Dynamics of the key indicators of the oncology service in Perm Krai over a 35-year period (1990–2024)

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Introduction

After the "victory" over infectious diseases as a result of the discovery of antibiotics and the invention of numerous vaccines, cardiovascular and oncological diseases became the main threat to humanity. The former still prevail, while the latter are increasingly "fighting" for the top spot. The incidence of malignant neoplasms (MN) is growing worldwide, including in the Russian Federation [3]. We tracked and analyzed the dynamics of certain cancer indicators over a long period (35 years) in the Perm Krai, a large industrial region in the Western Urals.

It should be noted that a number of indicators from the late 1990s and early 2000s could only be traced thanks to our article published in the proceedings of the Italian-Russian conference on oncology and endocrine surgery, held in Spoleto (Perugia province, Italy) in May 2010, as the documentation for this period has not been preserved or was extremely fragmented [2].

Materials and Methods

Over the past 35 years, 309,885 patients with malignant neoplasms have been registered in the Perm Krai. In the 1990s, 7,300–7,800 patients were registered annually, in the early 2000s, 8,200–8,900, and since 2019, 10,000–11,500 patients. The incidence of malignant neoplasms in 1990 was 236.1 per 100,000 population, and in 2024 it was 456.3. That is, if we take these extreme values of the study period for calculations, the increase in incidence will be 93.3%. However, while the 2024 figure was the highest for the period under review, the 1990 figure mentioned above was not the lowest. The spread of annual incidence rates for the first five-year period was 8.2% (233.8–253.8 per 100,000), and for the last five-year period of the study period, it was 16.6% (377.7–456.3). Given the long time period and the significant variation in most annual indicators (6–26%), it was decided to use median indicators for five-year periods—the sum of five annual values divided by 5. This will provide a more objective picture. Based on this calculation, the increase in MN incidence in the Perm Krai over 35 years was 74%, or an average of 2.1% per year and 10.5% per five-year period.

Results and Discussion

An analysis of the dynamics of MN incidence in the region shows that growth was moderate in the last decade of the 20th century. The difference between the median indicators for 1990–1994 and 1995–1999 was 8.2%. With the beginning of the 21st century, the first five years saw a significant increase of 13.6%, followed by a five-year "lull" with a growth of 2.8%. And starting in 2010, each five-year period saw an increase in the median incidence rate compared to the previous period, by 11.7%, 11.3%, and 11.1%, respectively (Table 1).

Table 1. Incidence and mortality from MN in the Perm Krai over 35 years (median "crude" indicators for five-year periods)

The situation with the growth of cancer incidence in the Perm Krai is quite consistent with Russian trends, but in the Russian Federation, this indicator has been significantly higher for many years. In 2005, it was 295.6 per 100,000 population in our region and 328.8 in the Russian Federation, and in 2015, it was 376.9 and 402.5, respectively. During the pandemic, the incidence rates of MN almost equalized due to the complexity of registration. Thus, in 2020, the incidence rate in the Perm Krai was 377.2, while in the Russian Federation it was 379.7 per 100,000 population. In subsequent years, the gap reappeared in favor of the Russian average (2023 – 435.9 and 461.1).

According to V.V. Dvoyrin [1], in the early 1990s, the leading MN localizations in the general population in Russia were: lung cancer, stomach cancer, skin cancer, colorectal cancer, and two female localizations—breast cancer and cervical cancer, which also occupy the "top spots" in the overall structure of MN incidence. In men in 1990, the leaders were: lung cancer (28.9%), stomach cancer (16.5%), skin cancer (7.9%), and hemoblastosis (4.5%). Among women, the leading causes were breast cancer (16.0%), stomach cancer (13.3%), skin cancer (12.9%), and cervical cancer (6.5%). The situation was similar in the Perm Krai during this period. Lung cancer, stomach cancer, breast cancer, and skin cancer led the way, alternately topping the list. In some years, breast cancer ranked first in the general population.

