XXII. MEZINÁRODNÍ KOLOKVIUM O REGIONÁLNÍCH
VĚDÁCH. SBORNÍK PŘÍSPĚVKŮ
22nd
INTERNATIONAL COLLOQUIUM ON REGIONAL
SCIENCES.CONFERENCE PROCEEDINGS
Place: Velké Bílovice (Czech Republic)
June 12-16, 2019
Publisher: Masarykova univerzita (Masaryk University Press), Brno
Edited by:
Viktorie KLÍMOVÁ
Vladimír ŽÍTEK
(Masarykova univerzita / Masaryk University, Czech Republic)
Vzor citace / Citation example:
AUTOR, A. Název článku. In Klímová, V., Žítek, V. (eds.) XXII. mezinárodní kolokvium o regionálních
vědách. Sborník příspěvků. Brno: Masarykova univerzita, 2019. s. 1–5. ISBN 978-80-210-9268-6.
DOI.
AUTHOR, A. Title of paper. In Klímová, V., Žítek, V. (eds.) 22nd
International Colloquium on Regional
Sciences. Conference Proceedings. Brno: Masaryk University Press, 2019. pp. 1–5. ISBN 978-80-
210-9268-6. DOI.
Publikace neprošla jazykovou úpravou. / Publication is not a subject of language check.
Za správnost obsahu a originalitu výzkumu zodpovídají autoři. / Authors are fully responsible for the content and
originality of the articles.
© 2019 Masarykova univerzita
ISBN 978-80-210-9268-6 (online : pdf)
 
 
 
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DOI: 10.5817/CZ.MUNI.P210-9268-2019-90
THE GEOGRAPHIC CONCENTRATION OF CANCER CASES
AND THE CENTERS OF ITS PREVENTION
Geografická koncentrace výskytu malignit a center jejich prevence
JANA ROZMARINOVÁ
Katedra veřejné ekonomie
Ekonomicko-správní fakulta
Masarykova univerzita
Department of Public Economics
Faculty of Economics and Administration
Masaryk University
 Lipová 41a, 602 00 Brno, Czech Republic
E-mail: 450924@econ.muni.cz
Annotation
Monitoring of population health is an important indicator of regional development. The paper deals with the
incidence of cancer cases in Czech population, the differences in individual regions are shown and discussed in
relation to the health policy and target prevention programs. The aim of this contribution is to map cancer
incidence from the perspective of the regions and to map activities at central and regional level, which aimed at
the prevention issues. Data and Methods: Epidemiology analysis is based on data from the Czech National Cancer
Registry and the associated portal svod was especially needed for the regional issue of the cancer incidence. It
was found that the issue of differences in the incidence of the particular types of cancer among individual regions
is not a negligible one. e.g. Plzeňský region is an absolute leader in the incidence of colorectal cancer. We also
mapped prevention activities in the Czech Republic in relation to the availability of special screening centres in
individual regions.
Key words
regions of the Czech Republic, cancer incidence, health policy,
Anotace
Sledování zdravotního stavu obyvatelstva je důležitým ukazatelem regionálního rozvoje. Příspěvek se zabývá
incidencí případů rakoviny v české populaci, rozdíly v jednotlivých regionech jsou uvedeny a diskutovány ve vztahu
k programům zdravotní politiky a cílové prevence. Cílem příspěvku je zmapovat výskyt rakoviny z pohledu regionů
a zmapovat aktivity na centrální a regionální úrovni, které jsou zaměřeny na problematiku prevence. Data a
Metody: Analýza epidemiologie se opírá o data národního onkologického registru a přidružené aplikace „svod“,
která byla využita zejména k regionálnímu pohledu na výskyt rakoviny. Bylo například zjištěno, že Plzeňský kraj
je v České republice absolutním lídrem v incidenci případů rakoviny střev. V rámci zkoumané problematiky jsme
mapovali jednotlivé preventivní aktivity v České republice ve vztahu k dostupnosti specializovaných
screeningových center v jednotlivých regionech.
Klíčová slova
kraje České republiky, incidence malignit, zdravotní politika
JEL classification: O12, X12
1. Introduction
Cancer incidence is part of the population health even that the traditional concerns about access to primary and
hospital care continue to dominate health policy. The premature morbidity and mortality due to serious diseases is
an important demographic factor which undoubtedly has socio-economic impacts.
The concentration of the health policy to the preventive intervention of cancer should not be inferior. We focus on
the cancer's impact on public health disparities and study cancer incidence as an indicator of health status among
the regions of the Czech Republic, which can bring a clear message that appropriate health care policy aimed at
regions should be applied. Epidemiologic studies analyse the distribution and determinants of health and disease
and is an important part of public health. The aim of this paper is to point out the main problems and differences
XXII. mezinárodní kolokvium o regionálních vědách Sborník příspěvků Velké Bílovice 12.–14. 6. 2019
 
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among regions in the Czech Republic. Such a data can be useful in making decisions to address target populations,
and to influence policy makers and the public.
