Equal Care Across Finland · cancer pathway monitor

Where does cancer care fall behind, and what should each county do?

Bowel cancer: 5-year survival ranges from 63 % in Päijät-Häme to 74 % in Keski-Uusimaa (Finland 68 %, 2024): a gap of 11 percentage points in 5-year relative survival, depending on where the patient lives. S9 Mortality is significantly above the national rate in Kymenlaakso and Satakunta and Etelä-Pohjanmaa. S13

Goal 3: Ensure equal and effective cancer care (Varmistetaan yhdenvertainen ja vaikuttava syövänhoito) S1

  • 5-year relative survival of poor-prognosis cancers reaches the Nordic level (Sweden and Norway mean): lung +14 pp, pancreas +6 pp and liver +14 pp over the NORDCAN 2023 level. Today lung cancer survival in Finnish men is 17.9 % vs 31.3 % in Sweden.
  • Cancer mortality falls by 10 % (now 13,300 deaths a year).
  • Patients start treatment within the target times (THL Ohjaus 21/2016).

This tool tracks the Goal 3 outcome indicator that is public by county (5-year relative survival) and locates the gap on the pathway with the step indicators that exist.

1. Where does the gap emerge in Päijät-Häme?

No step before the outcome is in the bottom quartile for Päijät-Häme. Look at the trend and at the data gaps below.

  1. Early detection

    Bowel screening attended

    75.2% of invited

    Finland 73.5 · best quartile 75.4 · rank 7/22 · 2024

    Middle halfS3

    2022: 79.4 → 75.2 (-4.2 vs Finland -3.8)

    The national programme started in 2022 and reaches all age groups by 2031, so the invited cohorts still differ by county.

  2. Referral to specialist care

    Referrals handled ≤ 3 days

    85.3% of referrals

    Finland 76.8 · best quartile 79.7 · rank 3/18 · 2025

    Top quartileS5

    2019: 82.5 → 85.3 (+2.8 vs Finland -0.1)

    All specialties, not cancer only. Counted by the providing hospital. The four Uusimaa counties are reported jointly by HUS and are missing here.

  3. Diagnosis and treatment start

    Waiting > 6 months

    27.7per 10,000 inhabitants

    Finland 36 · best quartile 11 · rank 10/18 · 2025

    Middle halfS8

    2019: 5 → 27.7 (+22.7 vs Finland +30)

    All specialties, not cancer only: a capacity signal for diagnostics and treatment. Cancer patients are usually prioritised, so this is a proxy. Helsinki data resumed in 2025; Uusimaa counties are reported by HUS jointly.

  4. Outcome (Goal 3)

    Bowel cancer 5-y survival

    63%

    Finland 68 · best quartile 71.8 · rank 22/22 · 2024

    Bottom quartileS9

    2019: 70 → 63 (-7 vs Finland +2)

    Early warning: worsening faster than Finland

    Patients diagnosed in the statistical year and the 9 years before, followed for 5 years, age-standardised. Small counties have wide uncertainty: read the trend, not one year.

Significance check with the Cancer Registry (diagnosed 2020-2024, 95 % confidence intervals) S13

  • Bowel cancer 5-year relative survival in Päijät-Häme: 67 % (61.3-73.1) vs Finland 70 %: not significantly different from Finland.
  • Mortality: 23.6 per 100 000 (21.1-26.3) vs Finland 22: not significantly different from Finland.
  • About 192 new cases a year (962 in 2020-2024).

The registry window (5 years of diagnoses) is shorter than the 10-year pooled Sotkanet survival above, so the two can differ. Act on a gap when both sources and the trend point the same way.

Stage at diagnosis is the missing step. Stage is recorded for only 42 % of cancers nationally (Pirkanmaa 72 %), so late detection cannot yet be compared by county. S13S1

2. What should Päijät-Häme do? Compared with the best-quartile counties

Nemotron 3.5 Super VL · grounded county brief

  1. 1

    Peer benchmarking of outcomes with the best counties

    Outcome (Goal 3)

    Strategy sub-goal 3.2, measures 2 and 3: peer review processes and management mechanisms that react to gaps found in the quality registry. S1S20S13S9

    Impact estimate: If survival in Päijät-Häme matched the best-quartile counties (71.8 %), 5-year relative survival would rise by 8.8 percentage points: roughly 8.8 more of every 100 patients surviving their cancer for 5 years. With about 192 new cases a year (registry, 2020-2024), that is about 17 more patients a year. S9

    • Make the multidisciplinary team meeting mandatory and recorded for every new bowel and lung cancer; in lung cancer, MDT care is linked to better survival.
    • Join the national peer review (vertaiskehittäminen) of the cancer quality registry and compare the county's results with the best counties every year.
    • Review the pathway of every bowel cancer patient who died within one year of the diagnosis: where was the delay?
    • Visit the best-performing county and copy one concrete practice within 6 months.
    Owner
    County chief medical officer, with FICAN
    When
    Peer review once a year; first case review in 3 months.
    Monitor
    5-year relative survival (trend over 3 years, not one year).
  2. 2