In the late 1990s and early 2000s, statistics were quite difficult to obtain, and many documents have not been preserved. Nevertheless, it is possible to identify the leading causes of cancer in the Perm Krai during those years with certainty. According to some data from 1998–2003, these were skin cancer (11–13%), lung cancer (12–13%), breast cancer (10–11%), stomach cancer (8–9%), colon cancer (6–7%), and rectal cancer (5–6%).

Changes in the structure of cancer incidence in the general population over 20 years (2005–2024) are presented in Table 2.

Table 2. Structure of cancer incidence in the Perm Krai in 2005, 2014, and 2024 (rating – % of all registered MN)

Skin cancer (excluding melanoma) confidently holds first place in the structure of MN incidence in the general population in our region in 2005, 2014, and 2024. Breast cancer ranks second or third in the same years. Lung cancer moves from second to third and then to fourth place. Stomach cancer loses ground every decade, moving from fourth to seventh place, and in 2024 it will already be in eighth place. In 2005, as can be seen from the data in Table 2, prostate cancer was not among the top eight leaders. But in 2014, it was already in fourth place, and in 2024, it was in third place. Cancer of the colon (always in fifth place) and rectum (sixth-seventh place) was calculated separately for each year in terms of incidence. But, in essence, these are different parts of the same organ—the large intestine. The colon is also divided into the cecum, ascending colon, etc.

So, if we calculate their sum in the incidence structure, colorectal cancer ranks first in 2005 (12.4%), second in 2014 (12.1%), and first again in 2024 (13.6%).

It is quite difficult to track the growth of newly diagnosed MN cases in absolute numbers over a long period of time. But even the figures for 2024 compared to 2023 are impressive: prostate cancer increased by 24.2% (817 and 1015 cases), liver and bile duct cancer by 16.3% (129 and 150), kidney cancer by 15.6% (258 and 276), pancreatic cancer by 13.5% (296 and 336), and bladder cancer by 6.9% (258 and 276). Except for prostate cancer, the other locations mentioned are not leaders in the incidence structure. But prostate cancer was not a leader 15–20 years ago either.

Among men, the top three rankings were as follows: 2005 – lung cancer (20.9%), stomach cancer (11.7%), skin cancer (10.6%); 2014 – lung cancer (18.4%), prostate cancer (16.1%), skin cancer (10.3%); 2024 – prostate cancer (19.6%), lung cancer (13.3%), and skin cancer (9.2%). Thus, prostate cancer has overtaken all other types of cancer in terms of incidence growth over the past 20 years, while at the end of the 20th century and the beginning of the 21st century, it was not even close to the top ten. At the same time, stomach cancer, the "monster" of all time, continues to lose ground. However, this only applies to the incidence rate and ranking in the structure.

In the female population, the situation with the structure of MN morbidity was as follows: 2005 – breast cancer (19.7%), skin cancer (15.2%), colon cancer (7.8%); 2014 – breast cancer (20.2%), skin cancer (15.5%), uterine cancer (8.0%); 2024 – breast cancer (19.5%), skin cancer (15.8%), colon cancer – 8.4%). Colorectal cancer as a whole accounts for 14.2%. And in 2014, if we consider rectal and colon cancer together, this localization will also come in third place (12.8%).

The second most important indicator is mortality from malignant neoplasms. And while we cannot globally influence the incidence of malignant neoplasms in today's world, mortality can certainly be influenced by humanity. This indicator reflects not only the current level of scientific achievement and the state of the entire healthcare system, but also characterizes the maturity and consolidation of society as a whole in this regard.

With a 74% increase in incidence, mortality from MN in the Perm Krai increased by 6.5% over 35 years (from 187.6 to 199.8 per 100,000 according to median indicators, see Table 1). During this period, nearly 174,000 residents of the region died from malignant tumors.

The variation in the indicator's values differed significantly between different five-year periods. In 1990–1994, 1995–1999, and 2000–2004, not only the median but also the annual indicators fluctuated within very narrow limits—180–189 cases per 100,000. Only in 1996 was a low indicator of 175.2 recorded, and in 2000, an abnormally high indicator for that time—208.4 cases. During these three five-year periods (1990–2004), mortality from MN in the Perm Krai was at the level of 186.8–188.9 and was lower than the average for Russia (in the Russian Federation in 2004 – 200.6).

In 2005–2009, there was an inexplicable downward trend of 9.6%, with a median value of 170.5 per 100,000 (ranging from 169.4 to 172.7; Russian Federation: 2005 – 200.6, 2009 – 204.9 per 100,000 population). The decline is difficult to explain because there was no decrease in incidence during this period, which remained at 307 per 100,000, and no significant advances in early diagnosis were noted. The trend continued for another two years: 2010 – 169.5, 2011 – 169.3 (in the Russian Federation in 2010 – 204.4). In 2012, mortality rose sharply to 205.7 per 100,000 population; in 2013 and 2014, it was 200.3 and 194.2, respectively (median 187.8 per 100,000), approaching the Russian average (in the Russian Federation in 2012– 201.0). The increase in mortality between these two five-year periods, based on median indicators, was 10.1%.

In 2015–2024, there were no significant increases or decreases in mortality rates in the Perm Krai. Mortality fluctuated between 193.3 in 2017 and 207.6 in 2022. (in the Russian Federation in 2015 – 202.5; in 2017 – 197.9; in 2019 – 200.6; in 2023 – 194.3). Median indicators for the Perm Krai: 2015–2019 – 197.8, 2020–2024 – 199.8. The difference is 1.01%. During these same years, starting in 2010, the incidence rate increased by more than 11% every five years (Table 3).

In 2005–2024, six localizations accounted for 54–59% of all deaths from cancer. Table 3 shows that the main cause of death among cancer patients was lung cancer, as was the case in the 1990s and early 2000s. At the present stage, there are no screening and early diagnosis methods that could remedy the situation. Neither low-dose computed tomography nor large-frame fluorography yield results and are not screening methods.

Table 3. Structure of mortality from MN in the Perm Krai in 2004, 2014, and 2024 (rating –% of all registered deaths from MN in the specified year)

Stomach cancer, which is losing ground in the incidence ranking, still occupies a "top position" in the mortality structure. Fibrogastroscopy with biopsy, which is available during the second stage of medical examination, could change this situation. But the problem is that biopsies for diagnoses of gastritis and even polyps are not always performed, to put it mildly, but rather in 5–10% of cases.

Breast cancer, while maintaining its position in the structure of morbidity in the general population, is losing ground in the structure of mortality, moving from third place in 2005 and 2014 to fifth place in 2024.

Mortality from rectal and colon cancer changed places in 2005 and 2014, and in 2024, colon cancer moved into second place, pushing stomach cancer and breast cancer to lower positions and leaving rectal cancer in its "rightful" fourth place. Colorectal cancer, when calculating the total mortality rate and mortality from rectal and colon cancer as a single localization of the pathological process, would have ranked second in 2005 (12.7%), in 2014 it would have been in first place (17.2%), and in 2024 it would have been in second place again (12.3%).

In 2005, cervical cancer ranked sixth, and in 2008 and 2009, it even ranked fifth. Starting in 2010, it finally began to lose ground in the mortality structure. This may be due to the wider introduction of the screening method of early diagnosis using liquid cytology. Prostate cancer took its place, which continued in 2014 and 2024.

The annual reports we studied do not contain information on the structure of mortality by gender. However, we can assume that for men, the leading causes of death are lung cancer, stomach cancer, colorectal cancer, and, in later years, prostate cancer. Among the female population, the leading causes are breast cancer, lung cancer, cervical cancer (at the beginning of the study period in the 1990s, the incidence rate exceeded 50%), or stomach cancer, and in later years, colorectal cancer replaced stomach cancer and cervical cancer.

Let us briefly touch upon some other important indicators. Unfortunately, data for the 1990s and early 2000s are fragmentary or completely absent. However, certain trends can be traced.