2. Theoretical frame
The health of the population is one of the most important indicators for the regional development (Pavlík, 2015),
State of the health of the population is essential for the reproductive process and the development of employment
potential and thus for overall economic growth (Somerlíková, 2015). Generally, the quality of health of the
population is one of the most important indicators of complex links between demographic, socio-economic,
environmental and political processes (Dzúrová, 2000). The extension of malign illnesses has become an important
part of it.
Within regions, in the literature there often mapped, for example, distinctive differences in the approach to primary
care (Gusmano, Weisz, Rodwin, 2014). But the incidence of a particular diagnosis is also important. Study of the
geographical distribution of cancer is a being performed to obtain its causation and determine the incidence of
different types of cancer in different parts of particular areas (McNamara, 2017; Muir, 1991; Randi, 2006;
Youlden, 2008; Baade, 2009; Bray, 2005). In general rising trend of cancer is a public health problem all over the
world, the Czech Republic is not an exception. Currently, malignant tumours are responsible for 12 per cent of the
deaths worldwide, according to WHO estimates, cancer now causes more deaths than all coronary heart disease or
all stroke. Previous studies have documented significant variations in cancer incidence rates across countries.
However, no research has examined the pattern among the Czech regions.
What is even more serious problem is that in comparison with other countries the Czech Republic suffer from the
alarmingly growing cancer burden of the Czech population (Ferlay, 2012). Moreover, the Czech Society for
Oncology and the Institute Biostatistics and Analyses of the Masaryk University repeatedly point out that problem.
Each year in the Czech Republic (total population of over 10.5 million), more than 77,000 people are diagnosed
with cancer and nearly 28,000 dies from it (Dušek, 2010). As it concerns e.g. colorectal cancer, the international
comparison shows that the Czech Republic ranks among the most affected countries (Ferlay, 2012). The overall
incidence of individual types of cancer is shown in fig. 1 and fig. 2.
The overall incidence (mortality) of the individual types of cancer are shown in graph 1 and graph 2.
The cancer incidence list is topped by prostate (192,6) and colorectum (101) and lung (91) cancer at men. For
women the leader is cancer of breast (128), colorectum (56) and lung (39) see Fig. 1. The values are reported per
100 000 inhabitants.
The mortality list differs substantially at both sexes. For men: lung (76), colorectum (50), prostate (41), pancreas
(24), kidney (17,5) and for women lung (30), breast (27), colorectum (24), pancreas (17,9), ovary at the fourth
place.
To understand the Czech context, it is important to note here that the Czech Republic is divided into 14 regions
(respectively in thirteen regions and the region of capital city Prague). This division is enacted according to the
Act no. 129/2000 Coll. (Law on Regions) and replaced the older administrative units seventy -six districts and is
in accordance with the European Charter of Local Self-Government (Radvan et al, 2018).
Fig. 1: Estimated incidence by cancer in the Czech Republic, Female and Male, all ages in 2018 (no of cases
per 100 000)
Source: Own processing, based on data
0
50
100
150
200
250
Male Female
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Fig. 2: Mortality by cancer in The Czech Republic, Female and Male, all ages in 2018 (no of cases per
100 000)
Source: Own processing, based on data European Commission
The relative profile of most prevalent cancer types (breast cancer in women, prostate cancer in men, colorectal and
lung cancer in both sexes) corresponds to the outcomes of most recent European epidemiology summaries (Ferlay,
2012) and furthermore in agreement with international reports, lung cancer is the most frequent cause of death
from cancer.
3. Methodology
To map and discuss the epidemiologic trends of incidence of the main types of cancer in the Czech Republic with
emphasis on the regional differences were used data of Institute of Health Information and Statistics (UZIS) of the
Czech Republic, an affiliated application “SVOD”. The data for UZIS is provided by the national oncologic
register, which is operated under The Czech Society for Oncology (CSO). The list of accredited mammography
screening centres in the Czech Republic sorted by the region was used, the data about the ordering periods were
available on the website of the screening program. Cancer incidence and mortality among males and females are
performed in ASR (W), world age-standardized incidence rate (number of newly diagnosed in case of incidence
and number of died in case of mortality per 100 000 inhabitants). Our aim is to map the differences in incidence
among the regions of the Czech Republic. E.g. for the colorectum incidence the code dg. C18 – C 21 was selected.
