CPI/CPIIg primers and INNO-LiPA HPV genotyping assay. Results After exclusion of 6 samples with unsuccessful amplification of beta-globin gene, 262 of 278 cervical cancer samples (94.2%) were HPV DNA positive. HPV genotypes found in the decreasing order of frequency were: HPV 16 (64.9%), HPV 18 (12.2%), HPV 33 (4.7%), HPV 45 (4.1%), followed by HPV 31, 51, 58, 59, 35, 52, 73 and 82 (3.5–0.2%). HPV positive samples were more frequent among squamous cell carcinomas than among adenocarcinomas/adenosquamous carcinomas (95.8% versus 85.5%; P = 0.003). HPV 16 was more frequently found in squamous cell carcinomas than in adenocarcinomas/adenosquamous carcinomas (69.9% versus 37.5%; P < 0.001), while the opposite was true for HPV 18 (6% versus 41.7%; P < 0.001). Conclusion Prophylactic HPV vaccination with currently available vaccines could prevent up to 77.1% of cervical cancer in Slovenia, which is caused by HPV 16 or HPV 18.

Rehabilitation after treatment of the breast cancer in Slovenia

Rehabilitation after treatment of the breast cancer in Slovenia

Breast cancer epidemiology in Slovenia

Introduction: As in other European countries, breast is the most frequent cancer site in Slovenian female population. The incidence rate is increasing since 1950, while mortality started to decrease in the nineties, though more pronounced in younger women. Epidemiologic characteristics: The crude incidence rate of breast cancer in Slovenia increased from 27.4/100.000 in the period 1963–1967 to 89.2/100.000 in the period 1998–2002. In the year 2004 there were 1084 new breasts cancer cases registered (106.3/100,000); it is predicted that in the year 2007 there will be 1182 (1092–1271) new cases. For several years, the incidence rate is higher in western compared to eastern Slovenia and in bigger cities compared to countryside. The percentage of cases diagnosed with localised disease is increasing very slowly; compared to 36% in the year 1985; it was 48% in the year 2000 and 51% in the year 2004. The number of in situ cancers is still low, but slowly increasing as well; in 2004 there was 87 cases compared to 52 in 2000. Survival of breast cancer patients is increasing: relative 5-year survival of patients diagnosed in the years 1968–1972 it was 50% and for those diagnosed in 1998–2002 it increased to 80%. Despite the increasing survival, breast cancer is still the leading cause of cancer-related death in females; in 2004, 375 died of this disease. Besides age and sex, the established breast cancer risk factors include certain benign breast diseases, family history, ionising radiation, some reproductive factors and obesity. With several analytical epidemiologic studies Slovenia contributed to the body of evidence on some of them. E.g. we were one of the participating centres in the international case-control study in seven locations of the world performed in late 1960s in which it has been demonstrated that the risk of breast cancer is lower for women with first child at an early age. With further studies we contributed to the body of evidence of a small adverse effect in current oral contraceptive users and in users of hormone replacement therapy. Conclusions: Breast cancer control could be achieved in Slovenia, as well as elsewhere, only by combined efforts directed into primary prevention and screening, and further more by increasing the availability of effective treatment.

Hereditary medullary thyroid cancer in Slovenia – genotype-phenotype correlations

Medullary thyroid cancer (MTC) is a rare endocrine tumor that may be sporadic or inherited in settings of MEN2A, MEN2B and FMTC. Germline point mutations in the RET proto-oncogene are responsible for tumor occurrence, inheritance and great clinical variability. The aim of this study was to correlate the genotype and phenotype of patients with hereditary MTC (age at diagnosis, sex, TNM classification and clinical features). Between 1997 and 2003 genetic testing was performed in 69 out of 98 patients with "sporadic" MTC. Carriage of mutation was found in 14 (20.2%) patients (index patients) and in 16 out of 31 (51.6%) of their relatives. One patient with MEN2B and codon 918 mutation was excluded from further analysis. Genomic DNA was isolated from peripheral blood leukocytes. Exons 10, 11, 13, 14, 15 and 16 of the RET proto-oncogene were amplified in polymerase chain reactions. Point mutations of the RET gene were detected with single-strand conformation analysis and DNA sequencing. Detected mutations were confirmed with restriction enzyme analysis. Codon 634 mutations were detected in 15 patients (50%; aged 18-76 years; 6 families), codon 618 in nine patients (30%; aged 12-65 years; 4 families) and codon 790 in five patients (16.6%; aged 16-74 years; 3 families). The median age at diagnosis was 31 +/- 17.3, 33 +/- 15.9 and 36 +/- 23.8 years for patients with codon 618, 634 and 790 mutations. Selected by sex, females with codon mutations 618 and 634 versus 790 had median age at diagnosis of 34.5 +/- 15.6 years and 43.5 +/- 22.9 years, whereas the inverse result was observed in males (26.5 +/- 18.0 versus 16 years). The male/female ratio was 1:2 for patients with codon 618 and 634 mutations and 1:4 for patients with codon 790 mutations. Some of the data suggested correlation between specific genotypes, tumor size, stage of MTC and age at diagnosis. Pheochromocytoma (12 out of 15 patients) and primary hyperparathyroidism (6 out of 15 patients) were diagnosed solely in patients with codon 634 mutations. One patient with FMTC and Hirschprung disease was found in a family with codon 618 mutations. Correlation between tumor size, stage of MTC at diagnosis in view of patient's age, and specific genotype were indicated in our limited series and were more evident in female patients with codon 790 mutations. Later onset and a probably less aggressive course of MTC in these patients than in patients with other mutations should be considered in planning prophylactic thyroid surgery. MEN2A syndrome was related solely to codon 634 mutations.

