The Riigikogu discussed the current state and prospects of cancer control as a matter of significant national importance
The Riigikogu discussed the current state and development prospects of cancer control in Estonia as a matter of significant national importance, initiated by the Social Affairs Committee.
Member of the Social Affairs Committee Eero Merilind, who spoke first, pointed out that for the health care system, the most critical issue that needed a solution was how to find the patient at the right time, provide them with prompt assistance, and support them throughout their entire treatment journey without leaving them alone. “If we can manage to do this with cancer patients, then we can manage to do it in the whole health care system. That is why cancer control is much more than just oncology; it is a test of the quality of the entire health care system,” he said.
Merilind noted that cancer is an issue that affects nearly every family in Estonia and gave an overview of cancer statistics, stating that, for example, 9,843 new cases of cancer had been diagnosed in Estonia in 2023, approximately 3,500 people died from cancer in Estonia each year, malignant tumours caused nearly a quarter of all deaths, and currently, about 56,000 people required cancer treatment or cancer-related monitoring. He also expressed satisfaction that participation in screening programs had risen to 62–65 per cent, HPV vaccination had been expanded to include boys, the ESTCAN cancer control network had been established, treatment options and treatment close to home had been developed, and palliative care services were be funded from 2025.
According to Merilind, these steps show that Estonia is moving in the right direction, but the interim report on Estonian Cancer Control Plan 2021–2030 states that systemic problems have not yet been resolved. “Who has read this interim assessment, knows: only 13 per cent of the actions have been systemically implemented, but 45 per cent of the actions have not yet been implemented. This means that our problem is not the lack of knowledge; the problem is the capacity to implement,” he noted. “Another OECD report states that the most successful countries, what do they do? They do more prevention, they detect earlier, and they manage the treatment more holistically. According to Europe’s Beating Cancer Plan, up to 40 per cent of cancers are preventable.”
In his speech, Merilind also pointed out that screening saved lives and was becoming increasingly accessible. He emphasised the effectiveness of HPV vaccines and importance of prevention work that covered all aspects of lifestyle. He also spoke of the need to strengthen the role of family physicians and primary care so that the system could find people in need of help at the right time. Merilind also spoke about the need to speed up diagnostics, the importance of a clearly managed treatment path, and noted that Estonia faced a shortage of oncologists, radiologists, pathologists, medical physicists and nurses. He explained the reasons for the rise in the number of cancer cases, acknowledged the role of patient organisations, and addressed issues related to the availability of medicines, and cancer control funding.
President of the Estonian Cancer Association Vahur Valvere highlighted the importance of addressing cancer control at national level. He thanked the Social Affairs Committee for raising the issue of cancer and noted that cancer remained a significant public health problem in Estonia, with both medical and socioeconomic impacts.
According to Valvere, cancer register data show that the five-year survival rate for cancer patients is 65 per cent, and this figure is improving. In total, there are over 70,000 cancer patients in the register; the number of cases has been on a long-term upward trend, and according to projections, the number of new cases could reach 11,000 by 2030. In his presentation, the president of the Cancer Association discussed the main types of cancer and trends separately for men and women. Among men, prostate cancer is the most common, followed by skin cancer and lung cancer. Among women, breast cancer ranks the first, followed by skin cancer and colorectal cancer. Valvere pointed out that survival rates had improved for several types of cancer, but lung cancer and pancreatic cancer, for example, were often detected at a late stage, which affected treatment outcomes. He also explained that the differences in survival rates between Estonia and the Nordic Countries were largely due to the higher coverage of screening programmes in those countries, which enabled earlier diagnosis of the disease.
Valvere also spoke about the strategic development of cancer control. He recalled the previous national strategy and the subsequent period when the comprehensive approach had been weaker. Motivated by this, the Cancer Association launched an analysis and the campaign “The Whole Estonia against Cancer,” which led to Estonia joining the World Cancer Declaration in 2019. The current Estonian Cancer Control Plan 2021–2030 was developed with the input of more than 100 experts and aims to reduce the number of cases, extend life expectancy after diagnosis, and improve the quality of life for cancer patients.
Valevere also confirmed the progress highlighted by Merilind and gave the example of mobile diagnostic solutions that had increased participation in screening programmes and led to the detection of cases at an early stage. At the same time, he emphasised that many problems persisted. The interim evaluation of the Cancer Control Plan shows that only a small portion of the planned activities have been systemically implemented. The problems are mainly related to management, the division of responsibilities, use of data, and human resources. He pointed out that there was a shortage of doctors and specialists in the field of oncology and that their workload was heavy. According to Valevere, there is a need for clearer coordination, better prioritisation, and a systemic assessment of the prerequisites for implementing activities.
In addition, Valvere focused on patient-centred approach, and support services, and emphasised the role of patient organizations. He gave examples of the Cancer Association’s activities and international cooperation, including the training of expert patients, which helped to share experience and knowledge more widely. “These four warmly smiling ladies are actually breast cancer survivors whom we can now call expert patients in the field of breast cancer; they successfully completed this training and share their experiences and theoretical knowledge through the Cancer Association’s podcast,” he noted.
