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The first studies

Erkki Saxén had from the outset thought it important that the Cancer Registry be both a registry and a research institute. At the beginning of its existence, it had been forced to concentrate on the creation and consolidation of the registry, but once this had been achieved, Saxén, with the support of the Cancer Registry Committee chaired by Atle M. Mali, was able to focus on the development of statistical and epidemiological research work.

Funding would have been needed to start the research, and the CSF, which was focused on expanding its hospital activities, was not in a position to provide it. When the association’s activities could not be built on the proceeds of fundraising and donations alone, Niilo Voipio decided to turn to the Finnish Slot Machine Association (RAY). The RAY, which had been in operation since 1938, was originally set up to support the funding of civil protection and gas protection, but soon expanded funding to include public health and child welfare. Voipio saw the fight against cancer as being very much a public health issue, which he decided to bring to the attention of the RAY in the early 1950s:

“That’s why I marched to the head of the relevant department of the Ministry of Social Affairs, Paavo Mustala – I had been one of his colleagues when I was the director of national Aid; he was on the National Aid board – and Paavo was horrified by my words: cancer cannot be treated, all those who suffer from it die; the money from RAY must only be used for public health work!”

Voipio had to use his extensive old boy networks to turn Mustala, and eventually the pressure worked or common sense prevailed: the CSF became eligible for RAY support in 1952. Such funding was irregular, variable and rigorously targeted, but it was a good supplement to the rather modest funding given the CSF by the state.

Further conditions for the start of the Cancer Registry’s research activities were created in March 1955, when a memorandum drawn up by Niilo Voipio and approved by the chairs of the boards of the cancer organisations that made up the CSF stated that they should pay more attention in the coming years to supporting scientific research. This was beginning to be possible, as the organisations’ finances were to break even within a couple of years. Once this objective had been achieved, the aim could be to use the RAY grant to cover all the costs of the core activities and to direct the donation funds to scientific research .

At a meeting of the CSF Council in November 1957, the matter made progress. The Cancer Registry Committee announced that such a large data set of cancer reports had now been compiled that the main possibilities for error in statistical probability had been obviated. A situation had finally been reached in which the reports received could be processed using scientific methods, as confirmed by the recently completed study on the prevalence of cancer in Finland in 1954, based on the registry data of Erkki Saxén and Aino Korpela. It was published the following year in the Finnish Medical Journal as an article in Finnish titled Uusien syöpätapausten esiintyminen Suomessa v. 1954, and published in English as Cancer Incidence in Finland, 1954.

The sympathy shown by the CSF board for the Cancer Registry’s own special studies. The Cancer Registry Committee quickly drew up a plan for a study to determine the cancer incidence in some of the central hospital districts on the basis of cancer reports from 1953-56. Among other things, attention would be paid to patients’ occupations, smoking and alcohol consumption habits, treatment outcomes, social issues and, in the case of female patients, the number of pregnancies.

As the Board of the CSF had reservations about such a large study, the Cancer Registry Committee proposed that it be carried out only at Lappeenranta Central Hospital. It would be a very suitable site for the study because two of the years of the study period were years when the central hospital did not yet exist in the area. This would provide comparative data on how patient care changed after the establishment of the central hospital. As the study could be carried out within the budget already allocated to the Cancer Registry, the Board unanimously approved the proposal. The development of the Registry’s research activities was finally secured in the spring of 1959, when the CSF, under the leadership of Sakari Mustakallio, decided to support the expansion of its activities.

International research projects

A major turning point in the development of the Cancer Registry came at the turn of the 1960s, when, with the help of Erkki Saxén’s good connections and Niilo Voipio’s favourable contribution, it became involved in two international research projects: the National Institutes of Health (NIH) Survival Study, the most important medical institution in the United States, and the World Health Organization (WHO) Norway-Finland Lung Cancer Project. Together, they represented the second most significant turning point in the history of the Cancer Registry since its inception.

Saxén’s relations with Harold L. Stewart and the first publications of the Cancer Registry led to Finland’s participation in the international geographical mapping of cancer diseases planned by the NIH, which Saxén had already discussed in 1952. To ensure the scientific quality of the Finnish Cancer Registry, NCI representatives Michael Shimkin, William I. Lourie Jr. and William Haenszel visited it in the early 1960s.

