Measuring the Burden of Cancer in Russia

Cancer is a major global health threat. Despite progress in cancer management, the number of deaths is increasing. The growing cancer burden is driven by population ageing and suboptimal approaches to cancer control, but there are marked differences in cancer incidence and mortality globally. Russia is the largest country in Europe, representing about 14% of the European population with cancer mortality above the average European rates. Unfortunately, cancer epidemiologic studies are carried out sporadically in Russia. They rarely include comprehensive cancer burden analysis. The cancer trends analysis could explain historical changes, predict future burdens, and set cancer control goals.

Well-validated population-based cancer registries (PBCRs) are reliable and unique sources of structured information for cancer surveillance and multiple research purposes. Russia, then part of the USSR, introduced compulsory cancer registration in 1953. However, regional PBCRs, which collect and store individual-level data, were fully established nationally only in 1999. The four key aspects of quality: comparability, validity, completeness, and timeliness, were never applied to evaluate the quality of cancer registration in Russia.

This study aimed to assess the quality of cancer statistics in regions of Northwest Russia. Data from ten Russian PBCRs from regions with a population of approximately 13 million were processed and analysed. Overall, data collection in Northwest Russia was according to international standards; even though national instructions for cancer registration were outdated, it was generally comparable. The proportion of multiple primaries ranged from 6.7% in Vologda Oblast to 12.4% in St. Petersburg (between 2008 and 2017), similar to most European PBCRs. Substantial regional heterogeneity for most indicators of quality was observed. Certain cancer types (e.g., pancreas, liver, haematological malignancies, and CNS tumours) and cancers in older age groups showed lower validity and completeness. The overall quality of PBCRs data of at least four Northwest regions meets international standards.

The study covered the incidence and mortality trends of two cancer types in women in Russia, breast and cervical cancer, and predicted the future burden. Breast and cervical cancer incidence age-standardised rates (Segi-Doll world standard population) increased from 33.0 to 47.0 per 100,000 and 10.6 to 14.2 per 100,000, respectively. Breast cancer mortality ASRs declined from 17.6 to 15.7 per 100,000 in 2013. At the same time, cervical cancer mortality ASRs increased steadily from 5.6 to 6.7 per 100,000. Changes in the risk in cohorts born between 1937-1953 indicated a recent generational decrease in breast cancer mortality and an increase in cervical cancer incidence and mortality. The annual years of life lost to cervical cancer mortality could reach 1.2 million, and years of life lost to breast cancer could decline to 1.8 million by 2030. These changes highlight the need to prioritise national screening and vaccination programs.

This study also focused on national mortality trends collected through the centralised state civil registration system. Cancer burden related to mortality data was approached through years of life lost and productivity losses. Mortality for most cancer types decreased between 2001 and 2015. There was an upward trend for melanoma, pancreas, brain and CNS cancer mortality. In addition, larynx, lip, oral and pharynx, and cervical cancer mortality increased only in women and prostate cancer mortality in men. Overall, years of life lost increased for most cancer types. Productivity losses due to premature cancer mortality amounted to $8 billion. The losses were expected to drop from 0.28% of GDP in 2001 to 0.14% in 2030, primarily because of a decline in cancer mortality. The increase in productivity losses was highest for HPV-related cancer mortality. The losses in absolute terms were highest for breast cancer in women and lung cancer in men.

This study sets a standard for measuring the burden of cancer in Russia. It includes a comprehensive assessment of PBCRs data quality, which is supposed to guide changes in cancer registration procedures and practices. National cancer statistics can be enhanced through contemporary trend analysis, predictions, and additional measures like years of life lost and costs. Future research projects should focus on specific cancer types to guide a pragmatic approach to evidence-based cancer control activities supported by cancer epidemiologic research.