From the list of cancer incidence, we excluded lung cancer for its specific. Moreover, the distribution of specialized
screening centers in relation to existing screening programs in the Czech Republic was mapped to find if there are
substantial differences in approach to prevention. With the epidemiological data accessible (which the National
oncologic register manages), the cancer burden in the Czech Republic can be assessed throughout the population
and for individual regions.
4. Results
Our results show that the incidence of diagnosis differs across the regions, e.g. the healthiest regions seems to be
Prague in case of colorectal cancer, but on the other hand, the Prague, together with the Královéhradecký Region
hold unfavourable pace when concerning the breast cancer. The Plzeňský Region is a sad leader of Colorectal
cancer incidence, followed by the Karlovarský and the Moravskoslezský Regions.
Tab. 1: Cancer incidence in particular regions, 2016 – 2018 (no of cases per 100 000 inhabitants)
Region PHA STC JHC PLK KVK ULK LBK HKK PAK VYS JHM OLK ZLK MSK
Breast 86.2 75.5 64.4 85.6 89.6 76.1 72.0 83.0 75.5 74.3 81.3 75.8 73.0 75.8
Prostate 74.0 66.5 64.6 64.5 58.9 69.8 67.2 69.4 74.4 67.4 76.2 67.5 82.8 69.6
Colorectal 33.0 34.7 39.7 43.2 41.3 39.5 39.0 36.3 35.6 37.4 37.0 39.0 38.2 40.8
(Abbreviations of regions: PHA – Praha, STC – Středočeský, JHC – Jihočeský, PLK – Plzeňský, KVK – Karlovarský, ULK –
Ústecký, LBK – Liberecký, HKK – královéhradecký, PAK – Pardubický, VYS – Vysočina, JHM – Jihomoravský, OLK
– Olomoucký, ZLK – Zlínský, MSK – Moravskoslezský
Source: Own processing, based on data
0
20
40
60
80
Male Female
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Fig. 3: Cancer incidence in particular regions, 2016 – 2018 (no of cases per 100 000 inhabitants)
Source: Own processing, based on data
The highest incidence of Breast cancer is in Karlovarský, Prague, and Plzeňský region. Zlínský region suffers from
the prostate cancer incidence at most, the Jihomoravský and Pardubický regions immediately follow.
The cumulative incidence numbers of colorectal, breast and prostate are shown in the fig. 4. Regions with the
highest incidence are Praha, Plzeňský, Jihomoravský and Zlínský. Our results point out the problem that
differences in the incidence of the cancer, no matter if types or overall are not negligible and these should,
therefore, be taken into account when planning the prevention plan no matter if primary or secondary one.
Fig. 4 Cancer incidence in the Czech Republic ∑ colorectal, breast, prostate per 100 000 in individual regions,
2016 – 2018
Source: Own processing, based on data
Activities aimed at the prevention
Concerning the prevention activities at the national level, we should remind two important strategic documents.
The first programme of the Czech Government at the national level is the “Health for All in the 21st Century”
programme (hereinafter only “Health 21”) concerning the long-term programme of improvement of the population
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health status. The outcome of this programme for the regional level is the recommendation given to presidents of
regions that they should use this programme in preparing and implementing health policy projects at the regional
level. Health 21 is followed up by “Health 2020” – the national strategy of health protection and promotion and
disease prevention. It is a framework summary of measures to enhance public health in the Czech Republic. Health
2020 is a framework health programme of the European health policy aiming to improve population health
significantly, decrease inequalities in the accessibility of health care and ensure such health care systems that will
provide universal, equal and sustainable health care of high quality. The Czech government recommended the
regions of the Czech Republic that they should implement Health 21 and Health 2020 in preparing similar
documents within their regional health policies. Individual strategic documents of the regions were evaluated
concerning the two above mentioned conceptual strategic documents. However, both programs focus on general
goals.
Regarding the cancer target prevention practice, in the Czech Republic the inhabitants can up to two years visit a
general practitioner, from 50 to 55 years once a year, from 55 years every two years a test for faecal occult blood,
women once a year should visit a gynaecologist and women from 45 years of age every two years preventive
mammography examination, more often when a positive family history or other risk factor is present. It is estimated
that only 50 % of women utilize the possibility of mammographic screening. An important part of prevention is
special screening programs, there are 3 specialised screening programs, the cervical cancer screening, Breast
cancer screening, and the colorectal screening.
Cervical Cancer Screening Programme
The program was introduced in 2008 with the aim, a network of 37 accredited laboratories was established,
ensuring availability across the Czech Republic. The programme is equipped with information support provided
by the Institute of Biostatistics and Analyses of the Masaryk University (the Institute also runs the Cervical Cancer
Screening Registry). The programme has the ambition to decrease cervical cancer incidence rates in the Czech
Republic to values comparable with those reported by countries with advanced health care systems.
