ESTIMATING THE EFFICIENCY OF THREE NATIONAL CANCER SCREENING PROGRAMMES USING THE POPULATION-BASED CANCER REGISTRY DATA IN SLOVENIA Vesna ZADNIK MD, PhD Slovenian Cancer Registry Institute of Oncology Ljubljana ww.slora.si/en www.onko-i.si/en/crs vzadnik@onko-i.si

BACKGROUND: SLOVENIA SLOVENIA App: 20,000 km2 2 million inhabitants

BACKGROUND: SLOVENIAN CANCER REGISTY General cancer registry Population-based Compulsory notification since 1950 PIN Follow-up through Central Population Registry Linkage to screening registries database

BACKGROUND: CERVICAL CANCER SCREENING ZORA started 2003 conventional cytology 3 years interval age 20–64 participation 72%

BACKGROUND: COLORECTAL CANCER SCREENING SVIT started 2009 immunochemical fecal occult blood test, follow up colonoscopy 2 years interval age 50–74 participation 62%

BACKGROUND: BREAST CANCER SCREENING DORA started 2008 in central region, countrywide in 2018 digital mammography 2 years interval age 50–69 participation 73%

METHODS SCR data: C53, C18-C20, C50 INCIDENCE TREND: APC (before/after screening) SCR data linked to screening registries: ATTENDANCE analysis of screened age groups NET SURVIVAL (screend/non-screened) RISK OF DYING (screend/non-screened) STAGE DISTRIBUTION (screend/non-screened) Incidence for CerC and CRC for all pts diagnosed in Slovenia from SP start. Stage distribution, net survival and hazard ratio (HR) of death for screen vs not screen detected cancers diagnosed with CerC, CRC and BC from 2011-2015 for all invited patients to the SPs

RESULTS: CERVICAL CANCER SCREENING incidence trend ZORA Fifteen years after ZORA started, the incidence of cervical cancer has decreased for more than 50%

RESULTS: CERVICAL CANCER SCREENING net survival ZORA 5-yeat net survival: SCREENED / NON-SCREENED 92.1% / 63.7% HR: SCREENED / NON-SCREENED 0.18 (0.11 – 0.28)

RESULTS: CERVICAL CANCER SCREENING stage distribution ZORA

RESULTS: COLORECTAL CANCER SCREENING incidence trend SVIT APC-males: 2001-2010: + 7.6% 2010-2015: - 5.2% APC-females: 2001-2010: + 3.9% 2010-2015: - 4.5%

RESULTS: COLORECTAL CANCER SCREENING net survival SVIT 5-yeat net survival: SCREENED / NON-SCREENED 88.4% / 57.1% HR: SCREENED / NON-SCREENED 0.26 (0.23-0.29)

RESULTS: COLORECTAL CANCER SCREENING stage distribution SVIT

BACKGROUND: BREAST CANCER SCREENING net survival DORA 5-yeat net survival: SCREENED / NON-SCREENED 100% / 89% HR: SCREENED / NON-SCREENED HR 0.17 (0.10-0.31).

BACKGROUND: BREAST CANCER SCREENING stage distribution DORA

CONCLUSIONS Slovenian population-based cancer registry database is adequate for estimating the efficiency of three national cancer screening programmes. Soon after the introduction of organised cancer screenings in Slovenia the two basic cancer burden indicators incidence and survival have improved dramatically. Pts with screen detected cancers are diagnosed in earlier stages and have lower probability to die from cancer. The two presented and many other cancer burden indicators reported by the PBCRs are (also in Slovenia) most important for planning and evaluation of national cancer screening programmes.