Sweden
Lotti Barlow
Sweden is bordered in the north and west by Norway, on the east by Finland and on the east, south and west by the Baltic Sea. Sweden is located between 55o20' and 69o04' N and 10o58' and 24o10' E. The total area of Sweden is 450,000 km2 (of which 39,000 km2 is covered with lakes). The maximum distance from north to south is 1,572 km. The highest point is 2,111 meters. Sweden has over 25,000 islands, the largest being Gotland (3,000 km2) and Öland (1,340 km2). The mean annual temperature ranges from 0oC in the north and 10oC in the south. The climate is quite different in the south compared to the north. The southern parts of Sweden seldom get snow during winter while the northern parts always get it. Forests consisting mostly of coniferous trees cover about 55% of the country. In 1990 the mean population of Sweden was 8,560,000 (4,230,000 males and 4,330,000 females). Sweden is divided into 24 counties. The five largest cities are Stockholm (674,000 inhabitants), Göteborg (433,000), Malmö (234,000), Uppsala (168,000) and Linköping (122,000). Virtually all of the population is white and Protestant. In December 1990, 5.6% of the population were aliens. The main immigration groups were from the Nordic countries, the rest from Europe and from Asia. The main occupations of the economically active population on 1 November 1990 were services 37%, manufacturing 20% and commerce 14%. The unemployment of the labour force was 1.5%. Life expectancy at birth in 1986-1990 was 74.4 for males and 80.2 for females. The birth rate was 14.5 and the death rate 11.1 per thousand. The infant mortality rate was 6.0 per 1000 live births. The leading causes of death were cardiovascular diseases (50%) and tumours (23%). The number of broken families per 1000 families was 43 in 1986. The total number of hospital beds of all kinds was 98,000. The total number of doctors in practice was 21,700 (253 per 100,000 inhabitants).
Cancer registration
The Swedish Cancer Registry, which was established in 1958, is managed by the Centre for Epidemiology (EpC) at the National Board of Health and Welfare. The Cause-of-Death Registry, the Medical Birth Registry and the Hospital Discharge Registry are also situated at the EpC. The Government finances all the registries. The registration of newly detected tumour cases is based on compulsory reporting by all physicians responsible for in-patient and out-patient departments in all public and private establishments for medical treatment. Private practitioners have been required to report such cases since 1983. In Sweden nearly every cancer case will sooner or later be seen at a hospital. Hospital and forensic pathologists make independent compulsory reports on every cancer diagnosis made from surgical biopsies, cytological specimens and autopsies. Reporting is also compulsory for pathologists working in private laboratories. Six regional cancer registries, that cover the whole country, perform the registration of new cancer reports and their major check-up and correction work. These registries are associated with the oncological centres in each medical region of Sweden. The rationalisation 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 National Registry has overall responsibility for registration and for the reporting of all cancer cases for the whole country. The overall reporting to the Registry is estimated to be nearly 99% of all cases diagnosed in living patients. Besides cases of cancer and malignant lymphoma, histologically benign and hormonally active endocrine tumours (except adenomas of the thyroid gland), noninvasive urinary tract papillomas, and benign intracranial and intraspinal tumours are included in reports on incidence. Basal cell carcinomas of the skin are excluded. Reports are received on a variety of benign and potentially malignant tumours; these are registered separately and not included in the incidence figures. Precancerous lesions, such as carcinoma in situ of the cervix uteri, are reported but computed separately. Likewise, hydatidiform moles are reported but registered separately. Primary tumours in different organs in one individual are classified as independent tumours. If multiple tumours occur within paired organs, or in other sites, the case is classified in such a way that it is possible to count the case as one primary can-cer only, as well as the number of primaries that actually exist. The data in the Registry are supplemented with information on cause and date of death by computerised linking with the Cause of Death Registry at Statistics Sweden. The Swedish Cancer Registry does not use infor-mation on cancers based on death certificates only, the reason being that the data on the death certificates in many instances is uncer-tain. In 1990, there were 1507 cases reported in the Cause of Death Registry, which stated cancer to be the underlying cause of death, but which were not on file in the Cancer Registry. The largest cancer sites were bronchus/lung, pancreas, liver, prostate and colon. 90% of these did not have an autopsy, and 81% were over 70 years of age. The only follow-up undertaken by the Registry is on the estimation of survival time, based on the date of death obtained from the Cause of Death Registry. Oncological departments and many other hospital departments follow their own patients. Information on occupation, industry, domicile, etc., can be obtained from censuses done by Statistics Sweden. Linkage of this kind has been done with the censuses from 1960 and 1970. This Registry is called The Cancer Environment Registry 1960/70.