Despite having an established systematic approach to population survival estimation in Slovenia, the influence of socioeconomic environment on cancer patients’ survival has not yet been evaluated. Thus, the main aim of our study was to quantify the potential impact of socioeconomic environment on cancer patients’ survival in our population in the 21st century. The net survival was calculated and stratified into quintiles of Slovenian version of the European Deprivation Index for all adult cancer patients diagnosed between 2004 and 2018 using the national cancer registry data. After accounting for basic demographic variables (age and gender), differences in stage at diagnosis, as well as the impact of the cancer treatment improvements over time, we found that cancer patients in Slovenia with lower socioeconomic status experience worse survival and have higher mortality. In particular, the odds of dying from oral, stomach, colorectal, liver, pancreatic, lung, breast, ovarian, corpus uteri, prostate, and bladder cancers, as well as for melanoma, leukemia, and non-Hodgkin lymphoma, are significantly higher in the socioeconomically most deprived group of patients compared to the most affluent group. The inequalities in cancer burden we found could help decision-makers to better understand the magnitude of this problem.

Indoor radon is an important risk factor for lung cancer, as 3–14% of lung cancer cases can be attributed to radon. The aim of our study was to estimate the impact of indoor radon exposure on lung cancer incidence over the last 40 years in Slovenia. We analyzed the distribution of lung cancer incidence across 212 municipalities and 6032 settlements in Slovenia. The standardized incidence ratios were smoothed with the Besag–York–Mollie model and fitted with the integrated nested Laplace approximation. A categorical explanatory variable, the risk of indoor radon exposure with low, moderate and high risk values, was added to the models. We also calculated the population attributable fraction. Between 2.8% and 6.5% of the lung cancer cases in Slovenia were attributable to indoor radon exposure, with values varying by time period. The relative risk of developing lung cancer was significantly higher among the residents of areas with a moderate and high risk of radon exposure. Indoor radon exposure is an important risk factor for lung cancer in Slovenia in areas with high natural radon radiation (especially in the southern and south-eastern parts of the country).

Background: Most commonly, mortality is used for evaluation of organized breast cancer screening programmes. Survival analyses are also being employed to provide more timely assessment. A novel approach has been introduced for calculating survival using Slovenian data. Methods: Breast cancer cases from the Slovenian Cancer Registry between 2008–2021 in women aged 50 to 72 were included, supplemented by data on the screening history from the screening registry. The comparison was made in two scenarios—invited or not invited to the screening. Survival, years of life gained, and number of avoided deaths over 10 years were calculated and standardized. The comparison was adjusted for confounding covariates, and a biological tumour growth model was used to adjust the survival of the invited group for lead time bias and over-detection. Results: A total of 9392 breast cancer cases were included in the study. Estimated median lead time for screen-detected cases was 1.23 years. The survival probability accounting for lead time bias and covariates of cancers patients invited to the programme was 4.3 percentage points higher than the not invited (0.81 vs. 0.76). Standardized to 100,000 women in the 2-year period, this would result in 22 avoided deaths. On average, the invited cancer patient lived 0.22 years longer, which amounts to a total of 114 years of life gained. Conclusions: The results show the overall benefit of the breast cancer screening programme. The standardized results enable cross-country comparisons. The calculation of years of life gained and avoided deaths can provide additional opportunities for communicating the results to non-expert populations.

