An analysis of malignant tumour incidence in the male population of Poland in the period 2006–2010

Introduction

The average man in Poland lives 8 years less than the average woman, and displays a lower health awareness [1]. In the age group 45–49, 107 women occur for each 100 men, and this trend indicates an increase in the subsequent age groups [2].
The major causes of death in Poland include cardiovascular diseases, carcinomas (in particular tobacco-related) [3–6] and deaths due to external causes, such as accidents, injuries or poisoning [2].
In global terms, cancer constitutes the third major cause of death, and the second major cause in Poland, also posing one of the most challenging health, economic and social problems of the 21st century [2, 7]. The analysis of the epidemiological situation in the field of carcinomas requires, among other things, conducting an incidence analysis of this group of diseases.
Morbidity, also referred to as incidence, reflects the number of newly registered cases of a given disease in a specified period (a year) when converted (usually) to per 10 thousand or 100 thousand individuals in the population examined [8]. Incidence is a very valuable measure of health-related needs. The monitoring of incidence trends allows the identification of changes over time and prompt reaction to the growing needs in certain medical specialisations (e.g. oncology) or treatment methods, and to the needs related to prophylaxis and health promotion.
In 2008, Poland was a European country characterised by an averagely low incidence and generally high mortality due to malignant tumours. The incidence was lower as compared to most EU-15 countries, but the mortality was much higher [7], which appears alarming.
This situation results, among other things, from the relatively low level of the demographic old-age of the Polish society as compared to the European Union. However, the vital-statistics trend which has prevailed since the end of the 20th century, manifested through the dropping birth rate, is likely to lead to the gradual ageing of the society. This may, in consequence, contribute to an increased incidence of malignant tumours in the future [9].
In 2006-2010, the National Cancer Registry indicated a gradual increase in the incidence of malignant tumours among men, from 64,092 thousand in 2006 to 70,024 thousand in 2010. In the same period, the number of deaths due to malignant tumours among men oscillated around 52 thousand [2, 6, 7].
The aim of this study was to analyse the malignant-tumour incidence in the male population of Poland in the period 2006–2010.

Material and methods

The study material comprised data obtained from the National Cancer Registry and the Central Statistical Office, available on their websites. The Register covers the incidence of carcinomas in the Polish population, which are coded in accordance with the International Statistical Classification of Diseases and Related Health Problems (ICD Revision 10, C00-D09). This data is presented chronologically in annual reporting periods, and is broken down by gender, age and voivodeship. This kind of information is collected in the Register on the basis of cancer-notification forms (MZ/N-1a). Their analysis makes use of basic statistical indicators such as absolute numbers, percentages, crude rates and standardised rates [10].
The epidemiological analysis employed absolute numbers, percentages, and also standardised and crude incidence rates, along with the cumulative risk of cancer by age, domicile and cancer type. The crude incidence (death) rate reflects the risk of contracting (dying of) a malignant tumour, and determines the number of registered incidence (death) cases due to a given cancer (cancer group) per 100 thousand people in a given year. The standardised incidence (death) rate (by age) reflects the risk of contracting (dying of) a malignant tumour, and determines the number of incidence (death) cases that would occur in a given population if its age structure were the same as in the standardised population, when converted per 100 thousand people. “The standard global population” was assumed as the population for the purpose of standardised rates. The population structure by gender and by 5-year age group was presented using data provided by the Central Statistical Office (CSO), based on the results of the 2011 National Census [11].
The resulting data was analysed using Microsoft Excel 2010 and Statistica 10.0 software.

