Kaire Innos

Background. Prostate cancer (PCa) is the most frequently diagnosed cancer in men in the European Union. Following the 2022 Council Recommendation to evaluate organised screening based on prostate-specific antigen (PSA) testing and magnetic resonance imaging (MRI), PRAISE-U defined 21 harmonised key performance indicators (KPIs). We report their first empirical values from the five PRAISE-U pilots and, through a common survey, from EUCanScreen pilots and the Swedish organised prostate cancer testing (OPT) programme. Methods. In PRAISE-U, men aged 50–69 years at five pilot sites in Spain, Lithuania, Poland and Ireland were invited to risk-stratified screening comprising PSA testing, first-level risk stratification, MRI for intermediate or high risk and selective biopsy, with prospective capture in a central REDCap database. EUCanScreen pilots and the Swedish organised prostate cancer testing (OPT) programme reported the same KPIs through an online survey. Results. Twelve programmes reported KPI values. Across the five PRAISE-U pilots, participation ranged from 7.1% to 43.0%, PSA exceeded 3 ng/ml in 9.2–15.0%, and compliance was 76.4–96.0% for first-level risk assessment, 89.9–98.3% for MRI and 78.9–99.0% for biopsy. Detection ranged from 8 to 26 per 1,000 screened in PRAISE-U and from 4.3 to 28 across all programmes. ISUP grade 1 accounted for 20.3–81.4% of cancers, active-surveillance uptake for 14.8–100%, and mean time from PSA result to MRI for 19–114 days; external values fell broadly within the PRAISE-U ranges. Thirteen of 21 KPIs were fully reported by all five pilots, all describing the diagnostic pathway; retention and the three impact indicators were reported only by Sweden, which reported 19 of 21. Conclusions. Diagnostic-pathway KPIs were measurable under pilot conditions, whereas programme-level indicators required a defined target population or registry linkage. Sweden, the only population-based programme, reported retention and long-term impact, identifying the infrastructure needed before organised PCa screening can be monitored at scale.

Introduction: Cancer patients may face elevated mortality not only from their malignancy but also from other factors including multi‐morbidity and the impact of treatment‐related complications. This study analyses mortality from all causes other than the index cancer among cancer patients compared to the general population. Methods: We analysed EUROCARE‐6 data on 1,894,057 cancers diagnosed in 13 European countries and collected by 17 cancer registries with complete official cause‐of‐death information. Included were first‐primary head and neck (H&N), stomach, colorectal, lung, breast, cervical, endometrial, ovarian, prostatic, kidney, and bladder cancers diagnosed between 1998 and 2013 in patients aged 15–79, with follow‐up until 31st December 2014. We estimated the relative risk (RR) of death from all other causes for patients relative to population mortality rates. Cause‐specific survival (CSS) was compared to relative survival (RS) at 5 and 10 years. Results: RR were > 2 for H&N and female lung cancers, between 1 and 2 for stomach, male lung, cervix, endometrial, ovary, kidney and bladder, and < 1 for prostate and female breast cancers. Relative risk declined with increasing age for almost all cancer types. Ten‐year CSS exceeded RS by 7%–11% points (pp) in H&N cancers, with smaller differences in bladder (2–6 pp), stomach, lung, cervix, ovary and kidney (2–3 pp). CSS was lower than RS in breast and prostate cancers. Conclusion: Differentiation between deaths due to the index cancer and to all other causes is crucial for patient follow‐up and to improve quality of life. Cause‐of‐death data should be a core component of population‐based cancer registries to inform interpretation of survivorship data.

Effective cervical cancer screening and progress toward WHO elimination targets depend on complete follow‐up for women with positive primary screening tests. However, real‐world data on this critical step in hrHPV‐based screening programs in Eastern Europe are scarce. We conducted a nationwide, population‐based retrospective cohort study in Estonia, analyzing records from the Estonian Health Insurance Fund and Population Register. We included 44,282 women aged 30–65 who were invited to hrHPV‐based screening between January 1, 2021, and December 31, 2022, with follow‐up through March 31, 2024. Screening attendance was 45.7% ( n = 20,242; 95% CI: 45.2%–46.2%), with 8.0% ( n = 1615; 95% CI: 7.6%–8.4%) testing hrHPV‐positive. A substantial loss to follow‐up was observed: 57.7% of hrHPV‐positive women did not undergo repeat hrHPV testing, colposcopy, or any post‐colposcopy care within 12 months. Among those referred for further diagnosis, colposcopy was performed in 77.9% within 6 months. Treatment for High‐Grade Squamous Intraepithelial Lesion (HSIL) cases was high (85.5%; n = 124; 95% CI: 78.7%–90.5%), mostly within 3 months. Predictors of lower follow‐up adherence included older age and residence in South Estonia. Suboptimal screening uptake and high loss to follow‐up among hrHPV‐positive women are significant barriers to effective cervical cancer prevention in Estonia. These challenges mirror those seen in many organized screening programs globally. Prioritizing strategies to enhance follow‐up adherence is critical for timely diagnosis and treatment, ultimately accelerating global efforts toward cervical cancer elimination.