Background: The registry-based collection of detailed cancer and late effect (LE) data in childhood and adolescent cancer (CAC) is rarely explored. Aim: We aimed to provide an overview of CAC registration practices in Europe and share a Slovenian example. Methods: We distributed a questionnaire among European cancer registries on disease, treatment and LE registration and present the system at the Slovenian Cancer Registry along with an example of retrospectively collected LE data from a cohort of central nervous system tumour survivors from 1983 to 2000. Kaplan–Meier and Cox regression were used to calculate the LE incidence. Results: Out of 27 responding registries, over 80% registered cancer type, vital status, death and second primary cancer data. Less than 20% registered cumulative doses of radiation and systemic therapy or progressions. Only three registered LEs. The obstacles in setting up LE collection in registries are a lack of standardization in the variable sets, definitions and methods of collection. In the retrospective cohort, neurological and endocrine LEs were most common. Females had a higher risk of endocrine LEs (HR of 1.89; 95% CI of 1.08–3.31), while patients treated with radiotherapy had higher risks of endocrine (3.47; 1.80–6.69), musculoskeletal and skin LEs (3.16; 1.60–6.26) and second primary cancers (2.85; 1.18–6.75). Conclusions: Standardization and harmonization are necessary to promote detailed CAC and LE registration.

Introduction: The aim of organized breast cancer screening is early detection and reduction in mortality. Organized screening should promote equal access and reduce socio-economic inequalities. In Slovenia, organized breast cancer screening achieved complete coverage in 11-years’ time. We explored whether step-wise implementation reflects in prognostic factors (earlier diagnosis and treatment) and survival of breast cancer patients in our population. Methods: Using population-based cancer registry and screening registry data on breast cancer cases from 2008–2018, we compared stage distribution and mean time to surgical treatment in (A) women who underwent at least one mammography in the organized screening programme, women who received at least one invitation but did not undergo mammography and women who did not receive any screening invitation, and in (B) women who were invited to organized screening and those who were not. We also compared net survival by stage in different groups of women according to their screening programme status. Results: Women who underwent at least one mammography in organized screening had lower disease stage at diagnosis. Time-to-treatment analysis showed mean time to surgery was shortest in women not included in organized screening (all stages = 36.0 days vs. 40.3 days in women included in organized screening). This could be due to quality assurance protocols with an obligatory multidisciplinary approach within the organized screening vs. standard treatment pathways which can vary in different (smaller) hospitals. Higher standard of care in screening is reflected in better survival in women included in organized screening (5-years net survival for regional stage: at least one mammography in the screening programme– 96%; invitation, but no mammography– 87.4%; no invitation or mammography in the screening programme– 82.6%). Conclusion: Our study, which is one of the first in central European countries, shows that introduction of organized screening has temporary effects on population cancer burden indicators already during roll-out period, which should therefore be as short as possible.

Issue: Strategic documents addressing major public health concerns should extend beyond health sector. Cancer control is commonly perceived only as a health issue, thus involving diverse stakeholders is challenging. Description of the problem: The inclusion of stakeholders within and beyond the health sector is crucial in the preparation, and through implementation of National Cancer Control Programmes (NCCP). Lessons learned on how to involve and maintain fruitful collaboration with diverse stakeholders in Slovenian NCCP are presented. Results: Over the past 14 years Slovenia’s NCCP has built a reliable and reputable partnership with diverse stakeholders, a collaboration that continues to evolve. Efforts extend across multiple sectors, encompassing health, education, employment, research, environment, technology, and non-governmental organizations. NCCP has set up multistakeholder governance structures: an advisory board, board of experts, specialised expert groups, and a group of representatives of cancer hospitals. These groups engage a diverse range of experts and institutions nationwide. Whenever feasible, representatives of patient organizations are included. All these structures hold regular meetings, complemented by an annual event that convenes all stakeholders and also provides an invaluable platform for informal networking. To ensure seamless coordination of all activities, a dedicated team is essential. Our approach has evolved to embrace a dual leadership, comprising both a public health specialist and a clinical expert. Additionally, we benefit from the expertise of communication experts, who offer valuable insights into effectively reaching diverse audiences. Lessons: Governing Slovenia’s NCCP by involving diverse stakeholders in planning and implementation activities has demonstrated its effectiveness. Furthermore, we are witnessing an increasing number of new stakeholders actively seeking out to participate in the NCCP. Key messages: • Slovenia’s NCCP is recognized for its credibility and strategic approach. • Involving diverse stakeholders in cancer control endeavours has proven effective, fostering trust and partnerships.