Results

A gradual increase in the crude and standardised incidence rates was recorded in the reporting period, together with a visible percentage increase in the male population aged 45 and more (society ageing) and a relatively constant number of men in the entire population (Table 1, Fig. 1).
The incidence of carcinomas is strongly age-dependent. The incidence rate displays an exponential dependence on age between the fourth and seventh decade of life (Fig. 1) [7].
The number of deaths due to malignant tumours in Poland for the last five decades has increased by nearly 2.4 times [7]. In the analysed period, it amounted to 463,521 thousand, including 260,531 thousand deaths among men, which accounted for 56.2% of all deaths due to malignant carcinomas in the discussed period (Table 2).
Lung cancer is the most-common type of cancer among men, in terms of frequency, accounting for around one-fifth of all incidence cases (22.1%). It is followed by prostate cancer (12.5%), colorectal cancer (12.2%) and bladder cancer (6.7%). Malignant skin cancer, stomach cancer, kidney cancer, laryngeal cancer, pancreatic cancer and leukaemia are also among the ten most frequent carcinomas contracted by men. Lung cancer constitutes the most frequent cancerous cause of death among men (over one-third, i.e. 31.7%, of all deaths). Colorectal cancer constitutes 10.8% of all deaths due to cancer, and prostate cancer 7.5%. Stomach cancer, bladder cancer, pancreatic cancer, kidney cancer, leukaemia and brain cancer are also among the major cancerous causes of death (Table 3).
The five-year relative survival rate of male patients with malignant tumours, diagnosed in 2000–2002 and 2003–2005, is shown in Table 4 [12, 13]. The highest increase is observed in the five-year survival rates of men suffering with prostate cancer, followed by bladder cancer and colorectal cancer, while a slight downward trend involves male patients with brain cancer and pancreatic cancer.
Cancer detectability among men differs in particular voivodeships of Poland. However, the types of most frequently recorded types of malignant tumours correspond to the national trends. The voivodeships with the largest numbers of registered carcinomas (over 34% of all notifications) in the analysed period included the Śląskie, Mazowieckie and Wielkopolskie Voivodeships. These voivodeships are inhabited by around 34% of the entire Polish population. The highest standardised incidence rates and the highest cumulative risk of cancer were recorded in the Wielkopolskie, Dolnośląskie and Pomorskie Voivodeships, while the highest mortality rates involved the Kujawsko-Pomorskie, Warmińsko-Mazurskie and Pomorskie Voivodeships (Table 5).

