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Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients’ age.

Methods

We analysed 101,714 CC women diagnosed in 2000–2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed.

Results

EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women.

Conclusion

Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.

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Data availability

Further information regarding survival data is available on the website of the EUROCARE study (https://www.eurocare.it) at the following page: https://w3.iss.it/site/EU5Results/forms/SA0007.aspx.

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Acknowledgements

We thank Simone Bonfarnuzzo for his assistance, and Camilla Amati for language revision. EUROCARE-5 working group: Austria: M. Hackl, P. Ihle (Austrian CR); Belgium: E. Van Eycken, K. Henau (Belgian CR); Bulgaria: Z. Valerianova, N. Dimitrova (Bulgarian CR); Croatia: M. Sekerija, P. Cukelj (Croatian CR); Czech Republic: L. Dušek, M. Zvolský (Czech National CR); Estonia: M. Mägi (Estonian CR); T. Aareleid (National Institute for Health Development); Finland: N. Malila, K. Seppä (Finnish CR); France: M. Velten (Bas Rhin CR); A. V. Guizard (Calvados, General CR); J. Faivre* (Côte d'Or Digestive Tract Registry, Burgundy); A. S. Woronoff (Doubs CR); B. Tretarre (Hérault CR); N. Bossard* (Hospices Civils de Lyon); Z. Uhry (Hospices Civils de Lyon; Institut de Veille Sanitaire); M. Colonna* (Isère CR); F. Molinié, A. Cowppli-Bony (Loire-Atlantique/Vendée CR); S. Bara (Manche CR); B. Lapôtre-Ledoux (Somme CR); P. Grosclaude (Tarn CR); Germany: R. Stabenow (Berlin CR; Brandenburg CR; Mecklenburg-West Pomerania CR; Saxony CR; Saxony-Anhalt CR; Thüringen CR); S. Luttmann, A. Eberle (Bremen CR, Leibniz Institute for Prevention Research and Epidemiology); H. Brenner (German Cancer Research Center); A. Nennecke (Hamburg CR); J. Engel, G. Schubert-Fritschle (Munich CR); J. Heidrich (North Rhine-Westphalia CR); B. Holleczek (Saarland CR); A. Katalinic* (Schleswig–Holstein CR); Iceland: H. Birgisson, L. Tryggvadóttir (Icelandic CR); Ireland: K. Clough-Gorr (National Cancer Registry Ireland); Italy: G. Mazzoleni, A. Bulatko (Alto Adige CR); C. Buzzoni (Associazione Italiana Registri Tumore); A. Sutera Sardo, P. Mancuso (Catanzaro CR); S. Ferretti (Ferrara CR); A. Barchielli, A. Caldarella (Firenze-Prato CR); G. Gatta*, M. Sant*, C. Amati, P. Baili*, F. Berrino*, S. Bonfarnuzzo, L. Botta, R. Capocaccia*, R. Foschi, C. Margutti, E. Meneghini, P. Minicozzi, A. Trama (Fondazione IRCCS Istituto Nazionale dei Tumori, Milan); D. Serraino, L. Dal Maso (Friuli Venezia Giulia CR, CRO Aviano National Cancer Institute); R. De Angelis*, C. Di Benedetto, M. Caldora, S. Francisci*, F. Galati, S. Mallone, D. Pierannunzio, M. Tallon, S. Rossi, M. Santaquilani, A. Tavilla (Istituto Superiore di Sanità, Rome); F. Pannozzo, S. Busco (Latina CR); R. A. Filiberti, E. Marani (Liguria CR, IRCCS AOU San Martino—IST); P. Ricci (Mantova CR); G. Spagnoli, C. Cirilli (Modena CR); M. Fusco, M. F. Vitale (Napoli 3 South CR); M. Usala (Nuoro CR); F. Vitale, W. Mazzucco (Palermo CR); M. Michiara (Parma CR); R. Zanetti, S. Rosso (Piemonte CR); R. Tumino (Ragusa CR); L. Mangone, E. Di Felice (Reggio Emilia CR); A. G. Russo, A. Andreano (Registro tumori ATS della Città metropolitana di Milano); F. Falcini (Romagna CR, IRCCS AUSL-IRST Meldola); A. L. Caiazzo (Salerno CR); R. Cesaraccio (Sassari CR); S. Piffer (Servizio Epidemiologia Clinica e Valutativa, Trento); A. Madeddu, F. Tisano (Siracusa CR); A. C. Fanetti, I. Cometti (Sondrio CR); P. Candela, T. Scuderi (Trapani CR); F. Stracci, F. Bianconi (Umbria CR); G. Tagliabue, P. Contiero (Varese Province CR, Fondazione IRCCS Istituto Nazionale dei Tumori); M. Rugge, M. Zorzi (Veneto CR); Latvia: S. Pildava (Latvian CR); Lithuania: G. Smailyte (Lithuanian CR); Malta: M. Azzopardi, N. Calleja (Malta National Cancer Registry, Health Information and Research); Norway: T. B. Johannesen (Norwegian CR); Poland: J. Rachtan (Cracow CR); S. Góźdź, P. Macek (Kielce CR); J. Błaszczyk, M. Bębenek (Lower Silesia CR, Wroclaw); M. Bielska-Lasota* (National Institute of Public Health-National Institute of Hygiene, Warsaw); Portugal: G. Forjaz de Lacerda (Açores CR); M. J. Bento, L. Antunes (Northern Portugal CR); A. Miranda, A. Mayer-da-Silva (Southern Portugal CR); Slovakia: C. Safaei Diba (Slovakian National CR); Slovenia: V. Zadnik (Cancer Registry of Republic of Slovenia); M. Primic-Zakelj*; Spain: A. Lopez de Munain, L. Gil (Basque Country CR); J. M. Díaz García, A. I. Marcos-Navarro (Cuenca CR); R. Marcos-Gragera*, M. Puigdemont (Girona CR); M. J. Sanchez, D. Y. L. Chang (Granada CR, CIBERESP, ibs.Granada); M. D. Chirlaque (Murcia CR, CIBERESP, IMIB-Arrixaca); E. Ardanaz, M. Guevara (Navarra CR, CIBERESP, IdiSNA); J. Galceran, M. Carulla (Tarragona CR); Sweden: M. Lambe* (Regionalt cancercentrum and Karolinska Institutet); S. Khan (Swedish CR); Switzerland: K. Staehelin (Basel CR); C. Bouchardy, E. Fournier (Geneva CR); S. M. Mousavi, S. M. Ess (Grisons-Glarus CR); M. Lorez (NICER); M. Mousavi, C. Herrmann (St. Gallen CR); A. Bordoni, A. Spitale (Ticino CR); I. Konzelmann (Valais CR); The Netherlands: O. Visser, M. Aarts (The Netherlands CR); R. Otter*; UK-England: M. Coleman*, C. Allemani, B. Rachet (London School of Hygiene and Tropical Medicine); J. Rashbass, J. Broggio (Public Health England); J. Verne*; UK-Northern Ireland: A. Gavin, D. Donnelly (Northern Ireland CR); UK-Scotland: D. Morrison, R. Black (Scottish CR); UK-Wales: D. W. Huws, R. Thomas (Welsh Cancer Intelligence and Surveillance Unit). (*EUROCARE Steering Committee).

