Iceland
Kristin Bjarnadottir
Iceland is a volcanic island situated in the North-Atlantic Ocean between Europe and America. The latitude is 66º32´ north and 62º23´ south, the longitude is 24º32´ west and 13º29´ east. The country lies just south of the Arctic Circle, but due to the Gulf stream, the climate is not as cold as might be expected. The mean temperatures are 10ºC in summer and 1ºC in winter. The size of the island is 103,000 km2, but the habitable area is only about 24,000 km2, the rest being glaciers, lakes and wasteland. Iceland is traditionally a European country, although recent geological studies have shown that the western part of the country is in fact situated on the North-American plate, moving westward, and the eastern part is situated on the Euro-Asian plate, moving eastwards. There has always been great volcanic activity on the continental rift that stretches from south-west to north-east of the island, and it is still continues. Iceland has always had close ties with the Nordic countries, having been first settled by Norway and later becoming a colony under Danish rule for centuries. Iceland is one of the smallest independent nations in the world. In 1991 the mean population was 258,000 individuals - 129,000 males and 129,000 females. Throughout the ages the main occupation had been agriculture. Then in the 19th century fishing became more important, and migration from the rural areas to more densely populated areas started. This was on a small scale compared with the great migration to the fishing and fishing industry towns in the 20th century. At that time the migration was mostly to the capital area, where more than half of the nation lives now. The main occupations have become commerce, services and industry, in addition to the traditional fishing and fish processing. All of this migration has meant great changes in lifestyles and in population growth. The population remained at 50,000-70,000 during the agricultural period. It was kept low by changes in the climate and epidemics. The nation was vulnerable to both those factors. Cold years meant loss of stock, and the country¹s isolation meant that the people could not develop any natural immunities to diseases that occurred perhaps once or twice during a century. With better health care and more occupational possibilities, the growth of the population has been enormous during the last 100 years, especially after World War II. The country is divided into 8 constituencies. The capital area is located in two of those and consists of the capital city, Reykjavik, its surrounding suburbs and the rural area in Reykjanes. The other half of the population lives mostly along the coast, as large parts of the country are inhabitable. For example, the whole centre of the country is a mountainous plateau with little or no vegetation, covered with lava, sand and glaciers. The most sparsely populated area is Vestfirir, where agriculture is disappearing and the once prospering fishing villages are growing smaller. Iceland was mainly settled by Norway and to some extent also from the British Isles, where some Nordic-speaking people were residing. Celtic people were also among the first inhabitants, mostly slaves of the Vikings. The nation is rather homogenous as there has been little immigration since the settlement of the country. Icelanders have always kept good family records. It is often said that that all Icelanders are related, which is of growing importance with increasing knowledge in genetics. During recent years the Icelandic Cancer Registry has participated in studies aiming at identifying genes that may be important for carcinogenesis. Birth rate for the period 1981-1990 was 17.8 per 1000. The life expectancy based on deaths in 1986-1990 was 75 years for males and 80 years for females. The death rate for the period 1981-1990 was 738 per 100,000 for males and 636 per 100,000 for females. The mortality rate for cardiovascular diseases was 352 for males and 285 for females; for neoplasms the rates were 178 and 162, and for accidents and other external causes 73 and 28, respectively.
Cancer registration
The nationwide Icelandic Cancer Registry was founded by the Icelandic Cancer Society in 1954 and has published statistics on malignant neoplastic diseases since January 1st, 1955. The Registry has used different ICD coding systems for topography, first ICD-7, then ICD-9 and now ICD-10. The old topography codes were kept when the new ones were entered and the older part of the registry has been updated to fit in the new codes. The morphology has been coded according to the ICD-O and ICD-O2. The first computerisation was before 1966, but in 1976 the registry got its own computer system. The data come mostly from the three pathology laboratories in the country. During the period 1981-1990 presented in the Atlas, 96.4% of all cases were histologically confirmed, 3.5 % were clinically diagnosed without histology and 0.15 % of the cases were reported by death certificate only. The registry also receives voluntary reports from hospitals and doctors on the patients. All reports and repeated histologies are entered into the main file, and from that file the most important information on each tumour is extracted for tables and statistics. A pathologist compares all second or later primary tumours to the histology of the previously diagnosed tumour. The staff of the registry scrutinises all death certificates where neoplasms are mentioned, and if there is no earlier information of such cases in the registry, the physician signing the death certificate or the hospital where the patient died is contacted and asked for details of the diagnosis. As a quality control the computer programs have inbuilt error checks, and all information is checked by a physician before it is entered into the registry. The highest incidence for females is in breast cancer, and for males in prostate cancer. The incidence for both types has been increasing. Breast cancer is twice, and prostate cancer four times as common as in the 1950s. Lung cancer incidence has also increased in both sexes, about threefold in males and nearly six fold in females during the same period. Bladder cancer incidence in males has increased about three-fold. The incidence in stomach cancer has decreased dramatically in both sexes, and cervical cancer incidence has also decreased. The mortality figures come from the Statistical Bureau of Iceland and are considered reliable.