Discussion

Within the last thirty years, the incidence of malignant tumours in Poland has soared. Since the beginning of the 21st century, we have noted a gradual ceasing of this trend, and in the recent decade the incidence curve has plateaued. In the analysed period, from 2006 to 2010, the malignant-tumour incidence among the male population indicated a slow but steady growth, while the death rate dropped slightly at the end of 2010 [2, 7]. The incidence of malignant tumours in Poland is lower than the EU average, but mortality is around 20% higher among men [7]. The five-year survival rate of patients with malignant tumours within the first decade of the 21st century grew from 32.9% to 37.3% among men, and from 51.2% to 53.5% among women. This growth might reflect an increased efficiency of cancer treatment in Poland, but there is no specific evidence to prove this hypothesis [12].
The difference in the 5-year survival rate among men and women stems, among other things, from the fact that organic carcinomas with poor prognosis, i.e. lung cancer, laryngeal cancer and oesophageal cancer, constitute over one-third of all cancer-incidence cases among men [13]. These trends require further thorough monitoring and an increased efficiency of oncologic care in our country.
The incidence risk grows with age, with peak values between the age of 55 and 79. Most incidence cases, i.e. 70%, among men occur after the age of 60. The risk of contracting cancer grows with age, and a considerable increase is observed from the fourth decade of life [2, 6, 7, 14]. Such a trend in the incidence change curve indicates the occurrence of specific cancer-risk factors associated with different stages of life. This data should be taken into account when planning any studies on cancer-risk factors related to human activity in various decades of life, and also when planning and establishing prophylactic programmes.
Malignant tumours constitute the second major cause of death in Poland. The epidemiological projections for the coming years are not optimistic, given the progressing ageing of society. This contributes to premature deaths among both women and men [2, 10, 11, 15], exerting an influence on the socioeconomic situation of Polish families and on the condition of public finances. For decades, such a situation has been triggered, among other things, by a low level of knowledge of pro-health behaviour, including oncologic prophylaxis in the female and male populations [16–19].
The continuously high incidence and mortality rates due to cancer in Poland require profound changes in the financing, planning, organisation, implementation and monitoring of the efficiency of various activities undertaken by the government administration (and mainly by the Ministry of Health) in the field of public-health improvement. It should be noted that the plans in the multiannual National Cancer Control Programme are being realised in 2006–2015. The main goals of the Programme include preventing further growth in the incidence rate of cancer, and achieving average European early-cancer detection and treatment-efficiency rates. Having inspected the implementation of the National Cancer Control Programme objectives by the Minister of Health in 2009–2013, the Supreme Audit Office has assessed their efficiency in a negative way. As revealed by the said inspection, the Programme goals determined by the Act have not been achieved, and the early cancer detection and treatment-efficiency rates are still very far from the European average [20, 21].
Other comprehensive programmes must be undertaken in the future, with a view to promoting modern prevention, diagnostic and therapeutic methods. The measures to be taken must provide for raising the social awareness of pro-health behaviour, including oncologic prophylaxis, by making better use of human resources available within the healthcare system. This is both the most essential and the cheapest way to conduct system activities oriented towards improving the state of health of the population [22, 23].
In 2010, 24.5% of all deaths in Poland were caused by malignant tumours. Cancer is the major cause of premature deaths among both women and men. The most-frequent malignant tumours in Poland include tracheal cancer, bronchial cancer and lung cancer, followed by prostate cancer and colorectal cancer [2, 7].
Screening tests constitute an indispensable tool for ensuring the early diagnosis of cancer. They allow cancer to be detected at an early stage. In Poland, there are screening test programmes, financed from public resources, which allow the detecting of colorectal cancer, breast cancer and cervical cancer. However, these measures are obviously insufficient, which often leads to late diagnosis of cancer at an advanced 3rd or 4th stage [24, 25].
The distribution of the incidence of malignant tumours among men by voivodeship also forms an interesting element of the analysis. Over one-third of all cancer-incidence cases are attributable to three out of sixteen voivodeships (i.e. Śląskie, Mazowieckie and Wielkopolskie), which are altogether inhabited by around 34% of the entire Polish population. These findings require further examination, as the regional differences observed may be caused by differences in the infrastructure of healthcare systems, communication, interest on the part of local-government bodies in the protection of citizens’ health, such demographic features as age and education, and access to various sources of information.
The analysis of death rates by voivodeship also requires an in-depth analysis in the context of improving the healthcare system efficiency [26].
In conclusion: the incidence rate of malignant tumours in the male population in 2006–2010 indicated a slow but steady growth.
The mortality rate decreased slightly at the end of 2010. This trend requires a separate analysis.
The incidence rate of cancer grows with age, with peak values between the age of 55 and 79. The upward trend starts with the fourth decade of life, and most incidence cases occur after the age of 60 (70% of new indecencies).
In the analysed period, the most common types of malignant tumours in Poland have been lung cancer, followed by prostate cancer and colorectal cancer. This trend has not changed for the last decade as regards the first two cancer types mentioned, whereas colorectal cancer has gone up from fifth to third position in the analysed period.
The conditions of reporting and mortality due to malignant tumours by voivodeship should be subject to separate analyses, in the context of shaping the regional and national health policy.

The authors declare no conflict of interest.