Funding

This work was funded by the Compagnia di San Paolo, the Cariplo Foundation, the European Commission [grant number 20102202, European Action Against Cancer, EPAAC Joint Action], and the Italian Ministry of Health [Grant number 1529710, Ricerca Finalizzata 2009, RF-2009]. The funding sources had no role in study design, the collection, analysis or interpretation of data, the writing of the report, or the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Health Promotion and Chronic Diseases Prevention, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland

    Magdalena Bielska-Lasota

  2. Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy

    Silvia Rossi & Roberta De Angelis

  3. Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland

    Michalina Krzyżak

  4. Research Department, Belgian Cancer Registry, Brussels, Belgium

    Annemie Haelens

  5. Malta National Cancer Registry, DHIR, G’Mangia, Malta

    Augius Domenic

  6. Lower Silesia Oncology Centre, Wroclaw, Poland

    Adam Maciejczyk

  7. Andalusian School of Public Health, Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain

    Miguel Rodríguez-Barranco

  8. Centro de Investigación Biomédica en Red de Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain

    Miguel Rodríguez-Barranco

  9. Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia

    Vesna Zadnik

  10. Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy

    Pamela Minicozzi

  11. Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK

    Pamela Minicozzi

Authors
  1. Magdalena Bielska-Lasota
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  2. Silvia Rossi
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  3. Michalina Krzyżak
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  4. Annemie Haelens
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  5. Augius Domenic
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  6. Roberta De Angelis
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  7. Adam Maciejczyk
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  8. Miguel Rodríguez-Barranco
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  9. Vesna Zadnik
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  10. Pamela Minicozzi
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Consortia