Breast Cancer Screening Programme (BCS)
Since September 2002, the Czech Republic has joined most European countries and has launched nationwide
mammography screening, allowing women aged 45-69 to undergo regular preventive examinations, with the aim
of increasing the proportion of early disease detection in the population. Early detection of breast cancer can find
lesions for which treatment is more effective and generally more favourable for the quality of life. In the further
development of the program, the upper age limit was abolished, mammography screening is covered by public
health insurance for all women aged 45 years and above
Screening centres for the early breast cancer detection are represented in all the regions, see the tab.4., the centres
s passed the accreditation process and its activity is continuously monitored according to the relevant rules.
Numbers of the centres are adequate to the population share, the waiting time (min, max, and average) and the
waiting time for the screening test do not differ significantly.
Tab. 4: Special centres for the prevention
Region PHA STC JHC PLK KVK ULK LBK HKK PAK VYS JHM OLK ZLK MSK
BCS 11 5 3 5 2 4 3 6 3 5 7 6 4 8
MIN BCS 2 2 1 3 25 3 5 3 7 2 2 1 2 7
MAX BCS 45 30 10 16 25 20 30 29 10 22 40 15 14 22
AV BCS 15 35 4 7 25 12 14 13,5 6,6 6,6 16 6 6 16
Colorectal 48 11 11 8 12 10 13 8 11 21 13 10 26
BCS – mammographic centres, Colorectal – prevention of cancer of colorectum
Source: Own processing, based on data
In tab.4 we show the special mammographic centres in the Regions of the Czech Republic. There are from 11
(Prague) to 2 (Královehradecký) special centres in the regions with the waiting time from 2 to 45 days. The contacts
for all accredited mammography screening centres in the Czech Republic are well available at the website.
Colorectal Cancer Screening Programme (CCS)
The third screening program is the colorectal cancer screening; it is a nationwide program as the previous two,
launched under the Czech Ministry of Health. Qualified colonoscopy examinations at accredited screening centres
are provided, these centres are monitored and checked according to the rules of the programme. Two independence
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organizations are responsible for it. The Board of Colorectal Cancer Screening at the Czech Gastroenterological
Society and Colorectal Cancer Screening Committee at the Czech Ministry of Health are the organizations. The
accredited centres are represented in all regions (tab. 4.). Note is that data about time availability of colorectal
screaning is not available. For the region, PHA and STC one number was available for both regions together.
What is common to these forms of screening is that since 2014 the citizens have been invited by their health
company to preventive examinations. The Czech Republic was criticised by the European Union not to perform
inviting to the screening before 2014.
Tab.5: Screening programs in the Czech Republic - summary
Screening Type Status Eligible age in year (from/ to)
Cervical Non-population based Nantionwide 25 69
Breast cancer Non-population based Nantionwide 45 69
Colorectal cancer Non-population based Nantionwide 50
Source: Own processing, based on data
Prostate screening – Is it a path?
In some countries, it is already obvious to lead a program for the prevention of prostate cancer. However, the
benefits of it remain unproven. There is currently no convincing evidence that this kind of screening improves
mortality. The limitations include potential adverse health effects associated with false positive and negative
results, which is presently a significant and not desirable effect of screening. “The American College of Preventive
Medicine concludes that there is insufficient evidence to recommend routine population screening” (Lim, 2008).
5. Conclusion
Through the analysis, we identified regions with a higher rate of particular types of cancer, the differences are not
negligible. Disparities of this health indicator among the regions of the Czech Republic can bring a clear message
that appropriate research and health policy aimed at more problematic regions could be needed. An interpretation
of the disparities is that the data show a need for more targeted regional prevention. The practice of using health
data to manage public health planning efforts would not be new but comprehensive planning for cancer prevention
and control is limited.
What is not less important is the existence of the cancer-preventing programs is the informational support of it. On
the other hand, public preventive programs are not the only way, how to prevent cancer and improve the health
status of the population. Data of word preventive centres shows that the prevention of some types of cancer
produces limited benefits (e.g. screening of prostate cancer). Therefore, all related factors need to be considered.
The second and very important way is promoting healthy lifestyles, nutrition has undoubtedly a major impact (in
case of the cancer of the lung may be the most significant). There is a need for effective communication of cancer
prevention issues to the lay public. Future research and activities included identifying and analysing relevant data
to develop a state cancer control plan would be needed. In the author´s opinion the comparison of the cure at an
early stage of cancer in the individual regions could be a new incentive to research. This issue can substantially
differ among the regions and can affect the mortality. Such a research is challengeable for the Czech strategy of
decreasing cancer mortality.
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This research is supported by the Masaryk Univesity internal grant no. MUNI/A/1103/2018 Hodnocení
zdravotnických technologií.