Colorectal cancer in Slovenia – differences in surgical treatment and patient survival

Background: Colorectal cancer (CRC) is one of the most frequent malignant diseases in Slovenia. Its incidence rises constantly in the last years while the outcome of treatment is poorer than in other developed countries. Methods: In a retrospective study we analysed 940 colorectal cancer patients diagnosed in Slovenia in 1997. Results: Differences in outcome between the Slovenian institutions are due to different stage-distributions and differences in surgical radicality. Differences in pathohistological staging and medical oncological treatment are probably less important. The same can be said regarding some of the examples from abroad. Conclusions: With constant and objective auditing, the improvement of all aspects of treatment can be achieved, resulting in better survival of all Slovenian colorectal cancer patients.

Colorectal cancer in Slovenia at the turn of the century

BACKGROUND: The incidence of colorectal cancer has been rapidly increasing during the last decades. It represents the third most common cancer in Slovenia. METHODS: In 1998, the incidence of colon cancer increased to 31.3 per 100,000 in men and to 25.8 per 100,000 in women, and the incidence of rectal cancer to 23.5 per 100,000 in men and to 13.1 per 100,000 in women. By a national cancer registry, incidence and follow-up are assessed. RESULTS: An insight into the operative treatment of patients with colorectal cancer in Slovenia was gained through surveys conducted in Slovenian hospitals between 1995 and 2000. CONCLUSIONS: Nationwide outcomes of treatment remain lower than those in other countries. However, there are centers in Slovenia achieving results in keeping with outcome reported from leading centers in Europe.

Evaluation of causes of increased incidence of cervical cancer in Slovenia

Objective: In Slovenia the opportunistic cervical cancer (CC) screening programme has been performed within the regular gynaecological practice since 1960. The incidence rate 28.8/10 5 decreased to 16.1/10 5 in 1982, and increased to 23/10 5 in 1996. To explain the increased CC incidence the patients’ screening histories, occurrence of symptoms, and details of preventive measures were studied on the basis of medical records and questionnaire. Errors of cytological screening were analysed by reviewing previous smears. Material: The answers obtained from 324 women, treated for CC in the period 1995–2000, were analysed in relation to age, stage and histology. The mean women’s age was 46.76 ± 13.07 (S.D.) years (range 23–85 years). After therapy, 271 patients were followed-up by the end of January 2004, (mean follow-up time 80.3 ± 20 S.D. months, range 29.7–110.3 months). Statistical analysis was performed using Chi-square test. Results: In 208 (80%) cases, CC was detected in stage 1, in 43 (17%) in stages 2A to 3B. Squamous-cell carcinoma (192, 74.1%) was followed by adenocarcinoma (61, 23.5%) and (5, 1.9%) other malignancies. The screening interval ranged from 6 months to 4 years. Statistically significant differences existed between clinical and screening variables. CC was diagnosed in higher stages in women who were ignorant of the Pap test. Re-screened smears ( n = 126) showed 27.8% of false negative results. Conclusions: The reasons for high incidence of CC are poor performance of cytological screening, failures in gynecological examinations and diagnostic procedures, and the patients’ negligence of attending regular screening.

Second neoplasms after treatment of childhood cancer in Slovenia.

The number of long time survivors of childhood cancer treatment is constantly increasing over the last decades as a result of advances in diagnosis and treatment. The occurrence of second neoplasms is one of most serious late effects observed in cancer survivors. The risk of secondary neoplasm was studied in a cohort of 1,577 patients treated for childhood cancer registered in the Cancer Registry of Slovenia (CRS) between 1961 and 2000. The time at risk was defined from the date of diagnosis of first malignancy to the time of death or the end of the study. The most frequent primary malignancies were: acute leukemia 28.5%, central nervous system (CNS) tumors 21.3%, and lymphomas 16.6%. Median observation time was 7.8 years. Forty-eight patients developed second neoplasms. CNS tumors, acute leukemias, and thyroid carcinoma were most frequent second neoplasms. The cumulative risk for second neoplasm in the entire cohort was 0.06% at 5 years, 5.1% at 15 years, and 12.6% at 25 years after diagnosis of first cancer. The overall survival after second neoplasm was 65% 10 years after the diagnosis of second neoplasm. Patients after treatment of childhood cancer are at special risk for subsequent neoplasms and long-term follow-up is mandatory.

