Poland
Witold Zatonski, Joanna Didkowska
Poland is situated in the middle of Europe between the Baltic Sea in the North and Carpathian range in the South, the river Odra in the West and the river Bug in the East. The country covers an area of 323,000 km2. Polandıs western neighbour is Germany (border 470 km); to the south are the Czech and the Slovak Republics (border 1,480 km); to the North is the Baltic Sea (coastline 524 km) and to the East lie Russia, Lithuania, Byelorussia and Ukraine with a total border length of 1,260 km. Poland is a lowland country. A total of 75% of its area is situated at an altitude below 200 m above sea level. Areas above 500 m make up only 3.1% of the total territory. The highest summit in the Tatra range is Rysy (2,499 m). The drainage area of the river Vistula covers 56% and that of the river Odra 34% of the countryıs total area. Poland has many thousands of lakes whose combined area is about 3,200 km2. In 1990 agricultural land covered 60% of the total land. The area of agricultural land is steadily shrinking each year. About 8.5% of the total agricultural land was converted to non-agricultural purposes after 1946. Forest area has grown from 21% in 1946 to 28% in 1990. One of the largest natural old forests is located in the northeast part of Poland, called 'Puszcza Bialowieska'. Poland has a mild climate characterized by features of both the continental climate of eastern Europe and the maritime climate of its western regions. Variability is typical of weather in Poland. The average temperature in January varies between 1oC and 5oC, while in July it varies between +17oC and +20oC. Southern Poland, especially the Tatra Mountains, has the heaviest precipitation exceeding 1,000 mm annually. The plains of central Poland have the lowest precipitation. In 1975, a new administrative division of the country resulted in 49 administrative provinces (voivodeships). Voivodeships are divided into communes (gminas) and towns. At the end of 1990 Poland had 830 towns, of which 20 were populated by more than 200,000 inhabitants, and 2,121 other gminas. A gmina is the basic unit of the administrative structure of the country and a seat of local government. The total population in 1990 exceeded 38.2 million, of which 18.6 million were men and 19.6 million women. During the post-war years, the Polish population has grown by over 14 million. Today, almost 62% of the nation lives in urban areas. After World War II only 33% lived in towns. The total population density in 1990 was about 122 per km2, but it varies significantly by voivodship. The highly urbanised and industrialised area of the Lodz agglomeration in the middle of the country was the voivodeship with the densest population in 1990 with 748 persons per km2. The wooded and rural Suwalki voivodship in northeastern Poland was the least populated with 45 persons per km2. In 1993, 91% of the Polish population declared themselves as Catholics, 1.5% as Orthodox and about 0.5% as Protestants. Poland is, in principle, a country with an ethnically homogenous population. Small ethnic minorities are found in southwestern Poland (Germans) and in its eastern part (Belorussians, Lithuanians, Ukrainians). It is estimated that Poland has about 400,000 Belorussians, 250,000 Germans, 250,000 Ukrainians, 30,000 Lithuanians, 30,000 Czechs, 10,000 Jews and 3,000 Gypsies. Polish industry is divided into mining (hard coal, brown coal, oil, other fuels, iron ores, nonferrous metals, copper ores, chemical raw-materials, and construction stone), and manufacturing. In monetary terms, mining yielded only 6% of revenue from production in 1990 and manufacturing almost 94%. In the latter, the fuel industry and power engineering produced 16% percent, electro-engineering 24% percent, the food industry almost 19%, metallurgy 13%, and light industry 8%. About 40% of Polish industry is located in southwestern Silesia. The Polish capital Warsaw is also a major industrial center. At the end of December 1990, the number of persons employed was 16.5 million, of which 46% were women. The transformation in the public industrial sector created structural unemployment (near 3 million in 1994). Almost 30% of working people are involved in agricultural production. Traditionally, Polish agriculture is based on small private farms. About 18% percent of the farms were smaller than 2 ha and nearly 50% were smaller than 5 ha in 1992. The composition of the diet has changed