References

1. Porębiak IM. Facts and myths concerning cancer. Psychoonkologia 2008; 2: 52-7.
2. Wojtyniak B, Goryński P, Moskalewicz B. Sytuacja zdrowotna ludności polski i jej uwarunkowania. Narodowy Instytut Zdrowia Publicznego-Państwowy Zakład Higieny, Warszawa 2012.
3. Zatoński W. Europejski kodeks walki z rakiem. Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie, Warszawa 2011.
4. Woźniacka A, Woźniacka-Węgierska M, Józefowicz O, Sysa-Jędrzejowska A. Medyczne i prawne aspekty palenia tytoniu. Pol Merk Lek 2012; 189: 202-7.
5. Coronado GD, Beasley J, Livaudais J. Alcohol consumption and the risc of breast cancer. Salud Publica Max 2011; 53: 440-7.
6. Tuchowska P, Worach-Kardas H, Marcinkowski JT. Najczęstsze nowotwory złośliwe w Polsce- główne czynniki ryzyka i możliwości optymalizacji działań profilaktycznych. Probl Hig Epidem 2013; 94: 166-71.
7. Wojciechowska U, Didkowska J. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie. Available at: http://onkologia.org.pl/raporty/ [access: 20.08.2014].
8. http://www.czytelniamedyczna.pl/3112,epidemiologia-metoda-pomiaru-stanu-zdrowia-zbiorowosci.html [access: 15.08.2014].
9. Eurostat, 2008, Prognoza ludności w Unii Europejskiej 2008–2060, Komunikat Eurostat, published 8.06.2011.
10. Wojciechowska U, Zatoński J. Rejestracja nowotworów złośliwych. Zasady i metody. Centrum Onkologii – Instytut im. M. Skłodow- skiej-Curie, Warszawa 2007; 9-139.
11. http://stat.gov.pl/cps/rde/xbcr/gus/L_podst_inf_o_rozwoju_dem_pl_do_2012.pdf.
12. Wojciechowska U, Didkowska J. Poprawa przeżyć chorych na nowotwory złośliwe w Polsce. Analiza przeżyć pacjentów zdiagnozowanych w latach 2003-2005. Nowotwory 2013; 63: 279-85.
13. Wojciechowska U, Didkowska J, Zatoński W. Pięcioletnie przeżycia chorych na nowotwory złośliwe w Polsce. Nowotwory 2010; 2: 122-8.
14. Ciałkowska-Rysz A, Kowalczyk M, Gottwald L, Kaźmierczak-Łukaszewicz S. The comparison of common cancer types and the coincidence of concomitant chronic diseases between palliative home care patients in Lodz Voivodeship and the general Polish population. Arch Med Sci 2012; 8: 496-503.
15. Wojciechowska U, Didkowska J, Zatoński W. Nowotwory złośliwe w Polsce w 2010 roku. Centrum Onkologii – Instytut im. M. Skłodowskiej-Curie, Warszawa 2012; 3-4: 13-21.
16. Ostrzyżek A, Marcinkowski TJ. Wymiary jakości życia w podeszłym wieku. Probl Hig Epidem 2009; 90: 465-9.
17. Frieden TR, Myers JE, Krauskopf MS i wsp. A public health approach to winning the war against cancer. Oncologist 2008; 13: 1306-13.
18. Syczewska-Weber K, Rucinski P. The main challenges of Polish oncology. Public Health Rep 2008; 123: 655-63.
19. Najdyhor E, Krajewska-Kułak E, Krajewska-Ferishah K. Knowledge of women and men about breast cancer prevention. Ginekol Pol 2013; 84: 116-25.
20. http://www.nik.gov.pl/aktualnosci/nik-o-realizacji-programu-zwalczania-nowotworow.html [access: 25.08.2014].
21. Narodowy Program Zwalczania Chorób Nowotworowych. Założenia i cele operacyjne 2006-2015 http://www.mz.gov.pl/wwwfiles/ma_struktura/docs/zalozenia_ustawy_o_npzchn.pdf, (access: 2014.05.30).
22. Chmielarczyk W, Galicka M, Wojtaszczyk K. Refleksje na temat perspektywy edukacji onkologicznej w Polsce. Nowotwory 2011; 61: 178-80.
23. Domżał-Drzewicka R, Charzyńska-Gula M, Szadowska-Szlachetka Z, Bartoszek A, Stanisławek A. Causes of late diagnosis of the reproductive organs’ cancer in the opinion of suffering women from urban and rural areas of Lublin as an indicator of the condition of the early cancer detection system: a preliminary report. Prz Menopauzalny 2014; 13: 174-9.
24. http://www.puo.pl/badania-profilaktyczne/program-badan-przesiewowych (access: 2014-05-15, 15:27).
25. Klimczak A, Miśkiewicz M, Mik M, Dziki A, Utada M, Kempińska-Mirosławska B. Colorectal cancer morbidity in Poland and Japan in the years 1999–2006 – a comparison. Arch Med Sci 2014; 10, 3: 490-7.
26. Grądalska-Lampert M, Borowska-Karczmarek B, Stryjkowska A. Epidemiological analysis of morbidity and mortality from breast cancer including screening in Podkarpackie voivodeship in the years 1999-2010. Prz Med Uniw Rzesz Inst Leków 2013; 1: 106-18.

Address for correspondence

Renata Domżał-Drzewicka
Chair of Oncology and Environmental Health
Faculty of Nursing and Health Sciences
Medical University of Lublin
Staszica 4-6
20-093 Lublin, Poland
e-mail: renatadd@op.pl

Submitted: 12.12.2014
Accepted: 7.04.2015