The Cancer Registry collects cancer data from all over Finland and from patients of all ages. The data can be used to produce reliable statistics to estimate the cancer burden in Finland. The quality and completeness of the data is constantly being studied. In 2021, quality checks have been made more systematic, for example by automatically checking the cancer notifications received by the Cancer Registry. Strengthening the knowledge base – monitoring and research Registration of cancer data Efforts were made to increase the submission of cancer notifications, in particular for so-called clinical notifications. These provide basic information about tumours at the stage of their detection. Regular meetings with the data providers were arranged to promote reporting activity. Electronic data transmission and guidance was improved and clarified. The THL Know and Act instruction card was made available to physicians. The submission of new cancer notifications was supported by providing guidance and advice on data to be collected in patient information systems in a structured and nationally consistent format. The national introduction of the pathology classification, SNOMED CT, was accompanied by a major integration of tumour codes into the new conceptual framework. Cooperation with Apot and the Helsinki and Uusimaa Hospital District (HUS) continued to integrate Apot’s cancer data into the processing of cancer notifications. During the summer, data extraction from Apot was carried out and regular data transfer to the Cancer Registry started. Cancer burden and research Cancer burden and research The monitoring of cancer burden was developed through the research and expert services (Tutka) development programme, which focuses on improving reporting and ways of presenting information in a client and target group-oriented way. A text linking algorithm developed at the Cancer Registry was used to start extending the knowledge base of the Cancer Registry by producing structured information on cancer notifications. A database model for Gleason scoring of prostate cancer patients’ prognosis was created and the efficiency of the algorithm was improved. The algorithm is openly available to researchers. Already about 10% of all cancers are diagnosed in the population aged 85 and over. Cancer incidence and excess mortality due to cancer were highest in people aged 85-94, but declined in people older than 85. Based on projected cancer incidence rates, the number of cancer cases in people aged 85 and over will at least double by 2035. The cancer burden and projections for the elderly population were presented to journalists in a webinar in June. The METCA research project, a joint project of the Cancer Registry and THL, which combines several Finnish population health surveys, provides unique, up-to-date information on cancer risk factors and their impact on the cancer burden of Finns. Overall diet was not found to be associated with the risk of post-menopausal breast cancer. One in four new cases of lung cancer in women is diagnosed in non-smokers, but in men the proportion of non-smokers was around 2-3%. The Cancer Registry is working with other cancer registries in the Nordic countries to investigate the impact of the Covid-19 pandemic on cancer patients. The first study compared differences between the Nordic countries in cancer notification and reporting during the pandemic. A study on the aggregation of haematological cancers in family members of cancer patients who had cancer at a young age found an increased risk of Hodgkin’s lymphoma and acute myeloid leukaemia in close relatives of patients. As part of the Academy of Finland’s Centre of Excellence programme, studies were launched on the association of autoimmune diseases with cancer risk and the familial clustering of brain cancers. Research on the role of other long-term diseases on cancer risk and survival rates continues. A joint study on the association of pregnancy-related chromosomal damage with the incidence of uterine leiomyomas was published by researchers from a leading centre of excellence. The quality of the Nordic statistics on uterine cancers was assessed using the NordCa application by the exact location (cervix or uterus) and the proportion of cancers with an unspecified location. The mortality rates for both cervical and uterine cancers increased by up to about 20% when the proportion of unspecified uterine cancers was reallocated to the two locations, assuming that it follows the age distribution of confirmed cervical and uterine cancer deaths. Finland is the only Nordic country where the mortality rates in question did not increase significantly, as only Finland’s data were based on linkage between the cancer registry and the cause of death registry. Registration and reporting of screening data Finland has two cancer screening programmes: mammography-based breast cancer screening for women aged 50-69 and Pap and HPV testing-based cervical cancer screening for women aged 30-60. HPV screening continued to expand in 2021, with almost 70% of the target population already invited. HPV testing coverage has increased significantly. In 69 municipalities, women aged 65 and over were also invited for cervical cancer screening, totalling 40% of the age group. In addition, 12 municipalities piloted colorectal cancer screening for men and women aged 60-68. Numbers of cytological and HPV tests 2003-19 All data collected from cervical and breast cancer screenings were submitted electronically to the registry. In 2021, a common data model for all cancer screenings was further developed, with separate variable classifications for the three screenings. The piloting of new data submissions continued with the old providers, and work started in the autumn on the development of data submissions for new colorectal cancer screening providers. The cervical and colorectal cancer screenings will move to the new data submissions model in 2022. The production capacity for these cancer screenings was established in autumn 2021. The piloting of breast cancer screening was postponed to 2022. Processes for quality assurance of screening data were developed in the Skriinari application. Missing follow-up and diagnostic data were completed from screening providers, the cancer registry database and the THL treatment notification system. In addition to screening programmes, there is a large amount of screening-type testing in Finland, for which data are collected under a research permit. In total, the register contains data on almost 9 million non-screening bulk cell tests for cervical cancer and about 1.5 million non-screening mammography and ultrasound examinations. In 2022, the focus will shift to integrating the data already collected into national registers, in line with the THL Act. Screening-related research The Cancer Registry monitors cancer screening programmes in Finland and evaluates and studies the development of programmes and the effectiveness and efficiency of different screening methods. Screening evaluation studies are used to determine the sensitivity, accuracy, benefit and harm of screening and the impact of screening on health care resource needs. A nationwide, randomly sampled questionnaire will be used to investigate the welfare effects of screening. Research results were used extensively to inform the population and health care providers, to develop guidelines for cancer screening and for screening decision-making. Health Promotion Health promotion by the CSF is a values-based, goal-oriented approach to enabling people’s health and well-being and preventing cancer. The CSF performs health promotion work in many areas. It seeks to influence social policy, public attitudes, social and health care practices and individual choices. The target groups are children, young people and adults and, where appropriate, selected special groups. Youth health promotion Strengthening health-promoting lifestyles among youth is a priority area for health promotion by the CSF. Since the early 2000s, work on promoting young people’s health has been carried out under the Youth Tobacco and Nicotine Products Reduction Project (NuoTup), funded by STEA (previously the Finnish Slot Machine Association). In 2021, the project continued under the name Fressis – promoting nicotine-free and healthy lifestyles among young people. In addition, you sexual health was promoted through a multi-agency, Ministry of Social Affairs and Health (MSAH)-funded Summer Rubber (Kesäkumi) campaign. The Good Day (Hyvä Päivä) project for young people under 29 years of age who are not in employment or education was funded by STEA and LähiTapiola. The Fressis service package promotes young people’s knowledge and motivation to adopt healthy lifestyles. It consists of the Fressis and Tobacco body websites, the Ask the Expert service, the Erovirasto tobacco quitting app, social media channels and cooperation with social media influencers. Topics include tobacco and nicotine products, nutrition, exercise, daily rhythm, sun and sexual health, and alcohol and mental well-being. In 2021, Fressis.fi had over 522 000 visitors and Röökikroppa.fi almost 59 000. The Ask the Expert service answered more than 800 health and lifestyle questions sent by young people. The free Erovirasto app to help people quit tobacco products was launched and downloaded more than 2 500 times. Collaborations with eight influencers on the themes of Fressis were carried out. During this period, the content on the influencers’ channels TikTok attracted over 300 000 views on TikTok and over 127 000 views on YouTube. Nicotine-free environments for young people in everyday life were promoted by strengthening the knowledge and motivation of professionals in supporting young people to become nicotine-free and by implementing nicotine-free policies in cooperation with seven regional cancer societies. Nikotiiniton amis – Namis (nicotine-free vocational college). A nicotine-free amis operating model was launched to develop a nicotine-free culture in vocational colleges, with roll-out to colleges in Seinäjoki, Salo, Savonlinna and Joensuu. Snuff-free sport. A snuff-free sports operating model was launched to promote snuff-free sports in sports clubs in cooperation with the Finnish Olympic Committee and the Finnish Association for Substance Abuse Prevention (EHYT). This raises awareness among sports club stakeholders about the harms of snus and provides tools for developing a snus-free sports environment. The model was disseminated to sports clubs in cooperation with regional cancer associations and with the support of the PEPP2 Rusfri fritid project (EHYT, Finnish Olympic Committee and Nykterhetsförbundet Hälsa och Trafik). Five sports clubs participated and several more were interested in using the method. The feedback from the sports clubs was excellent. Coaches were committed to promoting snuff-free behaviour, discussion of snuff with young people was facilitated and the presence of snuff in the daily life of sports clubs was reduced. Nicotine-free youth work training strengthens the motivation, knowledge and tools of youth workers to support young people to become nicotine-free in their environments. In 2021, four distance learning trainings were carried out with 31 participants. According to feedback, youth workers felt that the training strengthened their motivation to address nicotine issues in their work and increased their knowledge on supporting young people to become nicotine-free. FressisEdu.fi contains a wide range of materials and tools to promote nicotine-free youth and well-being in educational institutions, youth work and sports clubs. The site also provides tools for parents to promote nicotine-free youth. The main target group in 2021 was secondary school health education teachers. Learning materials targeted at vocational schools were produced as part of Saku:ry’s Work Capability Passport. Over 7 100 people were reached through Fressis.Edu.fin, social media and the newsletter. An expert group of teachers was involved in the