Cancer Incidence in Sweden 1998

STATISTICS HEALTH AND DISEASES 2000:4 Cancer Incidence in Sweden 1998 CENTRE FOR EPIDEMIOLOGY SVERIGES OFFICIELLA STATISTIK OFFICIAL STATISTICS OF SWEDEN

Statistics - Health and Diseases Cancer Incidence in Sweden 1998 The National Board of Health and Welfare CENTRE FOR EPIDEMIOLOGY OFFICIAL STATISTICS OF SWEDEN For information: Lotti Barlow The Cancer Registry, Centre for Epidemilogy Telephone: +46-8-5555 3000 Published at Internet: www.sos.se/epc: 30 June 2000 Artikelnr. 2000-42-004 ISBN 91-7201-450-4 ISSN 1401-0224

Preface The Swedish Cancer Registry was established in 1958. Since 1991, it is part of the Centre for Epidemiology (EpC). In this publication the National Board of Health and Welfare presents its 41st report on the incidence of cancer in Sweden. It comprises the material for 1998 and a description of trends covering the period of 1960-1998. Compared to the 1992 and previous reports, data on second and multiple primary tumors are added, and some changes in the names of the tables and the order of the figures have been made. Furthermore, a comment is made on certain discrepancies between the registration of cancer in the Cancer Registry and the Cause of Death Registry and their impact on the reliability of the incidence figures (se chapter 4). The prevalence of cancer in Sweden is presented in chapter 8. In accordance with an agreement between the five Nordic Cancer Registries, and the regional registries in Sweden, site and histopathology ("morphology") of the tumors has been coded in the ICD-O-2/ICD-10 systems of topography and morphology as of January 1st 1993. With these systems, a more detailed information is obtained (especially with regard to the morphology) than was previously possible with the ICD-7/WHO/HS/CANC/24.1 coding principles; further, the coding systems in the Cancer Registry will in the future be comparable with ICD-10 when used in its clinical context. In the present publication, ICD-O-2/ICD-10 figures for coding site have been translated to comply with earlier ICD-7 praxis, and are presented in the main tables according to this praxis. Table W1 and Table W2 show that, for all practical purposes, such a translation is feasible. Stockholm 2000 Kerstin Wigzell Director General National Board of Health and Welfare Måns Rosén Professor and Head Centre for Epidemiology National Board of Health and Welfare

Professional Staff of The Cancer Registry Anders Ericson, Deputy Head of Division Medical consultative staff: Jan Ericsson, MD Torgil Möller, MD Statistical and administrative staff: Lotti Barlow Raouf Ladjemi Mats Talbäck Gunn-Marie Tranberg For information: Lotti Barlow The Swedish Cancer Registry Centre for Epidemiology The National Board of Health and Welfare SE-106 30 STOCKHOLM SWEDEN Telephone: 08-5555 3000 Fax: 08-5555 3327 E-mail : cancerregistret@sos.se

Contents Page 1 Material 7 2 Information available in the Cancer Registry 8 3 Reporting procedures and controls of the material 9 4 Validity of the data 10 5 Statistical terms 12 6 The population of Sweden 13 7 Total cancer incidence 1998 15 8 The prevalence of cancer in Sweden 20 9 Trends in the cancer incidence 22 10 Coding according to ICD-O-2/ICD-10, and translation to earlier ICD versions: 106 Table W1 Translation of site codes from ICD-O-2/ICD-10 to ICD-7 and ICD-9 107 Table W2 Translation of site codes from ICD-O-2/ICD-10 to ICD-7 and ICD-9, 114 including relevant morphology codes FIGURES Figure A Comparison between different methods of calculating 15 incidence rates per 100 000, by sex. 1960-1998 Figure B The ten most frequent specified cancer sites, by sex 16 Figure C Age-specific incidence rates per 100 000. All sites, by sex 16 Figure D Grouped cancer sites, by sex 17 Figure E All sites. New cases. 1960-1998 25 Figure F1 All sites. Age standardized. 1960-1998 25 Figures F2-28 Age standardized cancer incidence rates per 100 000, 26 by site and sex. 1960-1998 TABLES Table A1 Main cancer sites in not autopsied cases in the Cause of 11 Death Registry 1997 but not in the Cancer Registry 1958-1997 Table A2 Main cancer sites in autopsied cases in the Cause of 11 Death Registry 1997 but not in the Cancer Registry 1958-1997 Table B Selected population data for Sweden 1998 13 Table C The mean population of Sweden 1998, by sex and age 13 Table D The mean population of Sweden 1998, by sex and domicile 14 Table E Total numbers and total rates per 100 000, by sex 15 Table F Percentage distribution of the new cases of cancer, by site and sex 18

Table G Number of tumors considered not to be infiltrating and metastasizing, but 19 included in the total cancer incidence, by diagnosis and sex Table H Number of benign tumors and precancerous lesions registered, but 19 not included in the total cancer incidence, by diagnosis and sex Table I Prevalence of cancer in Sweden, by site and sex, 1958-1998 and 1994-1998 21 Table J Estimates of the annual linear trend of selected sites, 1979-1998 and 1989-1998 23 Table 1 Number of new cases, by site, sex and age at diagnosis 31 Table 2 Number of new cases, by site, sex and county 45 Table 3A Number of new cases, by site, sex, medical region, and the municipalities 49 of Stockholm, Malmö and Göteborg Table 3B Number of new cases found incidentally at autopsy, by site, sex, medical region, 53 and the municipalities of Stockholm, Malmö and Göteborg Table 3C Number of second and multiple primaries, by site, sex, medical region, 57 and the municipalities of Stockholm, Malmö and Göteborg Table 4 Rates per 100 000, by site, sex and age at diagnosis and rates age 61 adjusted to the 1970 census and the world standard population Table 5 Rates per 100 000 age standardized to the 1970 census, by site, sex and county 75 Table 6 Rates per 100 000 age standardized to the 1970 census, by site, sex, 79 medical region, and the municipalities of Stockholm, Malmö and Göteborg Table 7 Rates per 100 000 age adjusted to the world standard population, 83 by site, sex and year of diagnosis 1979-1998 Table 8 Percentage of cytologically or histologically verified cases, 87 by site, sex and age at diagnosis Table 9 Percentage of cases found incidentally at autopsy, by site, sex and age at diagnosis 91 Table 10 Percentage of cases found incidentally at autopsy, by site, sex and county, 95 and the municipalities of Stockholm, Malmö and Göteborg APPENDICES Appendix 1 Major exceptions from the codes in the 7th WHO revision 99 (WHO/HS/CANC/24.1 Code for Anatomical Location) Appendix 2 Definitions of statistical terms 100 Appendix 3 Form used for clinical report 103 Appendix 4 Form used for cytology/pathology report 104 Appendix 5 Map of Sweden 105