    Record the stage at diagnosis, so late detection becomes visible

    Data gap

    Stage is recorded for only 42 % of cancers nationally, so no one can see where late detection happens. The strategy targets 90 % automated clinical notifications by 2030. S13S1S14

    • Send the clinical cancer notification with the stage automatically from the patient record at diagnosis.
    • Ask Pirkanmaa, which records the stage for 72 % of cases, how it does it, and copy the workflow.
    • Track stage coverage every quarter until it reaches 70 %, then 90 %.
    Owner
    County information management, with the Finnish Cancer Registry
    When
    6-12 months, with the patient record vendor.
    Monitor
    Share of cancer cases with stage recorded (now 42 % nationally).

3. Goal 3 priority: lung cancer, the largest Nordic survival gap

The national gap: lung cancer 5-year relative survival, 2020-2024 S17

SexFinlandSwedenNorwayGap to Sweden-Norway mean
Men17.9 %31.3 %30.8 %13.2 pp
Women30.8 %38.9 %38.4 %7.8 pp

Goal 3 asks for +14 pp in lung cancer survival over the NORDCAN 2023 level. S1

Where it emerges: share of lung cancer patients treated with curative intent, 2019-2023 S14

Päijät-Häme: 29.6 % (195 of 659 patients) vs Finland 27 %. The share ranges from 18.5 % to 35.6 %. A low share can mean later detection, slower referral, older or frailer patients, or gaps in recording: the report itself notes recording differences. Crude shares, not age-adjusted.

Green: at least 3 points above Finland, red: at least 3 points below. Dashed line: Finland.

Treatment start in the Etelä-Suomi cooperation area S16

  • Surgery: median 46 days from diagnosis to first treatment (middle half 33-63 days).
  • Radiotherapy: median 39 days from diagnosis to first treatment (middle half 18-56 days).
  • Drug therapy: median 36 days from diagnosis to first treatment (middle half 24-54 days).
  • Stage recorded for 41.7 % of all 2024 cancers in the area. S13

THL guidance: at most 6 weeks (42 days) from referral to first treatment for suspected cancer S15. These medians start at diagnosis, so the full wait from referral is longer. Diagnoses 2018-6/2022.

4. Early warning: where is survival moving away from Finland?

Counties whose bowel cancer 5-y survival moved at least 4 points away from the national trend. Falling counties need a pathway review now; rising counties have practices worth copying. S9

▼ Falling behind Finland

▲ Improving faster than Finland

5. All counties

Colorectal (bowel) cancer 5-year relative survival, %, 2024. Best first. The dashed line is the national value (68). S9

Patients diagnosed in the statistical year and the 9 years before, followed for 5 years, age-standardised. Small counties have wide uncertainty: read the trend, not one year.

6. Ask the analyst

The analyst answers only from the data on this page and cites a source for every claim.