significantly during the last 40 years. In the mid-1950s the average diet included first of all potatoes and cereals (about 70%) while meat products provided about 10% of the calorific value. The consumption of milk grew from 118 litres per capita in 1946 to 280 litres in 1986, after which it started to decline steadily to the level of 217 litres in 1992. The decrease of potatoes and cereals was replaced by a growing consumption of meat and fats (consumption of meat per capita increased from 43 kg in 1960 to 69 kg in 1990; respective figures for fat consumption are 16 and 23 kg). Pork makes up some 50-60% of meat consumption. The vegetable consumption per capita doubled during the years 1950-1988 from 60 to 115 kg yearly. The consumption of fruit increased from 8 to 32 kg. The consumption of tobacco increased very rapidly in post-war Poland. Before World War II the consumption of cigarettes in Poland was very low (between 450 cigarettes per head in 1923 to 600 in 1938). After the war the consumption jumped rapidly to 890 in 1949 and increased to 1,700 in 1965. The highest tobacco consumption was recorded in 1987: 2,700 cigarettes per capita. After the war (in 1950), the consumption of alcohol was three times higher than in 1936. A slowly increasing trend in alcohol con-sumption was parallel to the first stage of Polish industrialisation. In the years 1965-1980, alcohol consumption doubled from 4.1 to 8.4 liters of 100% alcohol per person. After the introduction of a market economy in Poland in 1989, alcohol consumption also increased rapidly up to 11 litres per capita by 1992. The number of heavy drinkers addicted to alcohol who drink almost every day, is estimated to be 3-3.5 million. Poland holds one of the leading positions in Europe in sulphur dioxide emission (10%) and the emission of nitrogen oxides (8%). Safety devices utilised only 16% of all gaseous pollutants. The total emission of toxic air pollutants in Poland was 5.1 million t in 1980, including 2.8 million t of sulphur dioxide. The emission decreased to 4.1 million t of total emission in 1990, of which sulphur dio-xide accounted for 2.2 million t. Power engineering, chemical industry, and metallurgy that are responsible for 60 to 70% of the total emissions. Industrial and municipal sewage are usually drained off to surface waters (rivers and lakes). In 1990 48% of industrial enterprises and 363 towns had no water treatment plants. Only 67% of the total sewage was treated, while the remaining third were dumped into surface waters without any treatment. Average life expectancy lengthened until the mid-1970s. Comparing the number of years an infant male had to live at birth in 1952-53 and 1975-76, life expectancy increased by almost 9 years. Among women the increase was by almost 11 years. In 1994, a male infant could expect to live 67.5 years, which is 0.3 years less than in 1974, when life expectancy reached a maximum. The average life expectancy for a female infant in 1994 was 76.1 years. Infant mortality before World War II was very high in Poland (140-130 deaths per 1000 live births). After the war, the infant mortality rate decreased dramatically. In 1994, this rate was 15/1000. Overall mortality (measured as a crude rate) fell in both sexes in Poland in the post-war period until the mid-1960s, after which an unfavourable trend began, and mortality rates grew until the early 1990s. In the peak year of 1991, mortality rates were higher than in the mid-1950s: for men, 1,169/100,000; for women 949/100,000. In recent years we have observed a decrease in overall mortality. The main cause of mortality in Poland is cardiovascular disease (in 1994, caused 46.5% of deaths in men and 56.4% of female deaths). The second most frequent cause of death is cancer (21.5% of deaths among men, and 17.9% in women), followed by sudden deaths from external causes ( 10.7% of male deaths, and 4% of female deaths). Infectious diseases, a grave danger to society in the 1950s, constitute only a marginal propotion of causes of death in the 1990s (0.9% of male deaths, 0.5% of female deaths). Throughout the post-war period, the divorce rate has systematically increased in Poland. In 1994, 152 new marriages out of 1000 were nullified, though a significant difference still exists between the rural and urban divorce rates (219 and 51/1000, respectively). The birth rate has decreased in Poland from 15-19 per 1000 population in 1946-1960 to a level of 2.5/1000 in 1994.