1 Material According to Regulations by the National Board of Health and Welfare (SOSFS(M) 1984:32) all physicians in hospitals and other establishments for medical treatment under public or private administration in Sweden must report all cases of cancer ("Clinical report", on Form A cf. Appendix 3) to the Cancer Registry. Furthermore, pathologists and cytologists separately report every cancer diagnosis on surgically removed tissues, biopsies, cytological specimens, bone marrow aspirates and autopsies (including forensic necropsies) ("Pathology report", Form B cf. Appendix 4) to the Registry. Thus, the majority of cases are notified twice, in separate reports. The registration of new cancer reports and the major check-up and correction work is performed by six regional cancer registries covering the whole country. These registries are associated with the oncological centre in each medical region of Sweden (Stockholm-Gotland, Uppsala-Örebro, Linköping, Lund-Malmö, Göteborg and Umeå). The regionalization implies a close contact between the registry and the reporting physician which in turn alleviates the task of correcting and checking the material. The regional registries send annual information about the newly registered cases and corrections concerning those previously reported to the National Cancer Registry. The present publication comprises statistics on cases of cancer diagnosed in 1998. The following diseases are to be reported to the National Cancer Registry. A All definitely malignant neoplasms (e.g. carcinoma, sarcoma, malignant lymphoma, leukemia and malignant teratoma). B Carcinoid tumors of digestive and other organs, granulosa cell tumors of the ovary, thymomas, adamantinomas and chordomas. C Histologically benign tumors of the central nervous system and meninges, transitional cell papillomas of the urinary tract, all hormonally active tumors of the endocrine glands (except the thyroid) and the entero-chromaffin and neuroendocrine systems. D Precancerous lesions of lip, mouth, larynx, bronchus, trachea, cervix uteri, skin, vulva and vagina, gastro-intestinal polyps with suspected malignancy, "bronchial adenomas", atypical epithelial proliferations of the breast (carcinoma in situ type) and adenoma phyllodes, precancerous endometrial lesions, hydatidiform moles of placental tissue, and ovarian cystadenomas of orderline type. Diseases mentioned under A - C are included in the total cancer incidence (Tables F, G, I, J and 1-10), although a number of the tumors listed under C are considered not to be "infiltrating and metastasizing" (Table G). The benign tumors and precancerous lesions mentioned under D are listed in Table H. Basal cell carcinoma (basalioma) have not been registered. If a person has more than one primary tumor, each tumor is registered separately. This also applies for tumors appearing in the same parenchymal organ, provided the

neoplastic tissues and histogenetic properties differ among the tumors (for instance, if one neoplasm is a carcinoma and another a sarcoma). Each new primary tumor in the skin, intestine and urinary tract is registered. Information from death certificates is available to the Registry, supplying date and cause of death. Death certificates up to January 1, 1998 have been merged with the files of the Cancer Registry 1958-1997. Cancer diagnoses based on death certficates only are not registered. This information, though, can be obtained from other sources. The persons in the Cancer Registry have also been followed up regarding to migration through Statistics Sweden. 2 Information available in the Cancer Registry 2.1 Data in cancer reports - Unique personal identification number composed of 8 digits based on century, year, month and day of birth, supplemented with the so-called registration number (3 digits) and a check digit - Sex - Name - Domicile (county, municipality, parish) - Hospital - Hospital department - Hospital-record, number and year - Pathology/cytology department - Specimen number, and year when specimen was taken - Site of tumor. The Registry has ever since 1958 and still, mainly followed a code based on the 7th WHO revision (WHO/HS/CANC/24.1 Code for Anatomical Location). For exceptions cf. Appendix 1. For the years 1987-1992, the ICD-9 coding system have been used and 1993-w the ICD-O-2/ ICD-10 (International Classification of Diseases for Oncology. Second Edition. WHO Geneva 1990) - Tumor serial number - Malignancy (yes/no) - Histological type (WHO/HS/CANC/24.1 Histology Code) and from 1993 according to SNOMED (International Classification of Diseases for Oncology. Second Edition. WHO Geneva 1990) - Basis of diagnosis: 1 Clinical diagnosis only 2 X-ray 3 Histological examination of surgical or biopsy material (patho-anatomic diagnosis, "PAD") 4 Autopsy with histopathological examination of surgical or biopsy material 5 Cytological diagnosis 6 Gross examination at surgery 7 Autopsy without histopathological examination

- Date of diagnosis (century, year, month, day) - Death from cancer (yes/no) - Diagnosis made incidentally at autopsy (yes/no) 2.2 Data from death certificates - Date of death (century, year, month, day) - Cause of death. Main underlying cause, according to: ICD-7 1958-1968, ICD-8 1969-1986, ICD-9 1987-1996 ICD-10 1997-w - Contributing cause of death, if cancer. 3 Reporting procedures and controls of the material The reports are registered continuously at the regional cancer registries. Usually, the pathology/cytology (B) report arrives first, followed by the clinical (A) report. Whenever reports arrive separately, they are registered with a flag to show that one report is lacking. If the missing report does not arrive within three to nine months, a reminder is sent out. In 20-30 per cent of the cases, reports have to be traced according to this scheme. If the missing report does not arrive, the required information can be taken from the hospital case record, if available. If this source of information is also lacking, registration is done on the basis of the information that is available on the A or B report at hand. The percentage of cases with such an incomplete registration is less than two per cent. A small number of cases (annually some hundred) are reported too late to be included in the publication. These cases are added to the registry whenever they arrive. An estimation of the drop-out rate of cancers can be done by comparing the Cancer Registry data with the Cause of Death Registry (see next chapter). The material passes through the following controls: - the identification number is checked against the register covering the total population of Sweden - duplicates are subject to special checking - the validity and logical contents of the codes are checked when the material is processed.

4 Validity of the data Approximately 98 per cent of the cases are morphologically verified (Table 8). The reliability of the diagnosis may vary with the hospital, department and/or physician concerned; this may add to a geographical variability, though the structure of the country's public health system is homogeneous. The availability of facilities for pathology service likewise varies. The reliability of the diagnosis also varies with age and type of disease. The figures on incidence from the Cancer Registry include data on cases of cancer found incidentally at autopsy. The contribution from this additional source varies with site and type of tumor. Variations in the incidence of a particular type of tumor in a certain geographical region may partly be due to differences in frequency and thoroughness of the autopsy examination and the histologic examination of the autopsy specimens. Cancer of bronchus/lung, pancreas, colon, liver and prostate are often overlooked at clinical examinations but are found incidentally at autopsy. Table 3B gives the number of all cases found incidentally at autopsy by site, sex and medical region. The Swedish Cancer Registry does not use information on cancers based on death certificates only, the reason being that the data on the death certificates in many instances are uncertain - especially regarding old persons - as shown in a separate analysis (1). In 1997, there were 2 337 persons in the Cause of Death Registry with cancer stated as underlying cause of death which were not on file in the Cancer Registry 1958-1997. The most common cancer sites were - as noted previously - bronchus/lung, pancreas, colon, liver and prostate. The distribution by sex, age, and autopsy is shown in Table A1 and Table A2. The figures show that most of the cases are 75 years of age, or older, and not autopsied. Due to the implimentation of the coding system, ICD-10, 1997 is the last year available from the Cause of Death Registry. REFERENCE 1. Britta Mattsson, Cancer Registration in Sweden, academic thesis, Karolinska Institute, Stockholm 1984