At the end of his speech, Valvere underlined the need for cooperation and the inevitability of the fight against cancer. “If we do not deal with cancer together, cancer will deal with us and our close ones,” he said, adding that the goal was to move towards a healthier and cancer-free Estonia.
Clinical Lead of the Estonian Cancer Network, oncologist Rille Pihlak pointed out in her presentation that the number of cancer cases was rising and that the disease was increasingly affecting younger people. According to Pihlak, more people are diagnosed with cancer in Estonia than there are births, which illustrates the scale of the problem. Although cancer mortality has decreased somewhat, it has not fallen as rapidly as in the case of cardiovascular diseases. She explained that the situation was influenced by both the ageing of the population and the increased incidence of the disease among people under 50. Pihlak emphasised that delays in diagnosis and treatment made treatment more expensive and reduced the chances of recovery. According to her, early intervention helps save lives and save resources.
Pihlak pointed out that Estonia was not hampered by a lack of knowledge. The Cancer Control Plan 2021–2030 provides clear guidelines, but the government has not implemented them in a uniform manner. The interim evaluation shows that a large part of the activities remained unimplemented, and progress often depended on the initiative of individual people. She highlighted shortcomings related to management, coordination, data utilisation, and human resources.
Pihlak also drew attention to areas where progress had been slow, including surgical treatment, paediatric oncology, and the well-being of cancer patients after treatment. According to her, some problems can be solved through better decision-making and organisation, but several goals require stable funding and systemic planning. “The reason we are here before you again today is that we need several decisions from you. We need stable funding for the Cancer Control Plan; we need your support for the continued funding of the EU Cancer Mission; and there are also several national decisions we can make together,” Pihlak said before the Riigikogu. Regarding cancer control funding, Pihlak emphasised that the state had not established permanent funding for the control plan, while other countries invested a fixed amount per capita. Currently, the development depends on project funding and fragmented grants, which do not allow for consistent development. She also considered it important to continue funding the EU Cancer Mission.
At the end of her speech, Pihlak mentioned the decisions the government must make in her opinion: prepare a development plan for the hospital network, expand the role of nurses, ensure stable funding for patient organisations, and strengthen primary care.
Representative of the NGO Onkoloogika Kristel Leif, who was the fourth speaker at the sitting, focused on the experience of cancer patients and underlined the need to involve patients in the decision-making process as equal partners. She pointed out that, in addition to medical knowledge, it was necessary to take into account issues related to human behaviour, social needs, and service design.
Leif introduced herself as a stage IV cancer patient and explained that she wanted to ensure that cancer patients were be visible and involved. According to her, a patient’s active role is not yet common in the Estonian healthcare system. She described a personal experience where she had felt after her diagnosis that the system treated her more as an object and that decisions had been made for her. “I was surrounded by very competent people whom I trust completely and who began making choices for me. And when I had some questions, when I felt that I, too, had a say regarding my own health – that I, too, could look up information, that I, too, could make suggestions about what I needed – I quickly felt that I was becoming a little too much,” she noted. In Leif’s opinion, the patients’ desire to participate in decisions regarding their treatment is growing, and this resource should be consciously used and further supported.
In her presentation, Leif highlighted the complexity and loneliness of a cancer patient’s journey. She said that patients were often left without the necessary support at a time when they needed it the most, especially after a hospital visit or the end of active treatment. She emphasised that, in addition to patients, their loved ones also needed help, as they often lacked clear support and guidance. Leif pointed out that in society, cancer was primarily discussed in the context of prevention and donations, but daily life with cancer was spoken about less. According to her, public discussion must also address how people with cancer live, work, and participate in society. “We need to start talking about the fact that people live with cancer and that it is possible to live a very normal life with cancer – it is possible to participate in society, raise children, build a career, run marathons, stand as a candidate for the Riigikogu, and start a business,” she said, and emphasised the need to reduce the stigma associated with the disease.
Leif highlighted the broader meaning of palliative care as a key issue, noting that it was often mistakenly viewed solely as end-of-life care. According to her, palliative care should begin immediately after diagnosis to support the patient throughout their entire treatment journey.
Leif also addressed the fragmentation of information systems and services. According to her, patients often cannot find the services intended for them because the information is scattered and difficult to access. She emphasised the need to create clearer treatment paths and provide patients with support in navigating, for example, with the help of patient journey coordinators.
Leif also pointed out that patient organisations played an important role today, but their activities relied heavily on volunteer work and uncertain funding. She thinks that the state should provide more support to the third-sector organisations and systemically involve them in cancer control.
At the end of her speech, Leif underlined that the patients’ experiences and knowledge must be valued and used in the development of the healthcare system. According to her, stronger cooperation between the state, experts, and patients would help better address the actual needs of cancer patients and improve their quality of life.
Jaanus Karilaid, Katrin Kuusemäe (Reform Party), Tanel Kiik, Irja Lutsar (Estonia 200) and Peeter Ernits took the floor during the debate.
Verbatim record of the sitting (in Estonian)
Photos(Erik Peinar/ Chancellery of the Riigikogu)
Video recording of the sitting is be available on the Riigikogu YouTube channel.
Riigikogu Press Service
Maris Meiessaar
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