Saxén also made presentations at meetings on research into the spread of cancer in Copenhagen, Geneva and Oslo, and Aino Korpela in Copenhagen and Oslo. The CSF, for its part, sought to ensure US confidence in the Cancer Registry by converting Korpela’s part-time post of office manager into a full-time post of statistician and office manager. In early 1960, the Cancer Registry began a series of special surveys.
Once the Americans were confident of the quality of the Cancer Registry, the CSF was able to sign an agreement with the NIH in the spring of 1960 for the Finnish Cancer Registry to participate with the cancer registries of Denmark, Norway, France, England and the US in a large-scale survival study to determine the prevalence and treatment outcomes of some of the most common cancers in these countries. The study mainly focused on new cases of cancer diagnosed between 1953 and 1956. The study was due to be completed before the International Congress of the International Union against Cancer in Moscow in 1962, so the timetable was tight.

Part of the data processing for the Finnish part was contracted to be done free of charge in the US, and the CSF also received funding from the US for the practical implementation of the study, mainly for hiring additional staff. This funding was hardly a pittance, increasing to FIM 1.3 million in 1960, and then to over FIM 4.8 million in 1961 and to FIM 2 million in 1962.

Almost at the same time as the NIH study, another international research project began, which was prompted by the WHO’s focus on the fact that lung cancer prevalence in Finland was about five times higher than in Norway. So in 1960 the organisation asked the countries’ cancer registries to investigate the causes of the difference by conducting studies, for which it agreed to reimburse the Finnish CSF more than FIM 320 000 for the costs incurred in Finland. The Finnish and Norwegian cancer registries quickly agreed to cooperate, and already in 1961 two preliminary studies were published, The incidence of lung cancer in Finland and Norway by Aino Korpela and Knut Magnus and A comparison of lung tumour types in Finland and Norway by Leif Kreyberg and Erkki Saxén.

The WHO was so convinced by these studies that it decided to fund a major study. The organisation invited the Finnish and Norwegian cancer registries to a consultation meeting in Oslo in autumn 1961, where it proposed that the registries should jointly investigate the causes of the differences in lung cancer incidence between Finland and Norway. The Board of the CSF supported the participation of the Cancer Registry in the study. The topic was important, as lung cancer overtook stomach cancer as the most common cancer in men in Finland around the same time.

The positive decision was made easier by the fact that the WHO said it was prepared to pay half of the estimated FIM 6 million cost of the Finnish share of the study, and also agreed to lobby the Finnish government, through the Finnish WHO working group, to obtain funding for the study. These promises were also met, as the Cancer Registry received more than FIM 4 million from the WHO in 1962 and FIM 2.2 million from the Finnish state, and more than FIM 13 000 in 1963.

The international research projects created the conditions for Saxén’s objective to be realised: the development of the Cancer Registry into a world-class research institute, but they did not come at the best time for him. Saxén had just been appointed Professor of Pathological Anatomy in Swedish at the University of Helsinki in 1961, so he was simultaneously responsible for the management of the university and for major research projects, which meant a heavy workload and a tight schedule. For research on cancer survival, the registry had to reprocess all cancer reports received since 1953 and encode them according to the NCI standard.

As no data had been collected in previous years on the impact of cancer treatment, it was necessary to carry out what proved to be a difficult survival survey for each patient. To avoid the same problem in the future, a new registry notification form was introduced at the beginning of 1961, which allowed cases to be followed up. At the same time, the National Board of Health made the submission of cancer notifications mandatory.

The Cancer Registry coped with the heavy workload by working overtime, hiring new registry staff and temporary staff, and postponing the processing of new registry data. In addition, the registry had to be strengthened in a very concrete way, as the increase in the number of notification cards it received led to the floor of the card room threatening to buckle. To avoid the risk of accidents, the registry was moved to small apartments in the courtyard, where it was cheaper to reinforce the mezzanine floor than in the old registry room. In case of fire, the Board of the Association decided that the material under discussion would be microfilmed and the film reels stored in the Radium archive in Taka-Töölö.

The progress of the survey had been hampered by a lack of human resources, but now the problem really became acute when Aino Korpela, the Registry’s statistician and office manager, resigned at the beginning of October 1961. She justified her resignation on the grounds that she could not “under the present circumstances take responsibility for ensuring that the periodic surveys were completed in accordance with the contracts”. Fortunately for the Cancer Registry, Korpela had just before her resignation completed the re-coding of the Cancer Registry data to the NCI standard required by the NIH contract.