Table A1: Main cancer sites in not autopsied cases in the Cause of Death Registry 1997, but not in the Cancer Registry 1958-1997 Age at death ICD-10 Site Sex All ages 0-49 50-74 75+ C16 Stomach M 29 1 7 21 C16 F 28 1 10 17 C18 Colon M 61 1 14 46 C18 F 65 1 7 57 C22 Liver and intrahepatic bile ducts M 76 2 28 46 C22 F 77 2 16 59 C23-C24 Gallbladder, other and unspecified M 26-7 19 C23-C24 parts of biliary tract F 78 1 18 59 C25 Pancreas M 147-58 89 C25 F 187-35 152 C26 Other and ill-defined digestive organs M 26-1 25 C26 F 34-4 30 C34 Bronchus and lung M 171 2 61 108 C34 F 129 2 39 88 C50 Breast M 1 - - 1 C50 F 53 6 6 41 C61 Prostate M 134 1 17 116 C64-C68 Urinary tract M 87-32 55 C64-C68 F 76-24 52 C80 Unspecified site M 95 1 36 58 C80 F 121 2 26 93 C81-C96 Lymphoid, haematopoietic and related tissue M 93 2 25 66 C81-C96 F 78 3 14 61 Other sites M 138 5 64 69 F 225 7 52 166 C00-C97 All sites M 1084 15 350 719 C00-C97 F 1151 25 251 875 Table A2: Main cancer sites in autopsied cases in the Cause of Death Registry 1997, but not in the Cancer Registry 1958-1997 Age at death ICD-10 Site Sex All ages 0-49 50-74 75+ C16 Stomach M 3 - - 3 C16 F 3-2 1 C18 Colon M 1 - - 1 C18 F 7-3 4 C22 Liver and intrahepatic bile ducts M 2 1-1 C22 F 5-2 3 C23-C24 Gallbladder, other and unspecified M 2 - - 2 C23-C24 parts of biliary tract F 3 - - 3 C25 Pancreas M 5-2 3 C25 F 3 - - 3 C26 Other and ill-defined digestive organs M - - - - C26 F 1 - - 1 C34 Bronchus and lung M 16-8 8 C34 F 4-1 3 C50 Breast M - - - - C50 F 1-1 - C61 Prostate M 2-2 - C64-C68 Urinary tract M 5-2 3 C64-C68 F 4-2 2 C80 Unspecified site M 2-1 1 C80 F 1-1 - C81-C96 Lymphoid, haematopoietic and related tissue M 9-4 5 C81-C96 F 5-2 3 Other sites M 9 1 6 2 F 9 1 1 7 C00-C97 All sites M 56 2 25 29 C00-C97 F 46 1 15 30

5 Statistical terms Age. The age of the patient at the date of diagnosis. Crude incidence rate. The total number of cases divided by the corresponding mean population per 100 000. Rates for males and females are calculated separately. Age specific incidence rate. Number of cases for each five year age-group divided by the corresponding mean population per 100 000. Rates for males and females are calculated separately. Age standardized incidence rate. In Tables E, J and 4-6, the figures have been adjusted for age distribution to a Swedish standard population (the 1970 census). In order to facilitate international comparisons, the incidence rates have also been adjusted to the world standard population (Tables E, 4 and 7). In the latter table the sites 204-209 (leukemia, polycythæmia vera and myelofibrosis) are aggregated. The standard populations and more details on definitions of statistical terms are given in Appendix 2. Prevalence. In Table I the number of resident persons in Sweden December 31, 1998 with a diagnosed cancer were counted as the prevalence. The calculations were done for two recruiting periods: the whole register 1958-1998, and to enable comparisons between years, the last five years 1994-1998. Trend. The trends over time are caculated from the age adjusted figures on tumor rates in the 18 different age groups. In Table J the trend figures for both the last 10 and 20 years are presented. The time series of age standardized rates plotted in Figures F1-F28 cover the period from 1960 to 1998. Comparisons between trends covering different time periods should be made with caution since diagnostic methods may vary, and coding practices change. Furthermore, in the trend periods shown in the present publication, the age structure of the population, the autopsy frequency (recent figure 18 per cent, compared to 50 per cent in the seventies), and type and forms of screening activities vary.

6 The population of Sweden The life expectancy at birth in Sweden for 1998 was 76.2 years for males and 81.4 for females. Some demographic data for the population are given in Tables B - D. Table B: Selected population data for Sweden 1998 Males Females Total Mean population 4 373 766 4 477 208 8 850 974 Number of live births 45 940 43 088 89 028 Number of late foetal deaths (still births) 157 149 306 Number of deaths 46 619 46 652 93 271 Number of deaths from cancer (1997)* 11 245 10 166 21 411 Crude death rates** 10.7 10.4 10.6 Infant mortality rates*** 4.0 3.0 3.5 * Last year available ** Number of deaths per 1 000 of the mean population *** Number of deaths during the first year of life per 1 000 live births Source: Statistics Sweden Table C: The mean population of Sweden 1998 by sex and age Age Males % Females % Total % 0-4 258 624 2.9 246 320 2.8 504 944 5.7 5-9 315 466 3.6 298 721 3.4 614 187 6.9 10-14 273 504 3.1 258 823 2.9 532 327 6.0 15-19 257 935 2.9 245 386 2.8 503 320 5.7 20-24 276 116 3.1 265 274 3.0 541 390 6.1 25-29 303 143 3.4 292 295 3.3 595 438 6.7 30-34 337 759 3.8 320 195 3.6 657 954 7.4 35-39 301 464 3.4 287 402 3.2 588 866 6.7 40-44 298 472 3.4 288 330 3.3 586 801 6.6 45-49 307 921 3.5 300 077 3.4 607 998 6.9 50-54 333 475 3.8 324 104 3.7 657 579 7.4 55-59 256 363 2.9 251 518 2.8 507 881 5.7 60-64 202 399 2.3 209 878 2.4 412 277 4.7 65-69 183 135 2.1 205 042 2.3 388 176 4.4 70-74 170 682 1.9 205 575 2.3 376 256 4.3 75-79 147 460 1.7 198 063 2.2 345 523 3.9 80-84 90 004 1.0 144 647 1.6 234 651 2.7 85+ 59 849 0.7 135 561 1.5 195 410 2.2 85-89 44 836 0.5 91 508 1.0 136 343 1.5 90-94 12 932 0.1 35 937 0.4 48 869 0.6 95+ 2 082 0.0 8 117 0.1 10 199 0.1 All ages 4 373 766 49.4 4 477 208 50.6 8 850 974 100.0 Source: Statistics Sweden

Table D: The mean population of Sweden 1998 by sex and domicile Code Males % Females % Total % Sweden 4 373 766 49.4 4 477 208 50.6 8 850 974 100.0 County (län) 01 Stockholms län 864 928 9.8 908 254 10.3 1 773 182 20.0 03 Uppsala län 143 232 1.6 147 712 1.7 290 943 3.3 04 Södermanlands län 127 103 1.4 129 467 1.5 256 570 2.9 05 Östergötlands län 205 964 2.3 207 422 2.3 413 386 4.7 06 Jönköpings län 162 555 1.8 165 509 1.9 328 064 3.7 07 Kronobergs län 89 437 1.0 89 113 1.0 178 550 2.0 08 Kalmar län 118 640 1.3 120 492 1.4 239 132 2.7 09 Gotlands län 28 574 0.3 29 144 0.3 57 717 0.7 10 Blekinge län 75 805 0.9 75 749 0.9 151 553 1.7 12 Skåne län 548 046 6.2 570 469 6.4 1 118 515 12.6 13 Hallands län 135 070 1.5 136 862 1.5 271 932 3.1 14 Västra Götalands län 736 247 8.3 750 018 8.5 1 486 265 16.8 17 Värmlands län 138 472 1.6 140 774 1.6 279 246 3.2 18 Örebro län 135 324 1.5 139 550 1.6 274 874 3.1 19 Västmanlands län 128 600 1.5 129 501 1.5 258 101 2.9 20 Dalarnas län 141 401 1.6 142 664 1.6 284 065 3.2 21 Gävleborgs län 140 893 1.6 142 539 1.6 283 431 3.2 22 Västernorrlands län 126 046 1.4 127 074 1.4 253 119 2.9 23 Jämtlands län 66 329 0.7 66 126 0.7 132 455 1.5 24 Västerbottens län 128 721 1.5 129 762 1.5 258 483 2.9 25 Norrbottens län 132 383 1.5 129 012 1.5 261 395 3.0 Municipality 0180 Stockholm 349 484 3.9 382 242 4.3 731 726 8.3 1280 Malmö 121 275 1.4 131 882 1.5 253 156 2.9 1480 Göteborg 224 034 2.5 234 069 2.6 458 102 5.2 Medical region R1 Stockholm/Gotland 893 502 10.1 937 398 10.6 1 830 899 20.7 R2 Uppsala/Örebro 955 024 10.8 972 205 11.0 1 927 229 21.8 R3 Linköping 487 159 5.5 493 422 5.6 980 581 11.1 R4 Lund/Malmö 771 486 8.7 794 884 9.0 1 566 369 17.7 R5 Göteborg 813 118 9.2 827 327 9.3 1 640 445 18.5 R6 Umeå 453 479 5.1 451 973 5.1 905 452 10.2 Source: Statistics Sweden