Cancer prevalence in Central Europe: the EUROPREVAL Study

Information on cancer prevalence is either absent or largely unavailable for central European countries. Austria, Germany, The Netherlands, Poland, Slovakia, Slovenia and Switzerland cover a population of 13 million inhabitants. Cancer registries in these countries supplied incidence and survival data for 465 000 cases of cancer. The prevalence of stomach, colon, rectum, lung, breast, cervix uteri, corpus uteri and prostate cancer, as well as skin melanoma, Hodgkin's disease, leukaemia and all malignant neoplasms combined was estimated for the end of 1992. A large heterogeneity was observed within central European countries. For all cancers combined, estimates ranged from 730 per 100 000 in Poland (men) to 3350 per 100 000 in Germany (women). Overall cancer prevalence was the highest in Germany and Switzerland, and the lowest in Poland and Slovenia. In Slovakia, prevalence was higher than average for men and lower than average for women. This was observed for almost all ages. As shown by incidence data, breast cancer was the most frequent malignancy among women in all countries. Among men, prostate cancer was the leading malignancy in Germany, Austria and Switzerland, and lung cancer was the major cancer in Slovenia, Slovakia and Poland. The Netherlands had a high prevalence of both prostate and lung cancer. Time-related magnitude of prevalence within each country and the variability of such proportions across the countries has been estimated and cancer prevalence is given by time since diagnosis (1 year, 1-5 years, 5-10 years, >10 years) for each site. The weight of 1-year prevalence (248 per 100 000 among men and 253 per 100 000 among women) was <15% of total prevalence. Prevalent cases between 1 and 5 years since diagnosis represented between 22% and 34% of the total prevalence. Prevalent cases diagnosed from 5 to 10 years before (335 per 100 000 for men and 505 per 100 000 for women) represented between 17% and 23% of prevalent cancers. Finally, long-term cancer prevalence (diagnosed >10 years before), reflecting long-term survival, and number of people considered as cured from cancer were 490 per 100 000 for men and 1028 per 100 000 for women, with a range between 26% (The Netherlands, men) and 50% (Slovakia, women). It is clear from observing countries in Central Europe, that high cancer prevalence is associated with well-developed economies. This burden of cancer could be interpreted as a paradoxical effect of better treatments and thereby survival. It could also be taken as a sign for not being satisfied with the advances in treating patients diagnosed with cancer, and for supporting more primary prevention.

QUALITY-CONTROL INDICATORS AND STANDARDS USED IN DETECTION AND TREATMENT OF PRECANCEROUS LESIONS OF THE UTERINE CERVIX

Background. In Slovenia the high incidence of cervical cancer after 1990 is unacceptable knowing that the local passive screening programme efficiently decreased the incidence of cervical cancer in the 1970', and that at present a well branched network of gynecologists and cytologists is available. Methods. The analysis of measures and actual situation in developed countries, national studies, analyses and numerous evidence-based conclusions published in Slovenia and worldwide, have resulted in the set of most probable causes of the increased incidence of cervical cancer in Slovenia. Conclusions. Some most relevant measures for decreasing the occurrence of cervical cancer have been planned and some have also been undertaken. The planned goals could be realized in a 5- to 8-year period, under certain conditions: if examination of the Slovene female population strictly following the criteria for efficient active screening is guaranteed, and if most relevant diagnostic procedures in the fields of gynecology and cytology are improved according to the prepared protocols and recommendations.

Second primary cancers in laryngeal cancer patients in Slovenia, 1961–1996

We analysed the incidence of second primary cancers (SPC) in male laryngeal cancer patients in Slovenia and their survival for the period of 1961–1996. Data were taken from the population-based Cancer Registry of Slovenia. The person-years approach was used and the risk for SPC was expressed as a standardised incidence ratio (SIR). Survival analysis was carried out using the Kaplan–Meier method. Of 2275 male patients, 369 developed SPC (16.2%, total SIR 2.83), most commonly in the head and neck region (SIR 6.07–15.97), lung (SIR 4.15), oesophagus (SIR 4.66), and bladder (SIR 3.0), which points to an important role of common risk factors of smoking and alcohol. SPC were diagnosed in significant excess up to 20 years after the diagnosis of laryngeal cancer. The median survival time from the diagnosis of laryngeal cancer was 3.25 years for patients without a SPC and 6.47 years for patients who developed a SPC. However, the median survival time from the diagnosis of a SPC was only 0.84 years. Patients with laryngeal cancer in Slovenia have a higher risk of developing a SPC than was reported in similar studies in Europe and the USA. This high risk is partly responsible for their relatively poor survival.