CANCER INCIDENCE IN BULGARIA 2006 ЗАБОЛЯЕМОСТ ОТ РАК В БЪЛГАРИЯ, 2006
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1 NATIONAL ONCOLOGICAL HOSPITAL НАЦИОНАЛНА БОЛНИЦА ПО ОНКОЛОГИЯ BULGARIAN NATIONAL CANCER REGISTRY БЪЛГАРСКИ НАЦИОНАЛЕН РАКОВ РЕГИСТЪР CANCER INCIDENCE IN BULGARIA 2006 ЗАБОЛЯЕМОСТ ОТ РАК В БЪЛГАРИЯ, 2006 Volume XVII 2008 Редактори Здрaвка Валерианова Mирчо Вуков Надя Димитрова Editors Zdravka Valerianova Mircho Vukov Nadya Dimitrova Издателство АВИС-24 ООД Publisher AVIS-24 Ltd.
2 БЪЛГАРСКИ НАЦИОНАЛЕН РАКОВ РЕГИСТЪР ПЕРСОНАЛ доц. д-р Здравка Г. Валерианова, дм ръководител регистър д-р Надя Е. Димитрова Мария С. Данова Минка М. Ненова Тинка П. Кунева Йовка К. Петкова Минка Р. Йорданова Лиляна Н. Узунова Теодора Й. Грозева Димитър Хр. Христов Траян Й. Атанасов BULGARIAN NATIONAL CANCER REGISTRY STAFF Zdravka G. Valerianova, MD, PhD Head of BNCR Nadya Е. Dimitrova, MD Maria S. Danova Minka M. Nenova Tinka P. Kuneva Iovka K. Petkova Minka R. Yordanova Lilyana N. Uzunova Teodora Y. Grozeva Dimitar H. Hristov Trayan Y. Atanasov ЗА ИНФОРМАЦИЯ Здравка Г. Валерианова FOR INFORMATION Zdravka G. Valerianova БЪЛГАРСКИ НАЦИОНАЛЕН РАКОВ РЕГИСТЪР Пловдивско поле СОФИЯ, БЪЛГАРИЯ тел/факс: 02/ , тел: факс: 02/ е-mail: BNCR_Zdravka@netbg.com web site: BULGARIAN NATIONAL CANCER REGISTRY 6, Plovdivsko pole Str SOFIA, BULGARIA tel/fax: / , fax: / е-mail: BNCR_Zdravka@netbg.com web site:
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6 REPUBLIC OF BULGARIA Republic of Bulgaria is situated in South-Eastern Europe, on the Balkan Peninsula, between and N (northern latitude) and and E (eastern longitude). Its total area is sq. km. Bulgaria is at the border of line between the temperate and Mediterranean climatic areas. In its Northern part, the climate is temperate continental, whereas the southern part is influenced by the Mediterranean Sea. The population of Bulgaria is (2006). The country is divided into 28 administrative districts and about 70% of the population lives in urban areas. The predominant religion in the country is Eastern Orthodox (85% of the population), followed by Muslims (13%), and Catholics (1%). A specialized cancer network was founded in Bulgaria in It consists of 13 Regional Oncological Centers (dispensaries) and a National Oncological Hospital in Sofia. The Regional Oncological Registries are part of the structure of each Regional Oncological Center, and the Bulgarian National Cancer Registry (BNCR) of the National Oncological Hospital. In the country exists a compulsory registration of malignant neoplasm, regulated by a Ministry of Health Instruction 858/ , a Ministry of Health Order RD / and a Ministry of Health Regulation 34/ Every physician/medical worker is required to send a rapid notification to the Regional Oncological Center for each newly diagnosed cancer case, for a person suspected of having cancer or for those dying from a malignant neoplasm, and since 1975 for carcinoma in situ, as well, by the patient s permanent residence. The BNCR uses active and passive methods of data collection. The personnel of the Regional Oncological Registries periodically visits the regional health facilities, which provide service, as well as actively seek all cases of malignant neoplasm and carcinoma in situ, unknown to the certain registry. Another source of information on cancer patients are death certificates. The BNCR receives information from all Regional Oncological Registries around the country. The data are verified for range and