Strengthening the knowledge base Regional and socio-economic disparities. In 2021, the Cancer Registry produced new cancer statistics and data showing that differences in cancer incidence by educational level were relatively highest for lung and tracheal cancer. The incidence of these among people with only primary level of education was more than double that of those with tertiary education. Cancer incidence for women was at best 10% lower and at worst 14% higher in some municipalities than the national average. The variation was slightly higher for men than for women. Regional differences in cancer burden were examined in the annual report (in Finnish) separately for prostate cancer, breast cancer in women, colorectal cancer and lung cancer. Delay before diagnosis. The research project ‘From symptoms to Patients’ looked at the use of health services by colorectal cancer patients in the year before diagnosis. Expanding the knowledge base. The aim is to compile and identify structural variables from existing data that are more useful to data users. For example, data mining has been launched to extract TNM classification of prevalence data from pathology text reports. International research cooperation of the Cancer Registry. In 2021, there was an ongoing joint Nordic study on cancer incidence, mortality and screening participation among migrant women, led by Finland and funded by the Nordic Cancer Union (NCU). The aim is to compare the cancer incidence and breast and cervical cancer screening uptake of women who have migrated to the Nordic countries from non-Western countries with the female population of the former. The registry data used in the study was edited to a uniform format in the participating countries, and the analyses of both cancer incidence and mortality and screening participation were finalised in Finland. The project to develop a web-based reporting system for joint Nordic screening statistics (NordScreen) was continued under the coordination of the registry with support from the Nordic Cancer Union. The project published web-based screening statistics and a comparative study of test results and findings from cytology and HPV screening with different follow-up periods after primary test results was ongoing. The project also compared the reliability of joint Nordic statistics on metastatic cancer in the NordScreen database. Several research articles were produced from the EU-TOPIA (Towards Improved Screening for Breast, Cervical and Colorectal Cancer in All of Europe) research project funded by the EU Horizon 2020 programme. The project published simulation modelling studies on the effectiveness of breast cancer screening in Europe and the results of the validation of a simulation model for colorectal cancer screening. Based on the simulation model developed with the project leader EMC (Erasmus Medical Center) and the results of the Finnish pilot screening, cost-effectiveness modelling of colorectal cancer screening for Finland was developed. The new model was used to optimise screening target groups and screening test cut-off values for the Finnish screening programme. The EU-TOPIA consortium analysed social inequalities in the use of cancer screening tests (gynaecological smear test, mammography, faecal blood test and colonoscopy) in health care, both within and outside screening programmes. The study is based on population health behaviour data (EHIS European Health Information Survey) collected by EUROSTAT in EU member states. The study found significant inequalities and disparities in the use of the above mentioned tests across the EU and at national level. The results will be published in 2022. A study on the validation of cancer registry data in North-West Russia was completed. The project was carried out in collaboration with the Petrov National Cancer Institute in St Petersburg, the European University of St Petersburg, the University of Tampere, the WHO International Agency for Research on Cancer (IARC) and the Cancer Registry. The Nordic Occupational Cancer Study (NOCCA), a joint Nordic project on cancer risks from occupational exposures coordinated by the Cancer Registry, published a study on cancer risks among musicians. The overall cancer risk for musicians did not differ from that of the general population. A joint NOCCA and IARC study examined the association of socio-economic status with lung cancer risk in the Nordic countries. The study will be published in 2022. NOCCA is also updating a large dataset on occupational cancer risks. Work has been completed in Finland and is progressing rapidly in the other Nordic countries. Cancer treatment costs. The Cancer Foundation has an online service, open to all, which provides information on the annual costs of cancer care by cancer type, region and cost category since 2014. It is updated and maintained by the Nordic Healthcare Group. The content and usability of the web service will be developed through separate projects. In 2021, a project was implemented to disaggregate pharmaceutical costs from hospital costs and provide an overall picture of the development of the former. The publication of the online tool, updated with pharmaceutical data and cost data for 2020, was postponed to early 2022. Screening services Invitation service. The basic data (personal identification number, municipality of residence) of men and women invited for cancer screening were extracted from the Digital and