The CSF’s board was facing a tough time, as it was hard to find a qualified successor for Korpela, who had returned to the Office of Statistics. Moreover, it was not only a question of filling her place, but also of taking a position on the proposal of the Cancer Registry Committee that the registry should include both the posts of doctor and assistant statistician. Eero Saksela, a medical doctor who had been responsible for the NIH study, had agreed to take up the post for the time being.

The Board agreed to the proposals of the Cancer Registry Committee. The post of permanent physician was created, and from the beginning of 1962, the post was filled by docent Tapani Vainio, who was selected from six applicants on the proposal of Erkki Saxén. Around the same time, Saxén, who had been the scientific director and chief physician of the registry, was renamed Director of the Cancer Registry.

Strengthening the statistical expertise of the Cancer Registry was not as easy, as its importance in medicine was not yet fully understood in Finland. However, Saxén accepted the idea, as he had already become familiar with the use of statistics in cancer research in the United States and had also gained practical experience working with Aino Korpela. On 3 January 1962, Heikki Lautkari, a bachelor of philosophy who had transferred from the Central Office of Statistics, was appointed as the new statistician and head of the office. Matti Hakama was appointed as the second statistician under the title of actuary, following the model of the Central Office of Statistics, starting in mid-December 1961.

The appointments were mainly for short periods. After Tapani Vainio died in a car accident at the beginning of October 1962, the duties of medical officer were transferred to Junno Hästbacka, who was succeeded by Kimmo Koskenvuo at the beginning of February 1963. Koskenvuo carried out his duties, which consisted mainly of coding cancer cases, i.e. converting the information contained in cancer reports into a numerical format, until 1970. Heikki Lautkari, on the other hand, resigned at the end of May 1963, when Hakama was appointed as the new statistician and office head.

The most obvious exception was Hakama, who had originally been the most uncertain choice. He had no known references and, in his early twenties, no work experience, and had applied for a job as a statistician by chance after seeing a job advertisement in Helsingin Sanomat. However, he had a cum laude degree in statistics, still rare at the time, which, together with a clear presentation, won over the interviewer, Niilo Voipio. The latter recommended Hakama’s employment to Saxén, who consented, although he did not meet with him until some weeks later.

The study data on cancer survival was mainly analysed in the US, so Hakama’s first contact with the study was a bunch of raw spreadsheets that included all of the findings from the Finnish portion of the study and cases related to ovarian cancer. William Haenszel and Sidney Cutler from the US visited Hakama in the summer of 1962 to explain the main features of the forthcoming reporting, but there was plenty of room for their own research. He spent it drawing up graphs and tables and calculating regression analyses, all done by pencil and paper.

Hakama worked at the Cancer Registry for just over two years before he was called up for military service, which he had to complete before an agreed scholarship trip to the US. Although he continued to contribute to research during his military service, the Cancer Registry had to hire a new actuary. The position was held for a short time by Kaija-Liisa Jahnukainen, a registrar, until September 1964, when Marja Lehtonen, a bachelor of social sciences, was appointed as the actuary. She served in this position until 1985 and then as chief actuary until 2000. Irma Ovaska took over as actuary in 2001.

Lehtonen was mainly responsible for the routine work of the Cancer Registry, involving the registration of cancer notifications and the preparation of annual statistics describing the situation each year. Until the 1980s, the annual statistics, which were sent to Finnish hospitals and medical authorities as well as to foreign researchers and research institutes, were published three of four years after the year of collection. For the compilation of the annual statistics, he had access to the first computer of the Cancer Registry, an IBM 101, an advanced punch card reader.

As actuary, Lehtonen was also responsible for ensuring that the Cancer Registry was properly managed. All registry data was confidential, which is why its staff were bound by strict confidentiality. In practice, the rules followed from the outset were laid down by the Cancer Registry’s 1967 statutes. Under these, the staff’s obligation to confidentiality was defined in Chapter 38, Section 3 of the Finnish Criminal Code, which provided that anyone who broke the law was liable to a fine or imprisonment for a maximum of six months. The obligation of secrecy of information obtained or received by the Registry was defined by the Act on the Publicity of Public Documents. Under Article 17(2), the information could be made available to researchers and other users on condition that they gave an undertaking not to misuse it.