completeness, duplication, and consistency between clinical and morphological diagnosis. The most recent update of the rapid notification was introduced in 1992 (Nomenclature 2 concerning medical forms, serial 120А of the Ministry of Health). For 1993 the cancer patients have been following up by type of treatment and date of death, as well. In January 2005 the X th revision of the International Classification of Diseases (ICD) since 1992 was introduced in Bulgaria. All cases of malignant neoplasm dated after 1993 (the initial year of cases identification by person) had to be recoded, according to the new classification requirements. The localization is coded according to the four-digit rubrics for all malignant neoplasm (С00 - С97), carcinoma in situ (D00 - D09) and for D39.0, D42, D43, D45, D46, D47.1, D47.3 which are changed from Borderline to Malignant according to ICD-O, Third edition, A software product Oncology , has been developed to serve the needs of registration of cancer cases and was implemented throughout the country in all Regional Oncological Centers at the beginning of The software meets all requirements of Standards and Guidelines for Cancer Registration in Europe, IARC Technical Publication 40, 2003, for coding of certain variables. It also allows additional information for cancer cases to be collected, for example: information for metastases localization; Clark and Breslow for the malignant melanoma of skin; estrogen and progesterone receptors of breast cancer; new information about the type of medical facility, where the initial treatment happened during the first year after cancer diagnoses. The introduction of the new classification required presenting of some data according to the old IX th and the new X th revision of ICD. The tables about basis of diagnosis and distribution by stage keep the same coding for malignant neoplasm from the old IX th revision, due to the fact that the new ICD happened in Data is represented according to both, the old and the new classification, in order not to disrupt the tendency of 6
7 standardized incidence rate by sex, established in New information for cancer cases sorted by site, sex, morphology and their distribution by age groups and country districts is represented in compliance with the X th revision. Data about some organizational aspects of cancer control is presented in three consecutive tables. The first table includes the distribution of the newly diagnosed cancer cases by basis of diagnosis. The second includes data by stage according to the cancer site, throughout the country. The last one contains information about the three major cancer sites (breast cancer, cervix uteri cancer and prostate cancer) sorted by country district for which there are no introduced organized population-based screening in the country. In this issue is presented data about the distribution of the new cancer cases of lung, breast, colon, rectum, cervix uteri and prostate by morphological type. Primary site is the topographic site, where the tumour originated. If there are two or more tumors of different histological types and/or localization, they are considered as two cases. When determining the multiple primary cancers the rules of the International Association of Cancer Registries (IACR) are followed. On December the 4th, 1992 a census of the population in Bulgaria was carried out. It was observed that the population has diminished with people for the preceding three years mainly due to emigration. Because of that, a