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Cancer survival in Estonian migrants to Sweden
B Nilsson1, E Gustavson-Kadaka, T Hakulinen
1Unit of Cancer Epidemiology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden.
Objective:
To quantify the eventual extra loss of life incurred to cancer patients in Estonia compared with those in Sweden that was possibly attributable to differences in society.
Design:
Population based survival of cancer patients in Estonia was compared with that of Estonian immigrants to Sweden and that of all cancer patients in Sweden. The cancer sites studied were female breast and ovary, male lung and prostate, and male and female stomach and colon.
Setting:
Data on incident cases of cancer were obtained from the population based Swedish and Estonian cancer registries.
Participants:
Data from Estonian patients in Sweden, Estonian patients in Estonia, and patients from the total Swedish population were included in the study.
Main Results:
Differences in survival among the three populations, controlling for follow-up time and age at diagnosis, were observed in breast, colon, lung, ovarian, and prostate cancers. The survival rates of Estonians living in Sweden and the total population of Sweden were better than that of the Estonians living in Estonia. For cancers of the breast and prostate, the excess mortality in the older age group (75 and above) was much greater in Estonia than in the other populations.
Conclusions:
Most differences in cancer survival between Estonian and Swedish populations studied could be attributed to a longer delay in diagnosis, and also to inferior treatment (including access to treatment) in Estonia compared with Sweden. Estonia's lag in socioeconomic development, particularly in its public health organisation and funding, is probably the main source of the differences observed.