7 Total cancer incidence 1998 The incidence is based on a total of 43 645 cancers reported to the Swedish Cancer Registry in 1998; 1 075 cases of them were found incidentally at autopsy. The number of persons with cancer diagnosed for the first time in 1998 was 37 581 (19 042 males and 18 539 females); thus, 6 064 cancers were diagnosed in persons with at least one previous cancer diagnosis. The distribution of all reported cancers is given by sex in Table E below. Table E: Cancer Incidence in Sweden 1998 Total numbers and total rates per 100 000, by sex Rates per 100 000 Sex New cases Crude rate Sweden* World** All tumors M 22 087 505.0 476.9 273.6 F 21 558 481.5 400.2 258.5 M+F 43 645 Number of persons (first primaries) M 19 042 435.4 415.6 242.6 F 18 539 414.1 349.2 229.3 M+F 37 581 Second primaries M 3 045 69.6 61.4 30.9 F 3 019 67.4 51.0 29.2 M+F 6 064 Tumors found incidentally at autopsy M 646 14.8 12.8 6.5 F 429 14.4 5.8 3.0 M+F 1 075 *Age adjusted to the 1970 census in Sweden **Age adjusted to the World population Figure A: Cancer Incidence in Sweden 1960-1998 Comparison between different methods of calculating incidence rates per 100 000, by sex MALES FEMALES Per 100 000 600 Crude rates 500 Age stand. Sweden Age stand. World 400 300 200 100 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 600 Crude rates 500 Age stand. Sweden Age stand. World 400 300 200 100 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis

The percentage distribution of the ten most frequent forms of cancer is given in Figure B below. The cases cover 76.8 per cent of all male cancer. The corresponding figure for females is 70.7 per cent. Figure B: Cancer Incidence in Sweden 1998 The ten most frequent specified cancer sites, by sex MALES FEMALES PROSTATE 29.9 BREAST 28.7 BRONCHUS AND LUNG 8.0 COLON 7.8 COLON 7.1 CORPUS UTERI 6.0 SKIN (MELANOMA EXCLUDED) 7.0 SKIN (MELANOMA EXCLUDED) 5.1 URINARY ORGANS (EXCL. KIDNEY) 6.7 BRONCHUS AND LUNG 5.0 RECTUM AND ANUS 4.6 OVARY 3.9 MALIGNANT LYMPHOMA 4.1 RECTUM AND ANUS 3.8 MALIGNANT MELANOMA OF SKIN 3.6 MALIGNANT MELANOMA OF SKIN 3.7 STOMACH 3.0 MALIGNANT LYMPHOMA 3.4 NERVOUS SYSTEM 2.8 NERVOUS SYSTEM 3.3 0 10 20 30 % 0 10 20 30 % The age-specific incidence rates for all cancer are shown in Figure C. The graph illustrates that cancer mainly is a disease of the older age groups. In the age groups from 25-29 to 55-59 years, the incidence is higher among females, mostly because of the dominance of breast and genital cancer. Figure C: Cancer Incidence in Sweden 1998 Age-specific incidence rates per 100 000. All sites, by sex Per 100 000 3500 Males Females 3000 2500 2000 1500 1000 500 0 00-04 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 90-94 05-09 15-19 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ Age at diagnosis

In Figure D, some closely related cancer sites have been grouped and presented by sex. The distribution by individual site and sex (with minor exceptions), is shown in Table F. Figure D: Cancer Incidence in Sweden 1998 Grouped cancer sites, by sex MALES GENITAL ORGANS 1.3 PROSTATE 29.9 SKIN 10.6 NERVOUS SYSTEM 2.8 LEUKEMIA & LYMPHOMA 8.2 RESPIRATORY SYSTEM 8.9 DIGESTIVE SYSTEM 22.7 URINARY SYSTEM 9.4 OTHERS 5.8 FEMALES GENITAL ORGANS 13.5 BREAST 28.7 SKIN 8.8 NERVOUS SYSTEM 3.3 LEUKEMIA & LYMPHOMA 6.9 DIGESTIVE SYSTEM 20.4 RESPIRATORY SYSTEM 5.3 OTHERS 8.3 URINARY SYSTEM 4.5