recalculation of the incidence rates for 1989, 1990 and 1991 was necessary. When using volumes one and two of Cancer Incidence in Bulgaria, one must take into account that the rates have been calculated before the correction of the population. A check of the Unified System for Civil Registration and Administrative Services to the Population ESGRAON was made for all cancer cases died since 1998 in order to improve the malignant neoplasm registration system in accordance with IARC requirements. Population and mortality data, published in the current issue, is provided by The National Statistical Institute. All records are kept stored according to The Archives Law from 1974 and The Health Law from The data on malignant neoplasms incidence, as well as the included additional data, is used for epidemiological studies, for public health administering, etc. This information is available to all individuals and institutions interested according to the legislation of the country for data confidentiality. 7
8 THE MEAN POPULATION OF BULGARIA BY AGE AND SEX 2006 AGE TOTAL MALES FEMALES ALL AGES THE MEAN POPULATION OF BULGARIA BY SEX AND DISTRICTS 2006 DISTRICT TOTAL MALES FEMALES BLAGOEVGRAD BOURGAS YAMBOL VARNA DOBRICH VELIKO TURNOVO GABROVO VRATSA VIDIN MONTANA PLEVEN LOVECH PLOVDIV PAZARDJIK SMOLYAN ROUSSE RAZGRAD SILISTRA SOFIA CITY SOFIA DISTRICT KYUSTENDIL PERNIK STARA ZAGORA SLIVEN HASKOVO KURDJALI SHOUMEN TURGOVISHTE
9 CANCER INCIDENCE IN BULGARIA 2006 DISTRIBUTION OF THE NEW CASES BY PRIMARY S AND SEX CODE NUMBER MALES CRUDE DATA % NUMBER FEMALES CRUDE DATA % NUMBER TOTAL CRUDE DATA % C00-97 ALL S C00 LIP C01-02 TONGUE C03-06 MOUTH C07-08 SALIVARY GLANDS C09 TONSIL C10 OTHER OROPHARYNX C11 NASOPHARYNX C12-13 HYPOPHARYNX C14 PHARYNX UNSPECIFIED C15 OESOPHAGUS C16 STOMACH C17 SMALL INTESTINE C18 COLON C19-21 RECTUM AND ANUS C22 LIVER C23-24 GALLBLADDER AND EXTRAHEPATIC BILE DUCTS C25 PANCREAS C30-31 NOSE, SINUSES C32 LARYNX C33-34 TRACHEA, BRONCHUS, LUNG C37-38 OTHER THORACIC ORGANS C40-41 BONE C43 MELANOMA OF SKIN C44 OTHER SKIN C45 MESOTHELIOMA C46 KAPOSI S SARCOMA C47,C49 CONNECTIVE AND SOFT TISSUE C50 BREAST C51 VULVA C52 VAGINA C53 CERVIX UTERI C54 CORPUS UTERI C55 UTERUS UNSPECIFIED C56 OVARY C57 OTHER FEMALE GENITAL ORGANS C58 PLACENTA C60 PENIS C61 PROSTATE C62 TESTIS C63 OTHER MALE GENITAL ORGANS C64 KIDNEY C65 RENAL PELVIS C66 URETER C67 BLADDER C68 OTHER URINARY ORGANS C69 EYE C70-72 BRAIN, NERVOUS SYSTEM C73 THYROID GLAND C74 ADRENAL GLAND C75 OTHER ENDOCRINE GLANDS C81 HODGKIN S DISEASE C82-85, C96 NON-HODGKIN S LYMPHOMA C88 IMMUNOPROLIFERATIVE DISEASES C90 MULTIPLE MYELOMA C91 LYMPHOID LEUKAEMIA C92 MYELOID LEUKAEMIA C93 MONOCYTIC LEUKAEMIA C94 OTHER LEUKAEMIAS C95 LEUKAEMIA UNSPECIFIED C26,C39, C48, OTHERS AND UNSPECIFIED S C76, C C00-97 BUT C44 ALL S BUT NON-MELANOMA SKIN D06 NOT INCLUDED ABOVE CA IN SITU OF CERVIX UTERI
10 Vidin Montana Pernik Kystendil VRATSA SOFIA BLAGOEVGRAD Bulgarian National Cancer Registry SPECIALIZED CANCER NETWORK IN BULGARIA ROUSSE Razgrad PLEVEN Turgovishte VELIKO TURNOVO Lovech Gabrovo Sliven STARA ZAGORA Yambol Pazardjik PLOVDIV HASKOVO Smolyan Kurdjali Regional Cancer Registry Silistra Dobrich SHOUMEN VARNA BOURGAS District City 10
11 PERCENTAGE DISTRIBUTION OF CANCER INCIDENCE IN MALES BULGARIA 2006 OTHER SKIN 10,3 % PROSTATE 8,7 % COLON 7,9 % STOMACH 6,3 % LUNG, TRACHEA AND BRON 18,4 % RECTUM AND ANUS 6,7 % BLADDER 6,8 % PANCREAS 3,7 % LARYNX 3,4 % OTHER 27,8 % PERCENTAGE DISTRIBUTION OF CANCER INCIDENCE IN FEMALES BULGARIA 2006 CORPUS 7,8 % OTHER SKIN 9,7 % CERVIX 7,7 % COLON 7,5 % OVARY ETC. 5,3 % BREAST 22,8 % RECTUM AND ANUS 5,2 % STOMACH 4,5 % LUNG, TRACHEA AND BRON 3,9 % OTHER 25,6 % 11