Cervical cancer (CC) mortality in the Baltic countries remains high. We explored CC mortality trends and educational inequalities in CC mortality in the Baltics in the context of organized CC screening (introduced in 2004 in Lithuania, 2006 in Estonia and 2009 in Latvia) and compared the results with Finland (where screening started in 1963). Data for the Baltic countries came from longitudinal mortality follow‐up studies of population censuses in 2000/2001 and 2011, and data for Finland from the longitudinal register‐based population data file of Statistics Finland. CC deaths (ICD‐10 code C53) were linked from national mortality registries. Information on education was census‐ or register‐based. Overall and education‐specific age‐standardized mortality rates (ASMRs) and mortality rate ratios were calculated for 2000–2007 and 2008–2015 for women aged 30–49 and 50–64 years. The Baltic countries had 5–9 times higher overall ASMRs than Finland and much larger inequalities in CC mortality between low‐ and highly educated women. From 2000–2007 to 2008–2015 absolute inequalities in younger women reduced in all countries, except Latvia and relative inequalities increased in Estonia and Latvia. In older women, absolute inequalities increased in the Baltics but not in Finland; relative inequalities increased in all countries. The reduction in CC mortality and in absolute inequalities in younger women in Estonia and Lithuania may be associated with the introduction of organized screening. However, increasing CC mortality among older low‐educated women in the Baltic countries is alarming, indicating that they have not benefitted equally from CC prevention.

Background: Cervical cancer incidence in Estonia ranks among the highest in Europe, but screening attendance has remained low. This randomized study aimed to evaluate the impact of opt-in and opt-out human papillomavirus (HPV) self-sampling options on participation in organized screening. Methods: A random sample of 25,591 women were drawn from the cervical cancer screening target population who were due to receive a reminder in autumn 2021 and thereafter randomly allocated to two equally sized intervention arms (opt-out and opt-in) receiving a choice between HPV self-sampling or clinician sampling. In the opt-out arm, a self-sampler was sent to home address by regular mail; the opt-in arm received an e-mail containing a link to order a self-sampler online. The remaining 30,102 women in the control group received a standard reminder for conventional screening. Participation by intervention arm, age and region of residence was calculated; a questionnaire was used to assess self-sampling user experience. Results: A significant difference in participation was seen between opt-out (41.7%) (19.8% chose self-sampling and 21.9% clinician sampling), opt-in (34.1%) (7.9% self-sampling, 26.2% clinician sampling) and control group (29.0%, clinician sampling only). All age groups and regions in the intervention arms showed higher participation compared to the control group, but the size of the effect varied. Among self-sampling users, 99% agreed that the device was easy to use and only 3.5% preferred future testing at the clinic. Conclusion: Providing women with a choice between self-sampling and clinician sampling significantly increased participation in cervical cancer screening. Opt-in and opt-out options had a different effect across age groups, suggesting the need to adapt strategies.

Recurrence after colorectal cancer resection is rarely documented in the general population while a key clinical determinant for patient survival. We identified 8785 patients with colorectal cancer diagnosed between 2010 and 2013 and clinically followed up to 2020 in 15 cancer registries from seven European countries (Bulgaria, Switzerland, Germany, Estonia, France, Italy, and Spain). We estimated world age‐standardized net survival using a flexible cumulative excess hazard model. Recurrence rates were calculated for patients with initially resected stage I, II, or III cancer in six countries, using the actuarial survival method. The proportion of nonmetastatic resected colorectal cancers varied from 58.6% to 78.5% according to countries. The overall 5‐year net survival by country ranged between 60.8% and 74.5%. The absolute difference between the 5‐year survival extremes was 12.8 points for stage II (Bulgaria vs Switzerland), 19.7 points for stage III (Bulgaria vs. Switzerland) and 14.8 points for Stage IV and unresected cases (Bulgaria vs. Switzerland or France). Five‐year cumulative rate of recurrence among resected patients with stage I–III was 17.7%. As compared to the mean of the whole cohort, the risk of developing a recurrence did not differ between countries except a lower risk in Italy for both stage I/II and stage III cancers and a higher risk in Spain for stage III. Survival after colorectal cancer differed across the concerned European countries while there were slight differences in recurrence rates. Population‐based collection of cancer recurrence information is crucial to enhance efforts for evidence‐based management of colorectal cancer follow up.