CANCER INCIDENCE IN SWEDEN 1998 Table F : Percentage distribution of the new cases of cancer by site and sex ICD-7 SITE Males % Females % Total % 140-209 ALL SITES 22 087 100.0 21 558 100.0 43 645 100.0 140 LIP 119 0.5 56 0.3 175 0.4 141 TONGUE 68 0.3 42 0.2 110 0.3 142 SALIVARY GLANDS 56 0.3 40 0.2 96 0.2 143 FLOOR OF MOUTH 38 0.2 10 0.0 48 0.1 144 MOUTH, OTHER PARTS AND UNSPECIFIED 57 0.3 51 0.2 108 0.2 145 MESOPHARYNX 75 0.3 34 0.2 109 0.2 146 NASOPHARYNX 31 0.1 12 0.1 43 0.1 147 HYPOPHARYNX 46 0.2 13 0.1 59 0.1 148 PHARYNX, PARTS UNSPECIFIED 2 0.0 1 0.0 3 0.0 150 OESOPHAGUS 254 1.1 109 0.5 363 0.8 151 STOMACH 664 3.0 399 1.9 1 063 2.4 152 SMALL INTESTINE 89 0.4 112 0.5 201 0.5 153 COLON 1 578 7.1 1 679 7.8 3 257 7.5 154 RECTUM AND ANUS 1 017 4.6 824 3.8 1 841 4.2 155 BILIARY PASSAGES AND LIVER, PRIMARY 436 2.0 440 2.0 876 2.0 155.0 LIVER, PRIMARY 265 1.2 155 0.7 420 1.0 156 LIVER NOT SPECIFIED AS PRIMARY 67 0.3 63 0.3 130 0.3 157 PANCREAS 431 2.0 497 2.3 928 2.1 158 PERITONEUM 9 0.0 22 0.1 31 0.1 160 NOSE AND NASAL SINUSES 39 0.2 28 0.1 67 0.2 161 LARYNX 142 0.6 25 0.1 167 0.4 162 TRACHEA, BRONCHUS, LUNG AND PLEURA, PRIMARY 1 771 8.0 1 075 5.0 2 846 6.5 162.1 BRONCHUS AND LUNG, PRIMARY 1 666 7.5 1 054 4.9 2 720 6.2 163 LUNG, UNSPECIFIED 33 0.1 32 0.1 65 0.1 164 MEDIASTINUM 5 0.0 3 0.0 8 0.0 170 BREAST 29 0.1 6 188 28.7 6 217 14.2 171 CERVIX UTERI - - 432 2.0 432 1.0 172 CORPUS UTERI - - 1 300 6.0 1 300 3.0 173 CHORIONEPITHELIOMA OF UTERUS - - 2 0.0 2 0.0 174 UTERUS PARTS UNSPECIFIED - - 128 0.6 128 0.3 175 OVARY, TUBE AND BROAD LIGAMENT - - 850 3.9 850 1.9 176 OTHER FEMALE GENITAL ORGANS - - 224 1.0 224 0.5 177 PROSTATE 6 610 29.9 - - 6 610 15.1 178 TESTIS 211 1.0 - - 211 0.5 179 OTHER MALE GENITAL ORGANS 73 0.3 - - 73 0.2 180 KIDNEY 599 2.7 430 2.0 1 029 2.4 180.0 RENAL PARENCHYMA 453 2.1 355 1.6 808 1.9 181 URINARY ORGANS (EXCLUDING KIDNEY) 1 480 6.7 547 2.5 2 027 4.6 190 MALIGNANT MELANOMA OF SKIN 805 3.6 802 3.7 1 607 3.7 191 SKIN (MELANOMA EXCLUDED) 1 539 7.0 1 093 5.1 2 632 6.0 192 EYE 49 0.2 56 0.3 105 0.2 193 NERVOUS SYSTEM 628 2.8 717 3.3 1 345 3.1 194 THYROID GLAND 85 0.4 197 0.9 282 0.6 195 ENDOCRINE GLANDS 216 1.0 419 1.9 635 1.5 196 BONE 46 0.2 30 0.1 76 0.2 197 CONNECTIVE TISSUE, MUSCLE 139 0.6 140 0.6 279 0.6 199 OTHER AND UNSPECIFIED SITES 713 3.2 958 4.4 1 671 3.8 200 MALIGNANT NON-HODGKIN LYMPHOMA 686 3.1 599 2.8 1 285 2.9 201 HODGKINS DISEASE 95 0.4 63 0.3 158 0.4 202 RETICULOSIS AND RELATED FORMS 55 0.2 34 0.2 89 0.2 203 MULTIPLE MYELOMA, PLASMOCYTOMA 305 1.4 235 1.1 540 1.2 204 LYMPHATIC LEUKEMIA 313 1.4 200 0.9 513 1.2 205 MYELOID LEUKEMIA 217 1.0 199 0.9 416 1.0 206 MONOCYTIC LEUKEMIA 15 0.1 14 0.1 29 0.1 207 OTHER AND UNSPECIFIED LEUKEMIA 25 0.1 30 0.1 55 0.1 208 POLYCYTHAEMIA VERA 50 0.2 59 0.3 109 0.2 209 MYELOFIBROSIS 77 0.3 45 0.2 122 0.3 200-202,209 MALIGNANT LYMPHOMA 913 4.1 741 3.4 1 654 3.8 204-207 LEUKEMIA 570 2.6 443 2.1 1 013 2.3

Table G: Cancer Incidence in Sweden 1998 Number of tumors considered not to be infiltrating and metastasizing, but included in the total cancer incidence, by diagnosis and sex Site / histopathologic diagnosis Males Females Total PAPILLOMA, URINARY TRACT 5 2 7 ANGIOSARCOMA OF KAPOSI 11 7 18 HISTOLOGICALLY BENIGN TUMORS 314 491 805 OF THE CENTRAL NERVOUS SYSTEM HISTOLOGICALLY BENIGN TUMORS OF ENDOCRINE 191 391 582 GLANDS (EXCLUDING THYROID ADENOMA) LOW GRADE FIBROSARCOMA (INCLUDING 19 13 32 DERMATOFIBRO-SARCOMA PROTUBERANS) Table H: Cancer Incidence in Sweden 1998 Number of benign tumors and precancerous lesions registered, but not included in the total cancer incidence, by diagnosis and sex Site / histopathologic diagnosis Males Females Total PRECANCEROUS LESIONS OF LIP AND MOUTH 16 12 28 PRECANCEROUS LESIONS OF LARYNX, 29 11 40 TRACHEA AND BRONCHUS PRECANCEROUS EPITHELIAL LESIONS OF SKIN 1 659 1 931 3 590 MALIGNANT MELANOMA IN SITU OF THE SKIN 212 288 500 PRECANCEROUS LESIONS OF VULVA AND VAGINA 0 148 148 GASTRO-INTESTINAL POLYP WITH 519 489 1 008 PRECANCEROUS CHANGE PRECANCEROUS CHANGE OF BREAST, AND 2 640 642 ADENOMA PHYLLODES CARCINOMA IN SITU ("STAGE 0") OF UTERINE. 3 082 3 082 CERVIX (SQUAMOUS CELL TYPE) HYDATIDIFORM MOLE. 95 95 PRECANCEROUS ENDOMETRIAL CHANGE. 55 55 OVARIAN CYSTADENOMA WITH. 226 226 BORDERLINE MALIGNANCY PRELEUKEMIA 131 128 259

8 The prevalence of cancer in Sweden Table I shows the numbers of persons diagnosed with cancer in the periods 1958-1998 and 1994-1998, respectively, that were resident in Sweden December 31, 1998. For simplicity all persons are considered as prevalent cases, although some might be cured from their disease. Some individuals may have more than one primary diagnosis. In all sites each person is counted only once. For the single sites they are counted once for each diagnostic group. The prevalence of a disease is affected by demographic, diagnostic and treatment factors that all may change over time: The incidence of the disease The age distribution Early diagnosis Length of survival This fact makes prevalence time trend analyses complex.

