title: Testicular cancer survival in Estonia: improving but still relatively low.
abstract: BACKGROUND
  international comparisons have pointed to very low survival of patients diagnosed with testicular cancer (TC) in Estonia.
  
  
  METHODS
  using population based data from the Estonian Cancer Registry and period analysis, we examined trends in TC survival between 1985 and 2004. Additional results from a review of clinical records to ascertain patterns of disease management (1990-2003) were used to explain the changes and identify the areas for potential improvement.
  
  
  RESULTS
  age-adjusted 5-year period relative survival increased from 47.9% in 1985-1989 to 74.5% in 2000-2004 (p for trend <0.01). A marked improvement was seen for the patients younger than 30, with the 5-year survival reaching 93.3%, while the improvement remained modest among patients aged 30 and above. Although substantial advances occurred in staging and treatment techniques since 1990, deficiencies remained evident in disease management, including not referring patients to an oncologist after their orchiectomy and less careful diagnostic workup for patients above 30 years of age. Low use of radiotherapy suggests poor access to contemporary equipment. Delays in seeking medical consultation, but also in starting adjuvant therapy, could have contributed to poorer outcomes.
  
  
  CONCLUSIONS
  survival in TC increased markedly in Estonia by the 21(st) century, but is still notably lower than in the more developed countries. Multidisciplinary efforts may help to achieve further improvement. The provision of TC care should be coordinated by specialised cancer centres.
authors.affiliation: Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia. tiiu.aareleid@tai.ee
authors.forename: Tiiu
authors.initials: T
authors.lastname: Aareleid
authors.forename: Adam
authors.initials: A
authors.lastname: Gondos
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.forename: Helis
authors.initials: H
authors.lastname: Pokker
authors.forename: Krista
authors.initials: K
authors.lastname: Leppik
authors.forename: Margit
authors.initials: M
authors.lastname: Mägi
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D014408:Biomarkers, Tumor / Q000097:blood; D004957:Estonia / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality; D012042:Registries; D018239:Seminoma / Q000401:mortality; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends; D013736:Testicular Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor