National cancer statistic

The national cancer statistic provides information on the situation and development of mortality and cancer incidence in Switzerland. This is a synthesis statistic based on data from existing sources. Different indicators are presented by cancer site to describe the importance of the cancer.

Surveys

Data sources

The registration of cancers in Switzerland is organised at the cantonal level by the cancer registries (CCR). The data are collected and aggregated at the National Agency for Cancer Registration (NACR). The data currently available online correspond to the data provided from 13 cancer registries for 24 cantons. Coverage in French-and Italian-speaking parts of Switzerland has been complete since 2006 and for the whole of Switzerland since January 2020.

Paediatric tumours are registered for the whole country by the Childhood Cancer Registry (ChCR).

The Cause of Death Statistics (COD) of the Federal Statistical Office records, for its part, all deaths of persons resident in Switzerland.

 Data on the mid-year permanent resident population come from the Federal Statistical Office's Population and Household Statistics (STATPOP) and apply to all persons with a permanent residence in Switzerland.  Up to and including 2010, however, data from the Annual Population Statistics (1981-2010) (ESPOP) were used.

Registration of new cancer cases in Switzerland

Every year, the cantonal cancer registries record all new cancer cases diagnosed in their resident population. However, there is one exception: the cancer registry of Basel-Stadt and Basel-Landschaft includes incidence cases of residents of the Laufen district (BL) only since 2013 because this district was one of the canton of Bern until 1994. Hence, the population of this district (around 7% of the population of the canton of Basel-Landschaft) was subtracted from the cantonal population of Basel-Landschaft for the calculation of incidence rates.

Included are all cases of malignant primary tumours, with the exception of non-melanotic skin cancer (C00-43, C45-97, ICD-10). Primary tumours are defined according to the rules of the International Association of Cancer Registries (IACR) / European Network of Cancer Registries (ENCR).

Share of the population (in %) covered by a cantonal cancer registry

	German-speaking Switzerland	French- and Italian-speaking Switzerland	Total Switzerland
1990-1994	46.5%	70.8%	53.5%
1995-1999	46.6%	82.5%	56.9%
2000-2004	46.6%	85.3%	57.9%
2005-2009	46.8%	97.7%	61.8%
2010-2014	68.0%	100.0%	77.5%
2015-2019	92.3%	87.4%	90.8%

Language regions

Data are published for the whole of Switzerland and for the language regions. The language regions were created on the basis of cantonal groups. Depending on the language spoken by the majority of the population, the cantons are combined to form one of the language regions. Hence, the cantons Vaud, Valais, Neuchâtel, Geneva, Jura, Fribourg and Ticino form the language region "French- and Italian-speaking parts of Switzerland" and the other 19 cantons the German-speaking language region.

Estimation of incidence

Assuming that the data are homogeneous among covered and uncovered regions, the observed numbers of cases and rates are applied to an entire language region. For this purpose, the numbers for each language region are multiplied by an extrapolation weight (population covered by registration / total population) to compensate for registration under-coverage. All rates are expressed as raw and age-standardised rates per 100 000 person-years. Since the risk of developing cancer is strongly age-dependent, the calculated rates depend on the age distribution of the population. Thus, for international and temporal comparisons, the rates are standardised to a common age structure. For this age standardisation (direct method) the European standard was used (Waterhouse et al, 1976). The sum of the estimates of the language regions corresponds to the nationwide estimate published by the Swiss Federal Statistical Office and the National Agency for Cancer Registration (NACR).

* Waterhouse JAH, Muir CS, Correa P, Powell J, eds. Cancer incidence in five continents. Lyon: IARC, 1976; 3: 456

Quality of incidence data

Before the entry into law of the new Cancer Registration Act (CRA) in 2020, the legal requirements regulating the registration of cancers varied considerably by canton, which sometimes limits access to data. Published trends could be affected by the gradual introduction of cancers registries. The first cantonal cancer register in Switzerland to have compiled the data collection in electronic form for a full year is Geneva in 1970. The registers have been gradually implemented and the interactive map shows the date from which the collection was carried out over the entire year.

At the time of the statistical analysis, data from the cancer registry of the canton Vaud was not available for the year 2018 and 2019 (NACR). The combination of all available data helps to improve the representativeness of the results over time. Nevertheless, the comparability of the periods is slightly impaired.

Usually, incidence data are matched with data relating to cancer mortality. This makes it possible to identify missing cancer cases. In some registries, complete and systematic matching was not carried out for all the years covered by registration: this is the case for the registry Basel-Stadt/Basel Landschaft (1981-2001, 2010-2012). For the canton of Zurich, the Zurich/Zug registry confirmed complete and systematic matching of incident cases and death records from 1997; for the period 1980-1996 it could not be established whether matching was done entirely or not.