CANCER INCIDENCE IN SWEDEN 1998 Table I: Prevalence of cancer in Sweden as of December 31, 1998 for cases diagnosed 1958-1998 and 1994-1998, respectively, and as a comparison the number of persons diagnosed 1998, by site and sex Prevalence of cases Prevalence of cases Incident cases diagnosed 1958-1998 diagnosed 1994-1998 diagnosed 1998 ICD-7* Site Males Females Total Males Females Total Males Females Total 140-209 All sites 117 171 176 347 293 518 58 955 66 742 125 697 19 042 18 539 37 581 140 Lip 1 667 472 2 139 510 206 716 119 56 175 141 Tongue 446 348 794 213 153 366 68 42 110 142 Salivary glands 519 661 1 180 164 163 327 56 40 96 143 Floor of mouth 189 97 286 111 51 162 38 10 48 144 Mouth, other parts and unspecified 459 511 970 191 215 406 57 50 107 145 Mesopharynx 354 198 552 206 89 295 75 33 108 146 Nasopharynx 209 111 320 81 38 119 31 12 43 147 Hypopharynx 136 40 176 90 19 109 46 12 58 148 Pharynx, part unspecified 14 3 17 7 2 9 2 1 3 150 Oesophagus 374 181 555 288 114 402 254 109 363 151 Stomach 2 010 1 548 3 558 942 663 1 605 663 399 1 062 152 Small intestine 588 563 1 151 256 262 518 89 112 201 153 Colon 9 110 12 268 21 378 4 410 4 915 9 325 1 538 1 645 3 183 154 Rectum and anus 6 183 6 356 12 539 3 051 2 679 5 730 1 010 822 1 832 155 Biliary passages and liver, primary 451 585 1 036 304 335 639 436 439 875 156 Liver, not specified as primary 30 33 63 21 25 46 67 63 130 157 Pancreas 280 318 598 221 255 476 431 496 927 158 Peritoneum 8 33 41 6 22 28 9 22 31 160 Nose and nasal sinuses 296 205 501 103 85 188 39 28 67 161 Larynx 1 565 293 1 858 554 90 644 142 25 167 162 Trachea, bronchus, lung and pleura, primary 2 803 2 221 5 024 1 793 1 405 3 198 1 757 1 074 2 831 163 Lung, not specified as primary 49 52 101 25 24 49 33 32 65 164 Mediastinum 38 7 45 11 2 13 5 3 8 170 Breast 287 63 550 63 837 132 24 362 24 494 28 6 052 6 080 171 Cervix uteri. 10 056 10 056. 1 762 1 762. 430 430 172 Corpus uteri. 16 414 16 414. 4 982 4 982. 1 299 1 299 173 Chorionepithelioma of uterus. 147 147. 12 12. 2 2 174 Uterus, part unspecified. 1 262 1 262. 343 343. 128 128 175 Ovary, tube and broad ligament. 8 617 8 617. 2 668 2 668. 849 849 176 Other female genital organs. 1 501 1 501. 616 616. 224 224 177 Prostate 34 498. 34 498 21 505. 21 505 6 608. 6 608 178 Testis 4 359. 4 359 1 095. 1 095 206. 206 179 Other male genital organs 700. 700 226. 226 73. 73 180 Kidney 4 056 3 445 7 501 1 579 1 243 2 822 592 424 1 016 181 Urinary organs (excl. kidney) 12 583 4 624 17 207 5 306 1 808 7 114 1 472 544 2 016 190 Malignant melanoma of skin 8 514 11 259 19 773 3 258 3 612 6 870 796 796 1 592 191 Skin (melanoma excluded) 8 628 6 877 15 505 4 811 3 599 8 410 1 468 1 046 2 514 192 Eye 731 780 1 511 234 232 466 49 56 105 193 Nervous system 4 854 7 018 11 872 1 626 2 224 3 850 628 715 1 343 194 Thyroid gland 1 218 4 303 5 521 306 867 1 173 85 197 282 195 Endocrine glands 3 184 7 871 11 055 953 2 329 3 282 214 419 633 196 Bone 605 484 1 089 146 104 250 46 30 76 197 Connective tissue, muscle 1 361 1 344 2 705 473 427 900 139 140 279 199 Other and unspecified sites 915 1 256 2 171 526 769 1 295 712 956 1 668 200 Malignant non-hodgkin lymphoma 4 246 3 825 8 071 1 982 1 812 3 794 686 599 1 285 201 Hodgkin's disease 1 610 1 225 2 835 404 303 707 95 63 158 202 Reticulosis and related forms 529 244 773 241 115 356 55 34 89 203 Multiple myeloma, plasmocytoma 1 068 972 2 040 747 664 1 411 305 235 540 204 Lymphatic leukemia 2 093 1 679 3 772 1 078 794 1 872 313 200 513 205 Myeloid leukemia 599 571 1 170 384 332 716 216 199 415 206 Monocytic leukemia 26 19 45 18 15 33 15 14 29 207 Other and un-specified leukemia 89 89 178 46 34 80 25 30 55 208 Polycythaemia vera 535 635 1 170 207 242 449 50 59 109 209 Myelofibrosis 194 200 394 162 163 325 77 45 122 * In the all sites each person is counted only once. For the single sites they are counted once for each diagnostic group.

9 Trends in the cancer incidence Factors that affect trends include changes in coding practices, age structure of the population at risk, and the autopsy frequency, as well as the introduction of screening activities and improvements in diagnostic practices. For this reason, conclusions may be difficult to draw from trend figures covering long time periods. In the presentation of the trends, we have chosen to give figures both for a 20-year period and the latest decade (Table J). The effect of this measure becomes apparent in several sites, for instance men in ICD-7 site 193, central nervous system (see Table J and Figure 22). Thus, the 20-year linear trend shows an average annual increase of 0.4 per cent, while the linear trend of the latest decade is an annual decrease of 0.6 per cent. The annual number of cancer cases in Sweden has increased constantly during the period of 1960-1998, as can be seen in Figure E. The average annual increase is 2.2 per cent for men and 1.9 for women. Almost half of this increase is explained by the continuous change in age structure of the population. This is seen in the graphs in Figure A (page 15) where the crude rates are compared with age standardized ones. When the number of cancer cases is considered over the period 1979-1998, the average annual increase is 1.2 per cent both for men and women. In Table J, concerning the years 1979-1998, the average annual changes in time trends are calculated according to an exponential model (the end of Appendix 2) with the age standardized incidence rates as point estimates. Changes in trend are given for the whole period, and for the latest 10-year period separately. The average annual increase in the age standardized rates for all cancer is 0.5 per cent for men and 0.6 for women during the complete period. The figure for the period 1989-1998 is 0.3 for males and 0.4 for females. An increase in the trend for the years 1979-1998 is seen e. g. for the following sites hmalignant melanoma of skin. Seen over a 20-year period, this is one of the most rapidly increasing malignant tumors in Sweden. For men, the average increase per year is 3.1 per cent and for women slightly less (2.3 per cent). The increase is less prominent during the last 10-year period. h non-melanoma skin cancer (mainly squamous carcinomas). An average annual increase of 4.3 per cent is observed for men and 4.6 for women. This is for both men and women the most rapidly increasing malignant tumor during the latest 10- year period studied (2.6 per cent for men and 4.0 per cent for women). h bronchus and lung, primary. Women show a rather strong average increase per year, 3.2 per cent, while the previously noted increasing trend in males has now turned to a decrease of 1.1 per cent calculated for the whole period. The decrease is more pronounced if only the latest period studied is taken into account. The gap between the incidence curves for both sexes is, however, still considerable. h breast cancer in women. The annual increase is 1.5 per cent for the whole period but 1.0 per cent if only the latest 10-year period is considered. h prostate. This is the most common cancer site in men with an average annual increase of 2.0 per cent. For the last 10-year period the increase is 2.7 per cent.