12 AGE-STANDARDIZED AND CRUDE INCIDENCE RATES OF ALL CANCERS IN MALES BULGARIA AGE-STANDARDIZED AND CRUDE INCIDENCE RATES OF ALL CANCERS IN FEMALES BULGARIA
13 AGE-SPECIFIC INCIDENCE RATES FOR ALL CANCERS IN MALES BULGARIA, 1981 AND AGE-SPECIFIC INCIDENCE RATES FOR ALL CANCERS IN FEMALES BULGARIA, 1981 AND
14 AGE-STANDARDIZED INCIDENCE RATES (WORLD STANDARD) OF THE MOST COMMON CANCERS IN MALES BULGARIA AGE-STANDARDIZED INCIDENCE RATES (WORLD STANDARD) OF THE MOST COMMON CANCERS IN FEMALES BULGARIA
15 AGE-ADJUSTED (WORLD STANDARD) INCIDENCE RATES PER FOR ALL CANCERS BY DISTRICTS IN BULGARIA MALES < from to from to from to > AGE-ADJUSTED (WORLD STANDARD) INCIDENCE RATES PER FOR ALL CANCERS BY DISTRICTS IN BULGARIA FEMALES < from to from to from to >
16 16 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C00-97 ALL S C00 LIP C C C C C C01 BASE OF TONGUE C02 OTHER AND UNSPECIFIED PARTS OF TONGUE C C C C C C C03 GUM C C C C04 FLOOR OF MOUTH C C C C C05 PALATE C C C C C06 OTHER AND UNSPECIFIED PARTS OF MOUTH C C C C C C07 PAROTID GLAND C08 OTHER AND UNSPECIFIED MAJOR SALIVARY GLANDS C C Part 1 ALL AGES
17 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C09 TONSIL C C C C C10 OROPHARYNX C C C C C C C11 NASOPHARYNX C C C C C C C12 PYRIFORM SINUS C13 HYPOPHARYNX C C C C C14 OTHER AND ILL-DEFINED S IN LIP, ORAL CAVITY AND PHARYNX C C C15 OESOPHAGUS C C C C C C C C C16 STOMACH C C Part 2 ALL AGES 17
18 18 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C C C C C C C C17 SMALL INTESTINE C C C C C C18 COLON C C C C C C C C C C C19 RECTOSIGMOID JUNCTION C20 RECTUM C21 ANUS AND ANAL CANAL C C C C C22 LIVER AND INTRAHEPATIC BILE DUCTS C C C C C C23 GALLBLADDER C24 OTHER AND UNSPECIFIED PARTS OF BILIARY TRACT C Part 3 ALL AGES
19 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C C C25 PANCREAS C C C C C C C C C26 OTHER AND ILL-DEFINED DIGESTIVE ORGANS C C C30 NASAL CAVITY AND MIDDLE EAR C C C31 ACCESSORY SINUSES C C C C C32 LARYNX C C C C C C C33 TRACHEA C34 BRONCHUS AND LUNG C C C C C C C37 THYMUS C38 HEART, MEDIASTINUM, AND PLEURA Part 4 ALL AGES 19
20 20 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C C C C C C39 OTHER AND ILL-DEFINED S WITHIN RESPIRATORY SYSTEM AND INTRATHORACIC ORGANS C C40 BONES, JOINTS AND ARTICULAR CARTILAGE OF LIMBS C C C C C C41 BONES, JOINTS AND ARTICULAR CARTILAGE OF OTHER AND UNSPECIFIED S C C C C C C43 MELANOMA OF SKIN C C C C C C C C C C44 OTHER SKIN C C C C Part 5 ALL AGES
21 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C C C C C C C45 MESOTHELIOMA C C C C46 KAPOSI S SARCOMA C C C47 PERIPHERAL NERVES AND AUTONOMIC NERVOUS SYSTEM C C C C C48 RETROPERITONEUM AND PERITONEUM C C C C49 CONNECTIVE AND OTHER SOFT TISSUES C C C C C C C C C C50 BREAST C C C C C Part 6 ALL AGES 21
22 22 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C C C60 PENIS C C C C C C61 PROSTATE GLAND C62 TESTIS C C C C63 OTHER AND UNSPECIFIED MALE GENITAL ORGANS C C C C64 KIDNEY C65 RENAL PELVIS C66 URETER C67 BLADDER C C C C C C C C C C C68 OTHER AND UNSPECIFIED URINARY ORGANS C C C69 EYE AND ADNEXA C C C C C Part 7 ALL AGES
23 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C C C70 MENINGES C C C C71 BRAIN C C C C C C C C C C C72 SPINAL CORD, CRANIAL NERVES, AND OTHER PARTS OF CENTRAL NERVOUS SYSTEM C C C73 THYROID GLAND C74 ADRENAL GLAND C C C C75 OTHER ENDOCRINE GLANDS AND RELATED STRUCTURES C C C C76 OTHER AND ILL-DEFINED S C C C C C80 MALIGNANT NEOPLASM WITHOUT SPECIFICATION OF C81 HODGKIN S DISEASE Part 8 ALL AGES 23