The rules gave researchers and authorities the flexibility to get the information they needed, but only for research and planning purposes. Data on individuals remained confidential, as the registry was never used to contact patients or give information to enquirers. This principle, which laid the foundations for the continuity of the Cancer Registry, was described by Lehtonen in 1977 as follows:

“To private people, we do not tell them anything about any patient, either by phone or by letter, not even if a person is on file or not. We deal here with cancer cases statistically, not with private people as patients.”

It was not until the turn of the 2000s that the strict encryption policy followed by the Cancer Registry was challenged, when the rapid electronification of patient data posed a serious issue for patient privacy.

New orientation

The expansion of the Cancer Registry’s activities led to a decision to reform the organisation of the Cancer Registry Committee, which manages its work. From 1963 onwards, the CSF appointed three members and the National Board of Health, the Finnish Statistical Office, the Finnish Medical Association and now also the Association of Finnish Life Insurance Companies each appointed one member. The inclusion of a representative of the insurance companies in the Cancer Registry was significant, as the information passed on through the registry may have contributed to the introduction of life insurance for cancer patients.

For the future, it was important that the Cancer Registry managed both research projects with distinction. Having completed their part of the international research on cancer survival, Saxén and Korpela attended a meeting in London in March 1962 to compare the results in different countries. The first preliminary summaries of the study were presented at the International Union Against Cancer Congress in Moscow in July of that year, where Saxén chaired the panel on the subject.

The full contents of the NIH study were finalised at a meeting in Sandefjord, near Oslo, in September 1963. The final results of the study were published in 1964 as a monograph, which was sent by the Cancer Registry to all Finnish medical research institutes and major hospitals.

The WHO-initiated Norway-Finland study was an epidemiological interview-based study focusing on the link between tobacco and lung cancer. It was Norwegian-driven, since after the Cancerföreningen i Norge, which had fallen into the hands of the Waerlandists, had been replaced in 1948 by the Kreftforeningen (Cancer Association), Norway had started to fund a lot of cancer research. Waerlandism, named after the Finnish-born health researcher Are Waerland, who emigrated to Sweden early on, emphasised the importance of a lacto-vegetarian diet for good intestinal function and thus for the health of the whole person. Waerlandism was particularly popular in Scandinavia, Switzerland, England and Germany, where several Waerland associations were founded. Within the new national association, the old association was affectionately known as the ‘carrot association’.

After Korpela, Heikki Lautkari took over the Finnish part of the study. In addition to the Cancer Registry staff, M. J. Karvonen, associate professor of physiology and a major developer of public health work and a key ideator of the North Karelia project started in 1972, also participated in the planning of the study. When the work was completed in early 1963, the data was sent to the Norwegian Cancer Registry for statistical processing and analysis.

Following a request from the WHO to extend the survey in some areas, the Cancer Registry started to refine the estimate of the amount of tobacco smoked per day. Initially, it had already taken into account the fact that in Finland, popular papirosa tube cigarettes (such as Työmies) contained twice the amount of tobacco as regular cigarettes (such as Klubi), but perhaps not enough that smokers might change tobacco brand from time to time. Statistical processing and analysis of the extended data took place in 1965. The results of the study were due to be published in 1966, but eventually Lung cancer in Finland and Norway. An epidemiological study was not published until April 1969.

The impact of these two international studies was not limited to the publications presenting their results. The study on cancer survival became one of the most important permanent research areas of the Cancer Registry, while the Norway-Finland study gave the CSF a solid basis for further strengthening its anti-smoking activities. Following the preliminary results of the study, a meeting of the CSF at the end of 1965 concluded that the state was receiving an estimated FIM 700 000 per day in tobacco revenue, which “can be considered as one of the causes of the increasing incidence of lung cancer”. If the state were to donate a single day’s income from tobacco to cancer prevention work, this would provide the necessary additional funding for the work of the CSF.

With no support from the government, the publication of the Lung cancer in Finland and Norway study prompted the CSF to take action. They increased funds for research into the harm caused by tobacco, and the CSF initiated the first nationwide anti-tobacco campaign in 1969, which was continued with its funding for many years. It was not until eight years later, in 1977, that the Tobacco Act came into force, banning smoking on public transport and in day care centres and schools, among other places.

International studies marked a turning point in the research orientation of the Cancer Registry . The Danish Cancer Registry and its long-time director, Johannes Clemmesen, had long played a pioneering role in the Nordic countries. The solid scientific cooperation between the Finnish and Norwegian cancer registries (Norway was also involved in NIH research, Denmark was not) started to change this situation. Especially as both directors, Einar Pedersen and Erkki Saxén, were strongly oriented towards English-language science, which was a global trend in medicine.