CANCER INCIDENCE IN SWEDEN 1998 Table J : Estimates of the annual trend of selected sites, 1979-1998 and 1989-1998 ANNUAL CHANGE IN PERCENT RATES AGE ADJUSTED TO FOR TREND PERIOD THE 1970 CENSUS. PER 100.000 OF THE LATEST ICD-7 SITE SEX 20 Years 10 Years 1979 1989 1998 140-209 ALL SITES (AGE STANDARDIZED) M.5 *.3 422.0 461.6 476.9 F.6 *.4 364.6 380.1 400.2 140 LIP M -3.3 * -2.3 * 4.4 3.1 2.5 F 2.9 * 3.5.4.7.9 150 OESOPHAGUS M -.2.3 5.2 5.5 5.8 F.6-1.1 1.7 1.7 1.8 151 STOMACH M -3.9 * -4.6 * 29.9 21.5 13.7 F -4.0 * -4.7 * 13.8 10.4 6.3 153 COLON M.4 *.5 31.9 31.8 33.5 F -.1 -.5 27.7 27.5 27.7 154 RECTUM M.4 *.2 20.8 21.8 21.9 F.2 -.2 14.1 14.5 14.5 155 BILIARY PASSAGES AND LIVER PRIMARY M -2.3 * -2.9 * 13.0 11.6 9.4 F -3.1 * -4.6 * 12.9 11.1 7.8 155.0 LIVER, PRIMARY M -2.0 * -2.5 * 7.5 6.7 5.6 F -1.8 * -2.9 3.8 3.4 2.7 157 PANCREAS M -2.8 * -3.0 * 14.7 13.0 9.4 F -1.6 * -2.8 * 11.1 11.0 8.5 161 LARYNX M -1.5 * -3.1 4.7 5.3 3.3 F.1-3.7.4.7.5 162.1 BRONCHUS AND LUNG PRIMARY M -1.1 * -1.8 * 41.2 42.6 37.2 F 3.2 * 2.6 * 11.2 16.5 21.1 170 BREAST F 1.5 * 1.0 96.7 105.6 122.6 171 CERVIX UTERI F -1.8 * -1.5 12.2 10.3 8.5 172 CORPUS UTERI F 1.1 * 2.1 * 21.3 19.9 25.6 175 OVARY, TUBE AND BROAD LIGAMENT F -1.5 * -1.3 * 24.2 19.6 17.2 177 PROSTATE M 2.0 * 2.7 * 92.7 107.4 142.4 178 TESTIS M 2.3 *.6 3.3 4.8 4.7 180.0 RENAL PARENCHYMA M -2.5 * -3.2 * 15.3 12.8 10.2 F -1.9 * -3.1 * 9.0 8.1 6.6 181 URINARY ORGANS (EXCLUDING KIDNEY) M.9 * -.4 26.3 33.7 31.6 F.9 *.8 7.9 8.5 9.2 190 MALIGNANT MELANOMA OF SKIN M 3.1 * 1.3 8.5 15.8 17.8 F 2.3 * 1.0 10.8 14.1 15.5 191 SKIN (MELANOMA EXCLUDED) M 4.3 * 2.6 * 14.8 24.1 30.5 F 4.6 * 4.0 * 6.3 10.4 14.7 193 NERVOUS SYSTEM M.4 -.6 11.5 15.0 14.4 F.6 1.0 13.1 14.4 15.0 194 THYROID GLAND M -1.6 * -.8 2.6 2.2 1.9 F -1.8 * -1.6 6.0 4.7 4.0 200 MALIGNANT NON-HODGKINS LYMPHOMA M 1.6 * -.8 12.2 15.9 14.9 F 2.2 * -.1 7.4 11.0 10.6 201 HODGKINS DISEASE M -1.7 * -1.1 3.3 2.3 2.2 F -1.0.1 1.9 1.6 1.4 203 MULTIPLE MYELOMA, PLASMOCYTOMA M -.1-1.6 6.4 7.5 6.7 F -.3 -.5 4.5 4.6 4.2 204-209 LEUKEMIA, POLYCYTHAEMIA VERA M -.6 1.6 15 14 15 F -.2 2.5 * 9 8 10 140-209 ALL SITES (NUMBER OF CASES) M 1.2 *.9 * 17 053 20 278 22 087 F 1.2 *.9 * 17 424 19 740 21 558 * Implies that the trend is considered to be strictly increasing or decreasing at the 98% confidence level

h testis. An average annual increase of 2.3 per cent is seen for the twenty-year period; however the change is less prominent during the period 1989-1998 (0.6 per cent). h urinary organs (excluding kidney). The figure for the whole period for both men and women is increasing by 0.9 per cent a year. For the last 10-year period, the decrease is 0.4 per cent for men, while the increase is 0.8 for women. h malignant non-hodgkin's lymphoma. The average annual increase for the whole period is 1.6 per cent for men and 2.2 per cent for women. These figures are partly "balanced" by a decrease in Hodgkin's lymphoma. The trend is also decreasing, as shown by the figures of the latest ten-year period. The calculations of the annual changes in trends and the graphs in Figures F8 and F9 show that the previous trends towards an increase in the incidence of cancer in the biliary passages and primary liver cancer (in both males and females) have been broken during the 1980s and early 1990s. This also applies for cancer of the ovary (Figure F16) and for cancers of pancreas (Figure F10), and lung (Figure F12a and 12b) in males. A decrease in trend is observed e. g. for Hodgkin's disease, cancer of lip in men, and for cancers of h h cervix uteri. The age standardized rate has decreased with 1.8 per cent a year for the 20-year period. This is evidently, in great measure, an effect of screening activities.the incidence may be leveling out at a rate of approximately 10 per 100 000. stomach. There is a remarkable decrease in incidence for both men and women during the whole period (3.9 per cent for men and 4.0 per cent for women annually). Corresponding figures for the last 10-year period is 4.6 for men and 4.7 for women. The rates in the incidence of cancer in various sites during the period 1960-1998 are plotted and presented in Figures F1-F28. For many sites, the number of cases is few and random variations play an important role for the configuration of the graphs. Please note that different scales are used among the figures. The rates are age standardized according to the population at the 1970 census.

Figur E. ALL SITES. New cases Number of cases 25000 Annual change in the two different trend periods 20 years (1979-98)* 10 years (1989-98)** 20000 15000 10000 Males (1.2)* (0.9)** Females (1.2)* (0.9)** 5000 0 1960 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 Year of diagnosis Figur F1. ALL SITES. Age standardized Per 100 000 600 Annual change in the two different trend periods 20 years (1979-98)* 10 years (1989-98)** 500 400 300 200 Males (0.5)* (0.3)** Females (0.6)* (0.4)** 100 0 1960 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 Year of diagnosis

Figure F2: LIP (icd-7: 140) Figure F3: OESOPHAGUS (icd-7: 150) Per 100 000 7 Males 6 Females 5 4 3 2 1 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 7 Males 6 Females 5 4 3 2 1 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Figure F4: STOMACH (icd-7: 151) Figure F5: SMALL INTESTINE (icd-7: 152) Per 100 000 60 Males 50 Females 40 30 20 10 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 4 Males Females 3 2 1 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Figure F6: COLON (icd-7: 153) Figure F7: RECTUM AND ANUS (icd-7: 154) Per 100 000 40 Males Females 30 20 10 Per 100 000 25 Males Females 20 15 10 5 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis

Figure F8: BILIARY PASSAGES AND LIVER, primary (icd-7: 155) Figure F9: LIVER, primary (icd-7: 155.0) Per 100 000 15 Males Females 10 Per 100 000 15 Males Females 10 5 5 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Figure F10: PANCREAS (icd-7: 157) Figure F11: LARYNX (icd-7: 161) Per 100 000 20 Males Females 15 10 5 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 7 Males 6 Females 5 4 3 2 1 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 50 Males Females 40 30 20 10 Figure F12a: BRONCHUS AND LUNG, primary (icd-7: 162.1) 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 7 Males 6 Females 5 4 3 2 1 Figure F12b: BRONCHUS AND LUNG, primary (icd-7: 162.1) Age group 0-54 years 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis

Figure F13: BREAST (icd-7: 170) Figure F14: CERVIX UTERI (icd-7: 171) Per 100 000 120 Females 100 80 Per 100 000 30 Females 20 60 40 10 20 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Figure F15: CORPUS UTERI (icd-7: 172) Figure F16: OVARY, TUBE AND BROAD LIGAMENT (icd-7: 175) Per 100 000 30 Females Per 100 000 30 Females 20 20 10 10 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Figure F17: PROSTATE (icd-7: 177) Figure F18: TESTIS (icd-7: 178) 120 100 80 60 40 20 Per 100 000 140 Males 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 7 Males 6 5 4 3 2 1 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis

Figure F19: KIDNEY, RENAL PARENCHYMA (icd-7: 180.0) Figure F20: URINARY ORGANS, excl. Kidney (icd-7: 181) Per 100 000 40 Males Females 30 Per 100 000 40 Males Females 30 20 20 10 10 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Figure F21: MALIGNANT MELANOMA OF SKIN (icd-7: 190) Figure F22: SKIN, excl. Melanoma (icd-7: 191) Per 100 000 35 Males 30 Females 25 20 15 10 5 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 35 Males 30 Females 25 20 15 10 5 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Figure F23: BRAIN AND NERVOUS SYSTEM (icd-7: 193) Figure F24: THYROID GLAND (icd-7: 194) Per 100 000 20 Males Females 15 10 5 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Per 100 000 7 Males 6 Females 5 4 3 2 1 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis

Per 100 000 20 Males Females 15 Figure F25: MALIGNANT NON-HODGKIN'S LYMPHOMA (icd-7: 200) Per 100 000 20 Males Females 15 Figure F26: HODGKIN'S DISEASE (icd-7: 201) 10 10 5 5 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis Figure 27: MULTIPLE MYELOMA PLASMOCYTOMA (icd-7: 203) Figure F28: LEUKEMIA (icd-7: 204-209) Per 100 000 20 Males Females 15 Per 100 000 20 Males Females 15 10 10 5 5 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis 0 1960 65 70 75 80 85 90 95 98 Year of diagnosis

CANCER INCIDENCE IN SWEDEN 1998 PART 1 ( 14) Table 1 : Number of new cases by site, sex and age at diagnosis CODE ICD-7 SITE S E X ALL AGES AGE AT DIAGNOSIS 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 140- ALL SITES M 22087 75 50 41 46 97 128 176 203 308 555 1146 1495 2004 3102 3851 4151 2835 1824 209 F 21558 57 35 41 47 77 128 270 398 724 1151 1889 2013 2079 2445 2734 2949 2407 2114 140 LIP M 119 - - - - - 1 1 1 3 1 3 9 10 15 19 25 20 11 F 56 - - - - - - - 1 1 2 5 2 7 7 3 5 15 8 140.0 UPPER LIP M 3 - - - - - 1 - - 1 - - - - - - - - 1 F 7 - - - - - - - - - - 1-2 - - 1 1 2 140.1 LOWER LIP M 61 - - - - - - 1-2 - 3 5 6 8 4 12 13 7 F 25 - - - - - - - 1 - - 2 1 3 6 2 1 8 1 140.8 MULTIPLE PARTS M 1 - - - - - - - - - - - - - 1 - - - - F - - - - - - - - - - - - - - - - - - - 140.9 LIP UNSPECIFIED M 54 - - - - - - - 1-1 - 4 4 6 15 13 7 3 F 24 - - - - - - - - 1 2 2 1 2 1 1 3 6 5 141 TONGUE M 68 - - - - - - 1 3 3 5 7 6 13 7 10 5 5 3 F 42 - - - - 1 1-1 2-3 2 4 6 4 7 7 4 141.0 BASE OF TONGUE M 29 - - - - - - - 2 2 3 1 4 4 3 6 2 2 - F 10 - - - - - - - 1 - - 2-2 2-1 1 1 141.7 OTHER SPECIFIED PART M 18 - - - - - - 1-1 2 2 1 4 1 3-1 2 F 12 - - - - 1 - - - 1-1 1 2 2-2 2-141.8 MULTIPLE PARTS M - - - - - - - - - - - - - - - - - - - F - - - - - - - - - - - - - - - - - - - 141.9 PART UNSPECIFIED M 21 - - - - - - - 1 - - 4 1 5 3 1 3 2 1 F 20 - - - - - 1 - - 1 - - 1-2 4 4 4 3 142 SALIVARY GLANDS M 56 - - 1 1-2 2 4 1 4 7 1 4 9 8 3 6 3 F 40 - - 1-1 1 1 1 2 2 2 2 5 1 8 4 4 5 142.0 PAROTID M 46 - - 1 1-1 2 3 1 2 5-3 7 8 3 6 3 F 32 - - 1-1 - - 1 1 2 2 2 4 1 7 3 3 4 142.5 SUBLINGUAL M - - - - - - - - - - - - - - - - - - - F - - - - - - - - - - - - - - - - - - - 142.6 SUBMANDIBULAR M 3 - - - - - - - - - 2 - - - 1 - - - - F 5 - - - - - 1 - - 1 - - - 1-1 - 1-142.8 MULTIPLE GLANDS M 1 - - - - - - - - - - 1 - - - - - - - F - - - - - - - - - - - - - - - - - - -

CANCER INCIDENCE IN SWEDEN 1998 PART 2 ( 14) Table 1 : Number of new cases by site, sex and age at diagnosis CODE ICD-7 SITE S E X ALL AGES AGE AT DIAGNOSIS 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 142.9 GLAND UNSPECIFIED M 6 - - - - - 1-1 - - 1 1 1 1 - - - - F 3 - - - - - - 1 - - - - - - - - 1-1 143 FLOOR OF MOUTH M 38 - - - - - - - - - - 9 10 7 7 1 2 1 1 F 10 - - - - - - - - - 1-2 2 2 - - 1 2 144 MOUTH, OTHER PARTS AND M 57 - - - - - - - - 2 6 5 7 8 4 7 5 7 6 UNSPECIFIED F 51 - - - - - - - - - 3 3 4 6 6 5 7 9 8 145 MESOPHARYNX M 75 - - - - - - - - 1 7 12 9 13 8 7 9 8 1 F 34 - - - - - - - - 2 6 6 4 4 4 4 4 - - 145.0 TONSIL M 4 - - - - - - - - - - - 1 1-1 - - 1 F 1 - - - - - - - - - - 1 - - - - - - - 145.7 OTHER SPECIFIED PARTS OF M 9 - - - - - - - - 1 1 2-2 - - 1 2 - MESOPHARYNX F 4 - - - - - - - - - 1 1 1 - - 1 - - - 145.8 MULTIPLE PARTS M 2 - - - - - - - - - - - - 1 1 - - - - F - - - - - - - - - - - - - - - - - - - 145.9 PART UNSPECIFIED M 60 - - - - - - - - - 6 10 8 9 7 6 8 6 - F 29 - - - - - - - - 2 5 4 3 4 4 3 4 - - 146 NASOPHARYNX M 31-1 - - - 1 1-3 2 5 2 2 3 2 4 4 1 F 12 - - 1 - - - 1 1 1-1 2 - - 1 3-1 147 HYPOPHARYNX M 46 - - - - - - - 1-2 2 3 5 8 10 10 4 1 F 13 - - - - - - - - - - 1-4 1 1 4 2-148 PHARYNX, PART UNSPECIFIED M 2 - - - - - - - - - - 1-1 - - - - - F 1 - - - - - - - - - - - - 1 - - - - - 150 OESOPHAGUS M 254 - - - 1 - - - - 3 7 20 31 34 42 44 31 24 17 F 109 - - - - - - - - - 1 7 5 8 15 18 24 20 11 150.0 OESOPHAGUS, SPECIFIED PART M 101 - - - - - - - - 2 1 9 15 11 18 16 14 8 7 F 51 - - - - - - - - - 1 4 3 6 5 10 9 8 5 150.8 MULTIPLE PARTS M - - - - - - - - - - - - - - - - - - - F - - - - - - - - - - - - - - - - - - - 150.9 PART UNSPECIFIED M 153 - - - 1 - - - - 1 6 11 16 23 24 28 17 16 10 F 58 - - - - - - - - - - 3 2 2 10 8 15 12 6 151 STOMACH M 664 - - - - - - 1 1 13 20 39 39 38 76 121 134 101 81 F 399 - - - - 2 1 2 8 10 14 16 21 19 30 53 88 75 60