Osobitosti trendova incidencije i mortaliteta od melanoma kože u Hrvatskoj i zemljama jugoistočne Europe [Characteristics of incidence and mortality trends of malignant melanoma of the skin in Croatia and South-Eastern European countries]

Abstract

Aim. To explore cutaneous malignant melanoma (CM) incidence and mortality trends for males and females of different age groups in Croatia and South-Eastern European countries (SEE), identify possible changes in the trends, and compare them with the trends in North-Western European countries (NWE). Methods. Data on incident cases and deaths from CM in Croatia were obtained from the Croatian National Cancer Registry and the Croatian Bureau of Statistics. Agestandardized rates (World Standard Population) were used to estimate the average annual percent of change (AAPC) in incidence and mortality trends 1988-2008 by joinpoint regression analysis. Incidence and mortality rate ratios according to birth cohorts were calculated using age-period cohort (APC) modelling for 1989-2013 data. Data for SEE were obtained from 11 population-based cancer registries in Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, the Czech Republic, Malta, Romania, Serbia, Slovakia, Slovenia and Turkey. Using Bureau of Statistics data from individual countries, age-specific rates were calculated for 25-49 ('young'), 50- 69 ('middle aged') and 70+ years ('older') groups. Using joinpoint regression analysis, AAPC in incidence and mortality trends 2000-2010 were estimated according to the age group and sex. Results. In Croatia, during the period 1988-2008, CM incidence was increasing significantly, with AAPC of 5.9% for men and 5.6% for women, and so was mortality, with AAPC of 3.0% for men and 2.4% for women. APC analysis showed that incidence rates increased in successive generations of men, whilst in women the risk of CM attenuated for the cohorts born around 1970. Male cohorts born around 1984 had about six-fold and female about four-fold higher risk of CM than the referent 1944 cohorts. Risk of CM death increased in successive generations until cohorts born around 1970 for women, and appears still not to have reached the peak for male cohorts. Incidence rates of CM across SEE were uniformly increasing. Significant increases in mortality rates were observed in middle aged men in Serbia and Bulgaria, middle aged women in Slovenia, older men in the Czech Republic, Serbia and Turkey, and older women in Slovenia and Serbia. Conclusion. CM rates in Croatia are rising. Increasing generational incidence trends indicate the need for more primary prevention efforts. Lack of decline of mortality rates, in particular in men, suggests inequalities in early detection and the consequent need for targeted interventions. CM incidence rates were still increasing across SEE, mortality trends diverged and were less favourable than in NWE. Empowering cancer registration and improving the quality of incidence and mortality data will be essential for monitoring progress in CM control. Disparities in early detection appear to be widening the gap between SEE and NWE, while the provision of care to patients with advanced disease is likely to prove a challenge for regional healthcare budget