development and evaluation of the activities. Two training sessions for health education teachers and trainee teachers (one in cooperation with EHYT) were organised, with 59 participants. Feedback indicated that the training provided tools for dealing with nicotine and substance abuse issues and that the participants intend to use what they learned in their future work. The Kesäkumi campaign (Summer rubber) was carried out in cooperation with the Family Federation of Finland, the Finnish Red Cross, the Soldiers’ Home Association and the radio station YleX. The main themes for the CSF were raising awareness among young people about the HPV virus (HPV) and promoting condom use. Fressis disseminated information about the campaign through its own channels and by answering young people’s sexual health questions on the Ask the Expert service. The campaign was run as a social media campaign due to the Covid-19 pandemic. More than 80% of respondents to the campaign evaluation survey had learned more about sexual health and more than 90% felt that the campaign sufficiently encouraged condom use and safer sex. Protection from UV radiation. The CSF in cooperation with the Radiation and Nuclear Safety Authority and the Finnish Meteorological Institute, was involved in the annual youth #suniho campaign, which encourages young people to protect themselves from the sun. Promoting healthy lifestyles among young adults Good Day project activities aim to increase the knowledge, skills and capacity of young people under 29 who are not in employment or education to manage their lives in a healthy way. Every year, the CSF trains professionals working with young people to become facilitators of Good Day groups. Good Day activities have been run since 2016 in cooperation with municipal youth services and Help Centres. In 2021, there were Good Day groups in Vantaa, Rovaniemi, Kajaani, Kuhmo, Seinäjoki, Joensuu, Huittinen, Harjavalta, Kerava, Kauhajoki, Oulu, Kuusamo, Riihimäki, Espoo and Lahti. A total of 25 groups were run, with 120 young people participating. Group activities for young people had to be adapted to Covid-19 restrictions. Some of the Good Day groups were carried out remotely. In addition to the groups for young people outside working life and education, a Good Day group for secondary school girls was organised in Kuusamo. Also, in the autumn, Salpaus piloted a Good Day model for vocational college students in Lahti at risk of dropping out of their studies. Two Good Day groups were held in the autumn for students in preparatory studies for vocational education and training. The Good Day groups received excellent feedback from the young people who participated in them, and they were keen to experiment with improving their health and well-being as part of the group process. A total of four remote Good Day facilitator training courses were held during the year. Forty-six people working with young people participated in these courses. Two webinars and four remote coffee mornings were also held for Good Day participants, with a total of 112 professionals working with young people. These events strengthened the knowledge and skills of their participants in health promotion and provided a platform for developing skills and sharing experiences in group facilitation. The Good Day project also launched a development group with experienced group facilitators. It worked on new exercises for group meetings for the benefit of all. To increase the visibility and awareness of the method, active use was made of Good Day’s social media and youth work networks. Cancer prevention and health promotion in other age groups General health promotion activities for children and adults were carried out with member associations, cancer centres, universities of applied sciences, universities and various organisations. Promotional work for children in daycare centres on self-applying sunscreen and healthy behaviour in the sun were continued in cooperation with regional cancer societies. Parents of children also received instruction. The sessions were run in cooperation with students from universities of applied sciences. The campaign to increase the consumption of vegetables by young children in daycare, which started in 2020, was continued. A model has been created to increase the use of vegetables through a short session for children, using artistic means. Collaboration with the health care sector was carried out through involvement in the development of the Stop Smoking before Surgery model with hospitals. Work to reduce the use of tobacco and nicotine products by pregnant women was carried out with the joint municipal authority for North Karelia social and health services (Siun Sote), the municipalities of Pohjois-Savo, the South Karelia Social and Health Care District (Eksote), the City of Helsinki and the City of Vantaa. Material on the topic was produced for clinics and support was provided to clinics in creating and implementing the treatment pathway together with the Cancer Society of North Savo and the Cancer Society of Saimaa. Cancer, exercise and nutrition were the themes of a joint annual meeting with cancer centres. Health care professionals were trained in brucellosis activities in the Central Finland Cancer Association region. Promoting exercise among cancer patients. The revised recommendations on physical activity for cancer patients were widely presented. The theme of cancer and physical activity was included in the online training content for applied physical activity of the Paralympic Committee and the Pajulahti Sports Institute in cooperation with the Finnish Adapted Physical Activity Federation SoveLi. In December, a series of three webinars for men with cancer was held in cooperation with the cancer societies of Southwest Finland, Satakunta and Ostrobothnia and the Western Finland Cancer Centre (FICAN West). Training was organised for teachers from universities of applied sciences on the role of exercise and nutrition in cancer prevention, treatment and rehabilitation.