Population Data Services Agency and transmitted to the screening services. For municipalities using the invitation service, name and address data were also extracted. Almost 700 000 individuals were sent to laboratories and services. Almost 100% of the population targeted for breast cancer screening and around 80% of the population targeted for cervical cancer screening were covered by the referral service. Colorectal cancer screening. An expert group on colorectal cancer screening, that included, in addition to representatives from the Cancer Registry, experts from four specialised areas of responsibility, drew up an action plan for colorectal cancer screening and a list of acceptable screening tests. These national recommendations were published on the Cancer Registry and MSAH websites in September. In August, a pathology group covering all university hospitals was set up alongside the expert group. The Cancer Registry, in collaboration with the CSF Communications Unit, produced material for the implementation of screening for colorectal cancer. A guide to organising colorectal cancer screening for municipalities was produced in September. Information on the start of colorectal cancer screening and versions of and links to the programme and guide were sent by email to all municipalities and health districts. Webinars were organised for various target groups and the results of the pilot phase were also presented at European webinars. Colorectal cancer screening information flow 2021 The Covid-19 pandemic impacted the work of the Cancer Registry in various ways. Instructions were sent to screening units and laboratories on how to carry out screening and that the screening year could be extended to the following summer if necessary. Delays in testing were addressed. Surveys showed that cancer screening activities throughout the country were almost normal and that there was no significant drop in screening uptake. Expert work. Most of the work of the Cancer Registry on the implementation and guidance of screening focused on the amendment of the Government Decree on Screenings, with the aim of extending cervical cancer screening to women aged 65 and starting nationwide screening for colorectal cancer. The National Steering Group for Cancer Screening met eight times. As a basis for the rationale for the amendment, among other things a modelling study was carried out at the Cancer Registry using pilot data and population-based registry data to determine the target population, screening interval and test sensitivity level for colorectal cancer screening. Resource and funding calculations were also done for the Ministry of Finance. The amendment to the decree was signed in August and the government increased the state subsidy to municipalities by Eur10 million, based on the calculations of the register. Screening-related research. Cervical cancer screening data and non-screening test data were used to examine the national coverage of testing and associated socio-economic disparities after the end of the screening programme. Of those women with abnormal results in the previous screening programme, only about 18% were tested at least once between the ages of 70 and 74 years, and relatively large socio-economic disparities in test coverage were observed. Women with a history of abnormal results and women not participating in the screening programme would benefit from continued testing beyond the overall end of the screening programme. In 2021, there were ongoing studies on the relatively high rates of colposcopy and precancerous lesions found during HPV screening, and an evaluation study on the cancer prevention effect of cervical cancer screening and non-testing. A survey was also carried out on young women’s attitudes to and perceptions of cervical cancer screening and testing, cervical cancer risk factors and HPV vaccines, among others. The study aims to find out why women younger than the target age for screening are being referred for testing outside the screening programme. The impact of extending the breast cancer screening invitation age on cancer incidence, the screening process and breast cancer mortality was studied. In addition, the cost-effectiveness of the screening intervention was investigated and large-scale research data on imaging outside the breast cancer screening programme were collected for use in the above analyses. The pilot phase of the new colorectal cancer screening programme launched in 2019 was studied using data from the first year. Participation rates for colorectal cancer screening were excellent, at 83% for women and 75% for men. Screening test cut-off values were verified using findings from the pilot study and simulation modelling. Educational level, gender and marital status were found to have an impact on the participation rate of the previous nationwide randomised colorectal cancer screening programme. The Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC) – a randomised population-based study – covers the follow-up of about 80 000 men over 25 years. In 2021, we investigated the overdiagnosis of PSA screening and assessed the accuracy of prostate palpation as a screening test. In addition, the association of other drugs used to treat other diseases with prostate cancer risk and mortality was assessed. The data was used to develop a prediction model to estimate the probability of death from prostate cancer at different time intervals.