The data quality of a cancer registry depends among other things on the completeness of the recorded data. This completeness corresponds to the proportion of new cases that occurred in the population recorded in the registry and that were also recorded in that register. Completeness should be as close to 100% as possible, so that the comparison of incidence rates (between time period or regions) can reflect true differences in the risk of developing cancer.

Three indicators are published by NACR as part of the standard analysis in order to assess the completeness of data collection among the different registries: proportion of cases identified with death certificates only (%DCO), proportion of histologically tested cases and the mortality/incidence ratio. In addition, a publication* using other methods to evaluate the completeness was released in 2017. The IARC (International Agency for Research on Cancer) publishes other qualitative indicators** for several Swiss registries.

*Lorez M., Bordoni A., Bouchardy C. et al. Evaluation of completeness of case ascertainment in Swiss cancer registration. Eur J Cancer Prev.2017
**Cancer incidence in five continents, Vol IX. Lyon: IARC/WHO, 2007. IARC/WHO Scientific Publications No. 160.

Quality of mortality data

Since every case of death needs to be registered, the survey is almost complete although the FSO is rarely informed on causes of death of persons, living in Switzerland but dying abroad. The number of missing data is estimated to be 3%. Thanks to standardisation rules of the WHO, the data are well comparable at international level. The further development of the medical diagnoses over time requires regular adaptations of the International Classification of diseases that is of high importance for the quality of the data.

Switzerland used the ICD-8 for the coding of causes of death until 1994. Coding rules specific to Switzerland were additionally used. If several causes of death appeared on the medical death certificate, these rules gave automatic priority to certain causes, regardless of the order in which the causes were reported by the doctor. This led to the favour of certain causes, especially cancer causes. The adoption of international coding rules came into effect at the same time when the transition to the ICD-10 took place. As a consequence, the priority rules that were only applicable for Switzerland were abandoned. When comparing the number of cases from the years until 1994 with those from 1995 onwards, one must bear in mind this methodological change.

To illustrate to what extent the number of registered new cancer cases up until 1994 can be influenced by the Swiss coding rules (and furthermore by the use of the ICD-8 prior to the introduction of the ICD-10), the table below shows the ratio between the number of cancer cases that would have been registered with the ICD-10 and the number of cases that were (actually) registered with the ICD-8. Due to multi-morbidity in older age groups, a main cause had to be selected more frequently (until 1994) from the causes of death mentioned on the death certificate. Therefore, the change of method was felt more noticeably in the older age groups.

Value of correction factor of data prior to 1995 by sex and age group

Sex	ICD-10	0-59	60-69	70-79	80-84	85+	Total
Men	C00-C97: All cancers	0,98	0,97	0,94	0,89	0,85	0,93
Women	C00-C97: All cancers	0,98	0,98	0,96	0,93	0,88	0,94

Note for interpretation : if the deaths recorded before 1995 had been coded according to the ICD-10 and to international standards their number would have been = (number of deaths registered before 1995)* (correction factor)

Source: Lutz JM, Pury P, Fioretta G, Raymond L. The impact of coding process on observed cancer mortality trends in Switzerland. European journal of cancer prevention 2004; 13: 77-81

Definition of Cancer Sites

In Switzerland the classification of the causes of death and of tumour incidence was based on the 8th revision (ICD-8) until 1994, and since 1995 on the 10th revision (ICD-10) of the International Statistical Classification of Diseases and Related Health Problems.

Definition of Cancer Sites

		ICD-8	ICD-10
Mouth and digestive organs	Oral cavity and pharynx	140-149	C00-14
	Oesophagus	150	C15
	Stomach	151	C16
	Colon-rectum	153 + 154.0 + 154.1	C18-20
	Liver	155	C22
	Gallbladder and extrahepatic bile ducts	156	C23-24
	Pancreas	157	C25
Respiratory organs	Larynx	161	C32
	Lung, Bronchi, Trachea	162	C33-34
	Pleura	163	C38.4 + C45.0
Bones	Bones, Joints, Cartilage	170	C40-41
Skin	Melanoma	172	C43
Reproductive organs	Breast	174	C50
	Cervix uteri	180	C53
	Corpus uteri	182	C54-55
	Ovary	183.0	C56
	Prostate	185	C61
	Testis	186	C62
Urinary organs	Kidney	189.0	C64
	Bladder	188	C67
Brain and CNS	Brain and central nervous system	191 + 192	C70-72
Thyroid	Thyroid	193	C73
Blood and lymphatic vessels	Hodgkin lymphoma	201	C81
	Non-Hodgkin lymphoma	200 + 202	C82-86 + C96
	Multiple Myeloma	203	C90
	Leukaemia	204-207	C91-95
	of which lymphocytic leukaemia	204	C91
	of which myeloid leukaemia	205 + 206 + 207.2	C92-94
	of which others and unspecified	207.0 + 207.1 + 207.9	C95

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