As the United States became the leading country in medical research after the Second World War, Finland also benefited from its support. Scholarships from the ASLA-Fulbright and the Fogerty International Center, which was set up as a spin-off from the NIH, gave many Finnish medical researchers access to the latest developments in the field, and many US foundations, such as the Rockefeller Foundation and the Damon Runyon Memorial Fund, began to support Finnish public health and cancer research.

Erkki Saxén had himself completed his training in the United States, where, thanks to close contacts, he was aware of how statistics were used in cancer research. For his presentation, the Cancer Registry sent statistician Matti Hakama on a 1965 NIH-funded study visit to the University of Minnesota in Minneapolis. There, Hakama became familiar with the latest research in statistics and, by taking courses, was able to earn a Bachelor’s degree in one year, leading to a Master’s degree.
Hakama’s new data was immediately useful in Finland, as the CSF had long been considering the creation of a Mass Screening Registry.

Establishment and early years of the Mass Screening Registry

In Finland, the first screening trials for early detection of cancer cases (including cancer of the reproductive organs, skin and breast cancer) were carried out in 1946-53. The screening team consisted of a general practitioner and a gynaecologist. When the results were examined, it was found that the method used in the experiment was costly and that there were not enough qualified staff. It was concluded that some form of screening should be carried out initially to eliminate those who were completely asymptomatic.

The idea to start screening was timely, as around the same time regular lung X-rays to detect tuberculosis started. These nationwide screenings were only stopped in the 1980s, when the number of TB cases had fallen to such a low level that subjecting the whole population to exposure to X-rays from imaging was no longer justified.

In the autumn of 1961, the CSF started a mass screening experiment in Karhula. The aim was to see if nurses could be taught to take cell samples to detect precursors of cervical cancer. Although the trial was limited, it produced results that highlighted the need for further research. At a meeting of the joint working committee of the boards of the cancer societies in the CSF in early 1962, it was noted that, since the mass screening of women had already begun or was about to begin in neighbouring countries, it was to be expected that “in Finland, too, there would be a growing public demand for such mass screening”. It was therefore decided to convene a meeting of the best experts in the field to discuss the issue.

A meeting held just over two weeks later concluded that Finland did not have the capacity to perform bulk cell examinations, as there were too few staff for cytological examinations and cytological diagnostic facilities still needed to be developed. The meeting concluded with a consensus that the only possibility for mass screening was to rely on the bulk cell method, which meant that the necessary support staff for cytologists needed to be trained quickly. In addition, a pilot activity for early detection of precancerous lesions had to be launched and progress made in line with the experience gained.

The experiment, which started in Karhula, was continued by including at least 10 000 women aged 25-60 in the survey. The new target areas were Nokia, Espoo, Kuusankoski and Turku. In Karhula and Kuusankoski, the sampling was carried out by nurses and midwives. The experiment was globally unique and aimed to demonstrate that those who had been trained in precision sampling were able to manage it.

The 1964 mass inspection covering the entire North Karelia Province must also be regarded as partly experimental. In the course of the postnatal check-up, a bulk cell sample was taken from all new mothers, which was sent to the mass screening laboratory of the CSF for examination. As screening at the maternity clinic was part of the statutory health care system, the aim of the trial was to see how early detection of gynaecological cancers could be integrated into this system.

At the request of the National Board of Health, the Cancer Foundation organised a nine-month training programme in 1963, based on Osmo Järvi’s plan, to qualify nurses and laboratory nurses for the preliminary examination of cytological cell samples. Despite the small budget it received, the CSF had to finance much of the training, although almost half of those who completed it ended up working in central hospitals and universities.

Although the screening was still experimental, more and more cities, towns and municipalities decided to order mass screening of their population from the CSF. The number of screenings increased from 41 municipalities in 1964 to almost 100 the following year and 305 by 1967.

The pressure to start screening increased year by year, and there were enough trained staff, but there were no funds to start. This obstacle was removed in 1967, when the state and the CSF reached a preliminary agreement that the responsibility for running the hospitals set up by the CSF would be transferred mainly to the state and the municipal associations. After a short delay, the resources of the CSF could be redirected towards the promotion of prevention and early detection of cancer and the funding of scientific research.

Now the CSF could also set up a Mass Screening Registry and make the Cancer Registry more efficient. In 1969, in order to ensure a continuous flow of donations, it also set up the Cancer Research Foundation with the Cancer Foundation. This was prompted by a change in the law, which allowed limited companies and cooperatives to deduct from their taxes donations to an organisation whose sole purpose was to support scientific work. The Cancer Foundation’s rules also had other purposes.

Following the CSF’s decision to launch nationwide cervical cancer screening, its Board had to decide how best to register their results. The matter had been prepared by a committee assembled by Tapani Kauraniemi, a Licentiate of Medicine, and consisting of Erkki Saxén, Matti Hakama, Marja Lehtonen and Niilo Voipio. The committee suggested that the best way to register screening results would be through the Mass Screening Registry under the Cancer Registry. To ensure efficiency, a system should be established whereby data from both registers could be compared. The Board approved the proposal on 2 October 1967.

Following the creation of the Mass Screening Registry, the CSF board decided that the two-registry system needed to be streamlined administratively. It therefore adopted at its December meeting, both the Cancer Registry Statutes and the Mass Screening Registry Statutes. According to the first article of the Cancer Registry’s Statutes:

  • The purpose of the Cancer Registry is to determine the prevalence of cancer and the different types of cancer in Finland and to carry out epidemiological research.
  • The registry should, where possible, seek to identify the effect of awareness-raising and emerging medical activities on cancer detection and treatment outcomes for cancer patients.
  • The registry will provide medical authorities and researchers with information on the incidence of cancer in Finland and provide expert advice when needed.

According to its terms of reference, the role of the Mass Screening Registry was to assist in the practical measures related to screening and to examine the effectiveness and appropriateness of mass screening activities by monitoring changes in the prevalence of cervical cancer and the potential impact of mass screening on its incidence. For the time being, it was to operate as an integral part of the Cancer Registry. It was decided to postpone the development of more detailed operational guidelines until the nature and policies of the Mass Screening Registry had been crystallised and the Cancer Registry Committee had made its presentation on the matter.

The establishment of a Mass Screening Registry within the Cancer Registry and its tasks took place largely along the lines set out by Saxén. He considered it apparently initially more as a health project than a research project, but later changed his mind. The Mass Screening Registry became operational in practice in early 1968. At that time, a meeting room in the Liisankatu office was renovated to house the information on cervical cancer screenings started by the Cancer Society in 1963.

In addition to planning future scientific activities, Matti Hakama, in collaboration with the State Computer Centre, started to prepare the practical work needed to start screenings. In 1969, the lists and invitation letters required for age-group screening for cervical cancer were sent to the municipalities, together with additional materials and summary statistics concerning the screening results.

Although mass screening specifically for the early detection of cervical cancer was becoming more common, Finland was apparently the first country in the world to establish a Mass Screening Registry to monitor and control such activity. So Hakama, who was in charge of mass screening, had no precedent to follow nor prior experience to learn from.

While the main focus of the CSF’s activities had been the establishment of cytology laboratories and the training of cytology assistants, Hakama defined the primary task of the Mass Screening Registry as the evaluation of the population impact of screening, i.e. the public health aspect. Achieving this objective required a comprehensive screening chain from the population being screened to treatment and its results. The effectiveness of screening was therefore determined by the weakest link in the chain; the failure of one part failed would compromise the whole.

In order to have a population impact, it was important that screening would target the whole population, not just those at risk or asymptomatic, and therefore reach a large number of healthy people. In this way, the potential harms associated with the intervention also affected those who were not affected by the intended benefit of screening – early diagnosis. Screening is thus ethically problematic because it benefits only a small proportion of the population screened and because it easily infringes on people’s right to self-determination. In assessing the legitimacy of screening, conclusions depend on the weight to be given to the benefits and harms of the intervention and the right of individuals to decide for themselves. One important argument is that screening has a sufficient impact on reducing mortality in the population.

The research activity of the Mass Screening Registry got off to a quick start. It was initially aimed at developing methods to assess the outcomes of patients treated at an early stage and the role of mass screening for cervical cancer. For the latter research, the Cancer Research Foundation awarded a three-year large grant to a research team led by Matti Hakama and including Urpo Joutsenlahti, Bachelor of Philosophy, and Arto Virtanen, Licentiate of Medicine.

Finland was among the first countries to create an operational system of mass screening of the entire female population of the country. Population screening for cervical cancer, which became nationwide in 1972, is one of the great Finnish public health success stories.