Sociodemographic factors associated with advanced-stage diagnosis of head and neck cancers in Estonia: A register-based study.

INTRODUCTION

Social disparities in cancer remain a well-recognized challenge, including in Estonia, despite a universal healthcare system designed to ensure equitable access and outcomes for all patients. We investigated sociodemographic factors associated with stage at diagnosis in head and neck cancer (HNC) patients in Estonia.

METHODS

This population-based cross-sectional retrospective registry study included all patients (≥15 years) with newly diagnosed invasive HNC recorded in the Estonian Cancer Registry (ECR) during 2009-2018 (n = 1748). Information on age, sex, site, TNM stage, and region of residence was obtained from the ECR and linked to the Population Registry for data on education, marital status, and nationality. Prevalence rate ratios (PRR) and 95% confidence intervals (CI) for advanced stage (III-IV vs I-II) were estimated using Poisson regression with robust variance stratified by three site groups: predominantly alcohol- and tobacco-related sites (tongue, oral cavity, hypopharynx); predominantly HPV-related oropharyngeal cancer (OPC), and salivary gland and nasopharyngeal cancer.

RESULTS

Overall, 68.1% of patients were diagnosed at an advanced stage (III-IV). Men were more often diagnosed at advanced stage than women (73.2% vs 54.4%). In multivariable model for predominantly alcohol- and tobacco-related sites, advanced-stage diagnosis was less likely in women (PRR 0.71, 95% CI 0.62-0.80) and more likely in patients aged 55-64 years, those with secondary education and single patients. For OPC, advanced-stage diagnosis decreased over time and was more common in patients with secondary education.

CONCLUSIONS

Sex differences in advanced-stage diagnosis were seen for alcohol- and tobacco-related sites, but not for OPC, while educational disparities were evident for both site groups. Our findings emphasize that early detection strategies need to be tailored for cancer sites with different etiology as well as for different population groups, including vulnerable populations.