24 24 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C C C C C82 FOLLICULAR NON-HODGKIN S LYMPHOMA C C C C C83 DIFFUSE NON-HODGKIN S LYMPHOMA C C C C C C C C C C C84 PERIPHERAL AND CUTANEOUS T-CELL LYMPHOMAS C C C C C C85 OTHER AND UNSPECIFIED TYPES OF NON-HODGKIN S LYMPHOMA C C C C C88 MALIGNANT IMMUNOPROLIFERATIVE DISEASES C C Part 9 ALL AGES
25 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 MALES AGE AT DIAGNOSIS C90 MULTIPLE MYELOMA AND MALIGNANT PLASMA CELL NEOPLASMS C C C C91 LYMPHOID LEUKAEMIA C C C C C C92 MYELOID LEUKAEMIA C C C C C C C93 MONOCYTIC LEUKAEMIA C C C94 OTHER LEUKAEMIAS OF SPECIFIED CELL TYPE C C C C C95 LEUKAEMIA, UNSPECIFIED CELL TYPE C C C C96 OTHER AND UNSPECIFIED NEOPLASMS OF LYMPHOID, BLOOD FORMING AND RELATED TISSUES C C Part 10 ALL AGES 25
26 26 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 FEMALES AGE AT DIAGNOSIS C00-97 ALL S C00 LIP C C C C C C C C01 BASE OF TONGUE C02 OTHER AND UNSPECIFIED PARTS OF TONGUE C C C C C C C03 GUM C C C C04 FLOOR OF MOUTH C C C05 PALATE C C C06 OTHER AND UNSPECIFIED PARTS OF MOUTH C C C C07 PAROTID GLAND C08 OTHER AND UNSPECIFIED MAJOR SALIVARY GLANDS C C C09 TONSIL C C Part 1 ALL AGES
27 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 FEMALES AGE AT DIAGNOSIS C C10 OROPHARYNX C C C C11 NASOPHARYNX C C C C C C C13 HYPOPHARYNX C C C14 OTHER AND ILL-DEFINED S IN LIP, ORAL CAVITY AND PHARYNX C C C15 OESOPHAGUS C C C C C C C C16 STOMACH C C C C C C C C C C17 SMALL INTESTINE C C Part 2 ALL AGES 27
28 28 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 FEMALES AGE AT DIAGNOSIS C C C18 COLON C C C C C C C C C C C19 RECTOSIGMOID JUNCTION C20 RECTUM C21 ANUS AND ANAL CANAL C C C C22 LIVER AND INTRAHEPATIC BILE DUCTS C C C C C23 GALLBLADDER C24 OTHER AND UNSPECIFIED PARTS OF BILIARY TRACT C C C C C25 PANCREAS C C C C C C C26 OTHER AND ILL-DEFINED DIGESTIVE ORGANS C Part 3 ALL AGES
29 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 FEMALES AGE AT DIAGNOSIS C C30 NASAL CAVITY AND MIDDLE EAR C C C31 ACCESSORY SINUSES C C C32 LARYNX C C C C C C33 TRACHEA C34 BRONCHUS AND LUNG C C C C C C C37 THYMUS C38 HEART, MEDIASTINUM, AND PLEURA C C C C C C40 BONES, JOINTS AND ARTICULAR CARTILAGE OF LIMBS C C C C C C41 BONES, JOINTS AND ARTICULAR CARTILAGE OF OTHER AND UNSPECIFIED S Part 4 ALL AGES 29
30 30 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 FEMALES AGE AT DIAGNOSIS C C C C C C C43 MELANOMA OF SKIN C C C C C C C C C44 OTHER SKIN C C C C C C C C C C C45 MESOTHELIOMA C C C46 KAPOSI S SARCOMA C C C C47 PERIPHERAL NERVES AND AUTONOMIC NERVOUS SYSTEM C C C C48 RETROPERITONEUM AND PERITONEUM Part 5 ALL AGES
31 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 FEMALES AGE AT DIAGNOSIS C C C C C49 CONNECTIVE AND OTHER SOFT TISSUES C C C C C C C C C C50 BREAST C C C C C C C C C C51 VULVA C C C C C C52 VAGINA C53 CERVIX UTERI C C C C C54 CORPUS UTERI C C C C Part 6 ALL AGES 31
32 32 CODE NUMBER OF NEW CANCER CASES BY PRIMARY S AND AGE AT DIAGNOSIS IN BULGARIA 2006 FEMALES AGE AT DIAGNOSIS C C C55 UTERUS, NOS C56 OVARY C57 OTHER AND UNSPECIFIED FEMALE GENITAL ORGANS C C C C58 PLACENTA C64 KIDNEY C65 RENAL PELVIS C66 URETER C67 BLADDER C C C C C C C C C C68 OTHER AND UNSPECIFIED URINARY ORGANS C C69 EYE AND ADNEXA C C C C C C C70 MENINGES C C C C71 BRAIN C C C Part 7 ALL AGES
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