EUROCARE-5 Working Group

  • M. Hackl
  • , P. Ihle
  • , E. Van Eycken
  • , K. Henau
  • , Z. Valerianova
  • , N. Dimitrova
  • , M. Sekerija
  • , P. Cukelj
  • , L. Dušek
  • , M. Zvolský
  • , M. Mägi
  • , T. Aareleid
  • , N. Malila
  • , K. Seppä
  • , M. Velten
  • , A. V. Guizard
  • , J. Faivre
  • , A. S. Woronoff
  • , B. Tretarre
  • , N. Bossard
  • , Z. Uhry
  • , M. Colonna
  • , F. Molinié
  • , A. Cowppli-Bony
  • , S. Bara
  • , B. Lapôtre-Ledoux
  • , P. Grosclaude
  • , R. Stabenow
  • , S. Luttmann
  • , A. Eberle
  • , H. Brenner
  • , A. Nennecke
  • , J. Engel
  • , G. Schubert-Fritschle
  • , J. Heidrich
  • , B. Holleczek
  • , A. Katalinic
  • , H. Birgisson
  • , L. Tryggvadóttir
  • , K. Clough-Gorr
  • , G. Mazzoleni
  • , A. Bulatko
  • , C. Buzzoni
  • , A. Sutera Sardo
  • , P. Mancuso
  • , S. Ferretti
  • , A. Barchielli
  • , A. Caldarella
  • , G. Gatta
  • , M. Sant
  • , C. Amati
  • , P. Baili
  • , F. Berrino
  • , S. Bonfarnuzzo
  • , L. Botta
  • , R. Capocaccia
  • , R. Foschi
  • , C. Margutti
  • , E. Meneghini
  • , P. Minicozzi
  • , A. Trama
  • , D. Serraino
  • , L. Dal Maso
  • , R. De Angelis
  • , C. Di Benedetto
  • , M. Caldora
  • , S. Francisci
  • , F. Galati
  • , S. Mallone
  • , D. Pierannunzio
  • , M. Tallon
  • , S. Rossi
  • , M. Santaquilani
  • , A. Tavilla
  • , F. Pannozzo
  • , S. Busco
  • , R. A. Filiberti
  • , E. Marani
  • , P. Ricci
  • , G. Spagnoli
  • , C. Cirilli
  • , M. Fusco
  • , M. F. Vitale
  • , M. Usala
  • , F. Vitale
  • , W. Mazzucco
  • , M. Michiara
  • , R. Zanetti
  • , S. Rosso
  • , R. Tumino
  • , L. Mangone
  • , E. Di Felice
  • , A. G. Russo
  • , A. Andreano
  • , F. Falcini
  • , A. L. Caiazzo
  • , R. Cesaraccio
  • , S. Piffer
  • , A. Madeddu
  • , F. Tisano
  • , A. C. Fanetti
  • , I. Cometti
  • , P. Candela
  • , T. Scuderi
  • , F. Stracci
  • , F. Bianconi
  • , G. Tagliabue
  • , P. Contiero
  • , M. Rugge
  • , M. Zorzi
  • , S. Pildava
  • , G. Smailyte
  • , M. Azzopardi
  • , N. Calleja
  • , T. B. Johannesen
  • , J. Rachtan
  • , S. Góźdź
  • , P. Macek
  • , J. Błaszczyk
  • , M. Bębenek
  • , M. Bielska-Lasota
  • , G. Forjaz de Lacerda
  • , M. J. Bento
  • , L. Antunes
  • , A. Miranda
  • , A. Mayer-da-Silva
  • , C. Safaei Diba
  • , V. Zadnik
  • , M. Primic-Zakelj
  • , A. Lopez de Munain
  • , L. Gil
  • , J. M. Díaz García
  • , A. I. Marcos-Navarro
  • , R. Marcos-Gragera
  • , M. Puigdemont
  • , M. J. Sanchez
  • , D. Y. L. Chang
  • , M. D. Chirlaque
  • , E. Ardanaz
  • , M. Guevara
  • , J. Galceran
  • , M. Carulla
  • , M. Lambe
  • , S. Khan
  • , K. Staehelin
  • , C. Bouchardy
  • , E. Fournier
  • , S. M. Mousavi
  • , S. M. Ess
  • , M. Lorez
  • , M. Mousavi
  • , C. Herrmann
  • , A. Bordoni
  • , A. Spitale
  • , I. Konzelmann
  • , O. Visser
  • , M. Aarts
  • , R. Otter
  • , M. Coleman
  • , C. Allemani
  • , B. Rachet
  • , J. Rashbass
  • , J. Broggio
  • , J. Verne
  • , A. Gavin
  • , D. Donnelly
  • , D. Morrison
  • , R. Black
  • , D. W. Huws
  •  & R. Thomas

Contributions

MBL and PM designed the study and drafted the report. MBL and MK defined morphology grouping and literature searching. PM and SR carried out statistical analysis and helped to write the manuscript. MBL, PM and AH revised critically the manuscript and contributed to data interpretation. All authors contributed to the writing of the paper. They reviewed and approved the final version.

Corresponding author

Correspondence to Pamela Minicozzi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethical Committees of the Fondazione IRCCS Istituto Nazionale dei Tumori (Milan) and of the Italian National Institute of Health (Istituto Superiore di Sanità-Rome). Data sending was considered to imply ethics approval of participating cancer registries.

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The members of EUROCARE-5 Working Group are listed in “Acknowledgements” section.

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Bielska-Lasota, M., Rossi, S., Krzyżak, M. et al. Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study. Arch Gynecol Obstet 301, 591–602 (2020). https://doi.org/10.1007/s00404-019-05412-5

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  • DOI: https://doi.org/10.1007/s00404-019-05412-5

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