At the end of the 20th century and in the early years of the 21st century, the incidence of advanced cancer (stage IV for internal localizations and stages III–IV for external localizations at the time of registration) reached 35–40% (48% for breast cancer, 45% for cervical cancer, and 54% for stomach cancer). In 2005, the rate dropped to 21.0% and has remained at this level until recently, with no downward trend (ranging from 19.9% in 2014 to 22.2% in 2023). When analyzing the causes of advanced stages, late treatment is most often cited. The most important and realistic opportunity to reduce the incidence of late-stage cancer is public awareness, i.e., health education and outreach!

The one-year mortality rate (% of deaths within one year of registration) is directly related to the stage of the disease. However, today it reflects not only the level of primary advanced disease, but also the capabilities of modern anticancer treatment in the later stages. In 1990–1994, the one-year mortality rate was 37.3% (median), in 1995–1999 – 32.9%; in 2000–2004, it was 26.4%; in 2005–2009, it was 24.8% (RF – 32%); 2010–2014 – 22.5% (Russian Federation – 24.4%), and in 2020–2024 – 19.4% (Russian Federation – 18.3%). The decrease over 35 years in median indicators is 92%.

Active detection (occupational health examinations and medical check-ups): in 1990–1994, the indicator was 9.9% (median); in 2005–2009, it was 18% (Russian Federation – 11.8%); in 2010–2014 – 24.4%; in 2020–2024– 32.3% (Russian Federation – 27%). The rate in the Perm Krai has increased more than threefold. Nevertheless, the level of active diagnosis in the current conditions leaves much to be desired.

Early detection (stages I–II at registration): between 1995 and 1999, the median rate in the Perm region was 38%; between 2000 and 2004, it was 44.1%; in 2005–2009, it was 46.9% (Russian Federation – 46%); in 2010–2014, it was 52.0%; in 2015–2019, it was 54.5% (Russian Federation – 56.4%); 2020–2024 – 57.1% (Russian Federation – 60.5%). The figures are close to the average for Russia, but neither are particularly impressive.

One of the most important, or rather the most important, indicator of the performance of the oncology service in the region and the country is 5-year survival. Accurate data has only been available since 2005. The median for 2005–2009 was 49.2% (in the Russian Federation in 2006 – 50%); in 2010–2014 – 51.0% (inthe Russian Federation in 2010 – 50.7%); in 2015–2019, it was 52.7% (in the Russian Federation in 2018, it was 53.3%); in 2020–2024, itwas 57.6% (in the Russian Federation in 2023, it was 58.8%). The increase in the indicator over 20 years is quite modest in both the Perm Krai and the Russian Federation – 17.1% and 17.6%, respectively.

As of January 1, 2005, there were 45,551patients registered with the Perm Regional Oncology Dispensary who had been treated and were alive, or were continuing to be treated for cancer. This is an absolute figure, and per 100,000 population, it is 1,644.6. This indicator is defined as a contingent. As of January 1, 2025, there were 78,988 such patients registered in our region, and the contingent was 3,165.5. The increase over 20 years was 92.5%. Median values were not used in the calculations, as the contingent grew evenly over the years, which made it possible to compare the extreme values of 2005 and 2024.

Conclusions

1. The number of cancer patients has increased by 92.5% over the past 20 years, from 1,664.6 per 100,000 population in 2005 to 3,165.5 in 2024, with the Russian indicator in 2023 at 2,887.6.
2. The incidence of malignant neoplasms has increased by 74% over the past 35 years, based on median values (average value for every five years).
3. Over the same period, mortality based on median values increased by 6.8%.
4. The incidence of advanced disease and one-year mortality rates are decreasing, while early and active diagnosis rates are increasing, and five-year survival rates are rising.

Funding. The study had no external funding.

Conflict of interest. The authors declare no conflict of interest.

Author contribution. 100%.

Study limitations. The study complies with the standards of the Declaration of Helsinki and has been approved by the Ethics Committee of the Ye.A. Vagner Perm State Medical University, protocol No. 6 dated September 10, 2025.

About the authors

O. A. Orlov

Author for correspondence.
Email: onko-perm@med.permkrai.ru

DSc (Medicine), Professor, Honored Doctor of the Russian Federation, Head of the Department of Oncology

References

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