Sources and limits

  1. S1Kansallinen syöpästrategia 2026-2035: Yhdessä syöpää vastaan. Ministry of Social Affairs and Health (STM). Retrieved 2026-11-13. Goal 3 'Varmistetaan yhdenvertainen ja vaikuttava syövänhoito' and its monitoring indicators, figure 1 on p. 5; sub-goals 2.5 (p. 30-31), 3.1 (p. 33-34) and 3.2 (p. 35-36).
  2. S2Kansallinen syöpästrategia: toimeenpanon tiekartta 2026-2031. Ministry of Social Affairs and Health (STM). Retrieved 2026-11-13. Implementation roadmap; metrics for poor-prognosis cancers: time to treatment, stage at diagnosis, share treated with curative intent and survival (p. 23-24).
  3. S3Colorectal cancer screening: attended, % of invited (Finnish Cancer Registry). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 6103, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=6103.
  4. S4Breast cancer screening: attended, % of invited (Finnish Cancer Registry). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 3621, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=3621.
  5. S5Specialist care referrals processed within 3 days, % (THL). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 13, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=13.
  6. S6Specialist care referrals processed after more than 21 days, % (THL). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 5033, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=5033.
  7. S7Referrals received by specialist care per 1,000 inhabitants (THL). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 5073, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=5073.
  8. S8Patients waiting over 6 months for specialist care per 10,000 inhabitants (THL). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 3336, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=3336.
  9. S9Bowel cancer 5-year relative survival, % (Finnish Cancer Registry). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 3627, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=3627.
  10. S10Breast cancer 5-year relative survival, % (Finnish Cancer Registry). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 3625, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=3625.
  11. S11Entitled to special refund for cancer medicines, age-standardised % (Kela). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 5093, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=5093.
  12. S12Population 31 December (Statistics Finland). THL Sotkanet. Retrieved 2026-11-13. THL Sotkanet indicator 127, by wellbeing services county, read from https://sotkanet.fi/rest/1.1/json?indicator=127.
  13. S13Syöpä 2024: tilastoraportti Suomen syöpätilanteesta. Finnish Cancer Registry. Retrieved 2026-11-13. Annual registry report, published 17.6.2026. Stage at diagnosis recorded for 41.9 % of 2024 cases (Sisä-Suomi 60.4 %, Pirkanmaa 71.9 %, Itä-Suomi 33.2 %). Tables 15.9-15.13: incidence, 5-year relative survival and mortality 2020-2024 by county with 95 % confidence intervals. The report notes that county differences in survival are not statistically significant, while some mortality differences are.
  14. S14Keuhkosyöpä Suomessa 2019-2023: rekisteripohjainen katsaus diagnostiikkaan, hoitopolkuihin ja hoidon laatuun. Finnish Cancer Registry and Syöpäjärjestöt. Retrieved 2026-11-13. 14,873 lung cancers diagnosed 2019-2023, 12-month follow-up. 27.0 % treated with curative intent (Taulukko 6-7); by county from 18.5 % (Lappi) to 35.6 % (Vantaa-Kerava) (Taulukko 11, crude). Stage missing for 47.7 %.
  15. S15Hoitoonpääsyn seuranta syövän hoidossa: määrittelyt ja ohjeistus (Ohjaus 21/2016). THL. Retrieved 2026-11-13. Section 4.1 (p. 13): suspected cancer, referral to first treatment at most 6 weeks; imaging, biopsy and pathology each within 1 week. Colon and rectum: first treatment within 3 weeks of the treatment decision (p. 18-19). The 2025 update of the PDF is stamped as outdated, with no replacement yet.
  16. S16Keuhkosyöpä Suomessa: katsaus keuhkosyövän hoidon laadusta. Finnish Cancer Registry. Retrieved 2026-11-13. Malila et al., December 2024; 13,324 lung cancers diagnosed 2018-6/2022. Median days from diagnosis to first treatment by cooperation area (Taulukko 4.1, p. 27): surgery 13.5-46, radiotherapy 25-45, drug therapy 34.5-43; whole country 37 / 36 / 38.
  17. S17NORDCAN survival table, data version 9.6.1. NORDCAN (IARC and the Nordic cancer registries). Retrieved 2026-11-13. NORDCAN 9.6.1, 5-year relative survival 2020-2024. Lung: Finland men 17.9 % vs Sweden 31.3 % and Norway 30.8 %; women 30.8 % vs 38.9 % and 38.4 %. Pancreas men 12.1 % vs 17.3 % / 18.7 %. Liver men 14.4 % vs 25.8 % / 24.5 %.
  18. S18Cancer patient pathways and the diagnostic interval in Denmark. BMC Cancer. Retrieved 2026-11-13. Jensen et al., BMC Cancer 2015;15:308. After Denmark introduced cancer patient pathways, the median diagnostic interval fell by 17 days (95 % CI 15-19), n = 12,558.
  19. S19Waiting times in Norwegian cancer patient pathways. BMC Cancer. Retrieved 2026-11-13. Nilssen et al., BMC Cancer 2022;22:220. In Norway's pathways, the share treated within the target time was 84 % for colon surgery and 76 % for lung systemic therapy; treatment outside the patient's own health trust added delay.
  20. S20Multidisciplinary team care in lung cancer: systematic review and meta-analysis. European Respiratory Review. Retrieved 2026-11-13. Stirling et al., Eur Respir Rev 2024;33:230157. Meta-analysis of 20 observational studies: lung cancer multidisciplinary team care linked to better overall survival (HR 0.63, 0.55-0.72) and more surgery (OR 2.01).
  21. S21Stage shift with colorectal cancer screening in Europe. The Lancet Gastroenterology & Hepatology. Retrieved 2026-11-13. Cardoso et al., Lancet Gastroenterol Hepatol 2022;7:711-723. Screen-detected colorectal cancers were stage I in 35.7-52.7 % vs 13.2-24.9 % for other cancers, and stage IV in 5.8-12.5 % vs 22.5-31.9 %.
  • Public, aggregate data only. No patient-level data.
  • Referral and waiting indicators cover all specialties, not cancer only. No public series gives cancer-specific time to treatment by county yet.
  • Survival pools 10 years of diagnoses and is noisy in small counties: read the trend, not one year. Quartiles are computed over the 22 counties (Åland excluded).
  • The four Uusimaa counties have no referral or waiting data: HUS reports them jointly.
  • Impact estimates are arithmetic on the published rates and counts, not causal forecasts.