Comparison of breast cancer and cervical cancer stage distributions in ten newly independent states of the former Soviet Union: a population-based study

Ryzhov A. Corbex M. Piñeros M. Barchuk A. Andreasyan D. Djanklich S. Ghervas V. Gretsova O. Kaidarova D. Kazanjan K. Mardanli F. Michailovich Y. Ten E. Yaumenenka A. Bray F. Znaor A.
March 2021 Lancet Publishing Group

The Lancet Oncology
2021 #22 Issue 3 361 - 369 pp.

Background: Screening for breast cancer and cervical cancer in the newly independent states of the former Soviet Union is largely opportunistic, and countries in the region have among the highest cervical cancer incidence in the WHO European Region. We aimed to compare the stage-specific distributions and changes over time in breast cancer and cervical cancer incidence in the newly independent states of the former Soviet Union. Methods: We collected breast cancer and cervical cancer incidence data from official statistics from Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Ukraine, and Uzbekistan for the years 2008–17 by tumour, node, metastasis (TNM) stage, and by age where population-based cancer registry data were available. We used log-linear regression to quantify the changes over time in age-standardised rates. Findings: During the period 2013–17, more than 50% of breast cancer cases across the analysed countries, and more than 75% of breast cancer cases in Belarus, Kazakhstan, and Ukraine, were registered at stages I–II. The proportion of stage I breast cancer cases was highest in the screening age group (50–69 years) compared with other ages in Moldova and the Russian registries, but was highest in those aged 15–49 years in Georgia and Ukraine. Breast cancer stage-specific incidence rates increased over time, most prominently for stage I cancers. For cervical cancer, the proportions of cancers diagnosed at a late stage (stages III and IV) were high, particularly in Moldova and Armenia (>50%). The proportion of stage I cervical cancer cases decreased with age in all countries, whereas the proportions of late stage cancers increased with age. Stage-specific incidence rates of cervical cancer generally increased over the period 2008–17. Interpretation: Our results suggest modest progress in early detection of breast cancer in the newly independent states of the former Soviet Union. The high proportions of early-stage disease in the absence of mammography screening (eg, in Belarus) provide a benchmark for what is achievable with rapid diagnosis. For cervical cancer, there is a need to tackle the high burden and unfavourable stage-specific changes over time in the region. A radical shift in national policies away from opportunistic screening toward organised, population-based, quality-assured human papillomavirus vaccination and screening programmes is urgently needed. Funding: Union for International Cancer Control, WHO Regional Office for Europe, and Ministry of Health of Ukraine.

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Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
WHO Regional Office for Europe, Copenhagen, Denmark
Tampere University, Faculty of Social Sciences/Health Sciences, Tampere, Finland
NN Petrov National Research Medical Center of Oncology, Saint Petersburg, Russian Federation
National Institute of Health, Ministry of Health, Yerevan, Armenia
Republican Specialized Scientific Practical Medical Center of Oncology and Radiology, Tashkent, Uzbekistan
Institute of Oncology, Chisinau, Moldova
P A Hertsen Moscow Oncology Research Center—Branch of FSBI National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
National Center for Disease Control and Public Health, Tbilisi, Georgia
National Center of Oncology, Baku, Azerbaijan
Scientific and Production Centre for Preventive Medicine of the Ministry of Health, Bishkek, Kyrgyzstan
International Higher School of Medicine, IUK Academic Consortium, Bishkek, Kyrgyzstan
NN Alexandrov National Cancer Centre of Belarus, Minsk, Belarus

Cancer Surveillance Branch
National Cancer Registry of Ukraine
Taras Shevchenko National University of Kyiv
WHO Regional Office for Europe
Tampere University
NN Petrov National Research Medical Center of Oncology
National Institute of Health
Republican Specialized Scientific Practical Medical Center of Oncology and Radiology
Institute of Oncology
P A Hertsen Moscow Oncology Research Center—Branch of FSBI National Medical Research Radiological Center of the Ministry of Health of the Russian Federation
Kazakh Institute of Oncology and Radiology
National Center for Disease Control and Public Health
National Center of Oncology
Scientific and Production Centre for Preventive Medicine of the Ministry of Health
International Higher School of Medicine
NN Alexandrov National Cancer Centre of Belarus

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