title: Trends in survival of patients diagnosed with cancer of the digestive organs in the Nordic countries 1964-2003 followed up to the end of 2006.
abstract: Cancers of the digestive organs (including the oesophagus, stomach, small intestine, colon, rectum and anus, liver, gallbladder, and pancreas) constitute one-fifth of all cancer cases in the Nordic countries and is a group of diseases with diverse time trends and varying consequences for public health. In this study we examine trends in relative survival in relation to the corresponding incidence and mortality rates in the Nordic countries during the period 1964-2003.
  
  
  METHODS
  Data were retrieved from the NORDCAN database for the period 1964 to 2003, grouped into eight 5-year periods of diagnosis. The patients were followed up until the end of 2006. Analysis comprised trends in 5-year relative survival, excess mortality and age-specific relative survival.
  
  
  RESULTS
  Survival following cancers of the colon and rectum has increased continuously over the observed period, yet Danish patients fall behind those in the other Nordic countries. The largest inter-country variation is seen for the rare cancers in the small intestine. There has been little increase in prognosis for patients diagnosed with cancers of the liver, gallbladder or pancreas; 5-year survival is generally below 15%. Survival also remains consistently low for patients with oesophageal cancer, while minor increases in survival are seen among stomach cancer patients in all countries except Denmark. The concomitant incidence and mortality rates of stomach cancer have steadily decreased in each Nordic country at least since 1964.
  
  
  CONCLUSIONS
  While the site-specific variations in mortality and survival largely reflect the extent of changing and improving diagnostic and clinical practices, the incidence trends highlight the importance of risk factor modification. Alongside the ongoing clinical advances, effective primary prevention measures, including the control of alcohol and tobacco consumption as well as changing dietary pattern, will reduce the incidence and mortality burden of digestive cancers in the Nordic countries.
authors.affiliation: Swedish Cancer Registry, National Board of Health and Welfare, Stockholm, Sweden.
authors.forename: Asa
authors.initials: A
authors.lastname: Klint
authors.forename: Gerda
authors.initials: G
authors.lastname: Engholm
authors.forename: Hans H
authors.initials: HH
authors.lastname: Storm
authors.forename: Laufey
authors.initials: L
authors.lastname: Tryggvadóttir
authors.forename: Mette
authors.initials: M
authors.lastname: Gislum
authors.forename: Timo
authors.initials: T
authors.lastname: Hakulinen
authors.forename: Freddie
authors.initials: F
authors.lastname: Bray
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D001661:Biliary Tract Neoplasms / Q000401:mortality; D003718:Denmark / Q000453:epidemiology; D004067:Digestive System Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D004781:Environmental Exposure; D004938:Esophageal Neoplasms / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D007414:Intestinal Neoplasms / Q000401:mortality; D008113:Liver Neoplasms / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009664:Norway / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000401:mortality; D012042:Registries; D012307:Risk Factors; D057185:Sedentary Behavior; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000401:mortality; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology