title: Disparities in melanoma incidence and mortality in South-Eastern Europe: Increasing incidence and divergent mortality patterns. Is progress around the corner?
abstract: BACKGROUND
  Most countries in South-Eastern Europe (SEE) have lower incidence, but higher mortality rates of malignant melanoma (MM) of the skin compared to North-Western Europe (NWE). We explored trends in MM incidence and mortality in SEE countries by sex and age and compared them with the trends in NWE.
  
  
  METHODS
  We obtained data on incident cases and deaths from MM (ICD-10 code C43) from 11 population-based cancer registries in Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Malta, Romania, Serbia, Slovakia, Slovenia and Turkey. We calculated age-specific rates for 25-49 ('young'), 50-69 ('middle aged') and 70+ years ('older') and estimated the average annual percent of change in incidence and mortality trends 2000-2010 according to age group and sex, using joinpoint regression analysis.
  
  
  RESULTS
  The incidence rates of MM across the region were uniformly increasing. Significant increases in mortality rates were observed in middle aged men in Serbia and Bulgaria, middle aged women in Slovenia, older men in the Czech Republic, Serbia and Turkey, and older women in Slovenia and Serbia.
  
  
  CONCLUSIONS
  While MM incidence rates were still increasing across SEE, mortality trends diverged and were less favourable than in NWE. Empowering cancer registration and improving the quality of incidence and mortality data will be essential for monitoring progress in MM control. In the context of prevention of melanoma, disparities in early detection appear to be widening the gap between SEE and NWE, while the provision of care to patients with advanced disease is likely to prove a challenge for regional healthcare budgets.
authors.affiliation: Agency for Quality and Accreditation in Health Care and Social Welfare, Department for Development, Research and Health Technology Assessment, Planinska 13, 10000 Zagreb, Croatia. Electronic address: j_barbaric@yahoo.com.
authors.forename: Jelena
authors.initials: J
authors.lastname: Barbaric
authors.affiliation: Croatian National Cancer Registry, Croatian Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia. Electronic address: mario.sekerija@hzjz.hr.
authors.forename: Mario
authors.initials: M
authors.lastname: Sekerija
authors.affiliation: Malta National Cancer Registry, Department for Health Information and Research, 95, G'Mangia Hill, Pieta, PTA 1313, Malta. Electronic address: domenic.a.agius@gov.mt.
authors.forename: Dominic
authors.initials: D
authors.lastname: Agius
authors.affiliation: Regional Cancer Registry of Cluj, Oncological Institute 'Ion Chiricuta', Republicii Street 34-36, 400015 Cluj-Napoca, Romania. Electronic address: dana.coza@iocn.ro.
authors.forename: Daniela
authors.initials: D
authors.lastname: Coza
authors.affiliation: Bulgarian National Cancer Registry, National Oncology Hospital, 6, Plovdivsko Pole Street, 1756 Sofia, Bulgaria. Electronic address: dimitrova.nadia@gmail.com.
authors.forename: Nadya
authors.initials: N
authors.lastname: Dimitrova
authors.affiliation: Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, 1 Prodromou Street & 17 Chilonos Street, 1448 Lefkosia, Cyprus. Electronic address: ADemetriou@moh.gov.cy.
authors.forename: Anna
authors.initials: A
authors.lastname: Demetriou
authors.affiliation: National Cancer Registry of Slovakia, National Health Information Center, Lazaretska 26, 81109 Bratislava, Slovakia. Electronic address: Chakameh.DibaSafaei@nczisk.sk.
authors.forename: Chakameh
authors.initials: C
authors.lastname: Safaei Diba
authors.affiliation: Hacettepe University, Public Health Institute, Sıhhıye Campus, Sıhhıye, 06100 Ankara, Turkey; Izmir Cancer Registry, Izmir Public Health Directorate, Zubeyde Hanim Caddesi No:100, 35067 Karsiyaka, Izmir, Turkey. Electronic address: sultan.eser@gmail.com.
authors.forename: Sultan
authors.initials: S
authors.lastname: Eser
authors.affiliation: Cancer Registry of Republic of Srpska, The Public Health Institute Banja Luka, Jovan Ducic 1, 78 000 Banja Luka, Bosnia and Herzegovina. Electronic address: zgavric210@gmail.com.
authors.forename: Zivana
authors.initials: Z
authors.lastname: Gavric
authors.affiliation: Cancer Registry of Republic of Slovenia, Oncology Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia. Electronic address: mzakelj@onko-i.si.
authors.forename: Maja
authors.initials: M
authors.lastname: Primic-Zakelj
authors.affiliation: Cancer Registry of Central Serbia, Institute of Public Health of Serbia, Dr Subotica 5, 11000 Belgrade, Serbia. Electronic address: snezana_zivkovic@batut.org.rs.
authors.forename: Snezana
authors.initials: S
authors.lastname: Zivkovic
authors.affiliation: Czech National Cancer Registry, Institute of Health Information and Statistics of the Czech Republic, Palackého nám. 4, PO Box 60, 128 01 Praha 2, Czech Republic. Electronic address: miroslav.zvolsky@uzis.cz.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Zvolsky
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 CEDEX 08 Lyon, France. Electronic address: BrayF@iarc.fr.
authors.forename: Freddie
authors.initials: F
authors.lastname: Bray
authors.affiliation: Department of Public Health, Erasmus University Medical Center, PO Box 2040 3000 CA Rotterdam, The Netherlands. Electronic address: j.coebergh@erasmusmc.nl.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Coebergh
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 CEDEX 08 Lyon, France. Electronic address: ZnaorA@iarc.fr.
authors.forename: Ariana
authors.initials: A
authors.lastname: Znaor
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D055088:Early Detection of Cancer; D005060:Europe / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors
keywords: Incidence; Malignant melanoma; Mortality; South-Eastern Europe; Trends