Cancer registration system
In 1951 the Minister of Health introduced regulation requiring registration of new cancer cases occurring in Poland. As a result of this regulation the Polish Cancer Registry was established in 1952, encompassing the entire country. However, in the period 1952-1962 data were obtained only from eight areas of Poland only covering approximately 20% of population, and the data contents and coverage were limited. It was a reason that the data before 1963 were not used in epidemiological analysis. In 1963 first regional cancer registries were organized including selected rural and urban areas, in order to control completeness and quality of incidence data. In 1975 oncological treatment in whole Poland was regionalized, and 11 regional oncology centers were created. Based upon this new division regional cancer registries were established in each region. Since that time cancer notification cards were collected and verified by the regional registries. Regional registries sent data to the National Cancer Registry where data were coded, combined and analysed. At the beginning of the 1990s all regional registries were computerized. The regional cancer registries created their own cancer databases which are continuously updated. The National Cancer Registry gathers annual data from the regional registries in a uniform format, making it possible to assemble data from the entire country. This is one of the few registries in the world which registers all cancer cases appearing in such a large country. The National Cancer Registry gathers records including the following information: hospital, date of admittance, sex, area code, town, street, birth date, occupation, clinical diagnosis, histopathology result, MOTNAC, other confirmation of cancer, method of treatment, type of treatment (palliative, sympto-matic, etc.), stage of development, TNM, year of diagnosis, date of filling out card, date of death, place of death and cause of death. Data concerning cancer cases are codified according to the current revision of the Inter-national Classification of Diseases and Causes of Death (ICD) . For example, data from 1980 to 1994 have been codified according. Two (or more) cancers present in the same person are always codified as separate cancers. In 1994, the National Cancer Registry regis-tered about 10% of cases on the basis on death certificate alone. In individual countries this percent ranged from 1% to 30%. The degree of histopathological or cytological confirmat-ions in Poland was 12%. Distinct regional differences were noted in this factor too: from fractions of percents to 35%. The growing risk of tobacco-related cancers (mouth, larynx, lung, urinary bladder, pan-creas, kidney) is significant, especially in the male population [1]. Incidence and mortality rates for lung and laryngeal cancer recorded in Poland are among the highest in the world. The lung cancer mortality rates go up twice as fast as in any other European country. The increase of lung cancer risk in women is rapid, although it started from a low level. This cancer is second-frequent cancer in women since 1992. Both men and women appear to be facing a growing risk of getting cancer in their lower digestive tract (especially rectum and pancreas) and a very rapidly growing risk of contracting malignant skin melanoma. The risk of cancer of these sites is still not very high in Poland as compared with other European countries. In 1986 mortality caused by large bowel cancer among women was for the first time higher than mortality from cancer of the stomach. Considerable reduction in stomach cancer mortality was observed among women. The decline is less rapid among men, and the risk of stomach cancer in Polish men continues to be one of the highest in Europe [2]. We observe a significant increase in the breast cancer risk (especially in women over 60 years of age), although Poland remained in the group of low-risk European countries [2]. The mortality caused by cervical cancer in Poland has been slowly declining since 1970 (besides the age group over 60 years of age), which testifies to a poor effectiveness of the early diagnosis programmes (population-based screening in Poland). Poland is still among the European countries with a very high risk of death from the cervical cancer.
Reference
1. Zatonski W, Pukkala E, Didkowska J, Tyczynski J, Gustavsson N. Atlas of cancer mortality in Poland, 1986-1990. SPAR - Oficyna Wydawnicza, Warsaw 1993.
2. Zatonski W, Smans M, Tyczynski J, Boyle P (eds.) Atlas of Cancer Mortality in Central Europe, IARC Scientific Publications No. 134, Lyon 1996.