According to the National Institute for Health Development (TAI), nearly 9,000 people are diagnosed with cancer each year in Estonia. Almost half of cancer-related deaths could be prevented if people adopted healthier lifestyles and received vaccinations against cancer-causing viruses, noted Keiu Paapsi, a TAI researcher specializing in cancer studies and one of the authors of the institute's latest yearbook.

"Socioeconomic status and education level are both critical factors that influence public and individual health. This is particularly evident in life expectancy," Paapsi said.

She explained that life expectancy is shaped by three key elements: health behavior, access to healthcare services and health awareness. In Estonia, people can already choose between services covered by the Health Insurance Fund and those they pay for out of pocket.

Unfortunately, such services are more accessible to wealthier segments of the population. Paapsi pointed out that many employers now offer health insurance to their staff, a benefit that typically comes with higher-paying jobs.

"When it comes to cancer, this gives those individuals the opportunity to undergo annual health screenings that may not be included in the Health Insurance Fund's budget, and to consult a doctor even with minor symptoms. It also shortens their wait times for treatment. If no free appointment is available, these people can choose paid services instead," she explained.

In other words, people who undergo checkups more frequently are more likely to detect cancer early, making treatment more effective. It's worth noting that, although national cancer screenings are available free of charge to everyone, TAI data show that participation is significantly higher among people with more education.

"In the case of cervical cancer, for example, women with lower levels of education participate less often in screenings and their cancers are more likely to be discovered at a later stage. Similarly, men with lower education levels tend to see a doctor much later, which also results in late-stage cancer diagnoses," Paapsi said.

Education level is also a major factor in cancer mortality, she added. "For example, when it comes to breast and lung cancer, we see that people with lower education levels are less likely to receive cancer-specific treatment. In the case of breast cancer, women with less education receive less radiation therapy, which is a vital component of treatment," she said.

The same pattern is seen among women who are single, divorced or widowed. Paapsi noted that a cancer patient living alone and far from a medical center often struggles to access treatment. For instance, they may not have anyone to pick them up by car after a chemotherapy session, when they might feel unwell. As a result, research shows that people living alone are less inclined to undergo treatment and are more likely to give up on it.

To address these inequalities, the National Institute for Health Development is working to make cervical cancer screenings more accessible to those living farther from urban centers. In the near future, it will be possible to purchase test kits from pharmacies and use them at home.

TAI's research also shows that people with lower education and income levels are more likely to engage in lifestyle-related risk behaviors such as smoking and alcohol use. Meanwhile, beneficial lifestyle habits — like healthy eating and regular exercise — require resources that are more accessible to those with better living conditions.

"Health awareness is also extremely important — meaning awareness of early cancer symptoms and of the different options provided by the state. Cancer screenings in Estonia are free for everyone, regardless of health insurance coverage. If people with higher education levels are more likely to participate in screenings, it simply shows that they are more informed about their health and how to take care of it," Paapsi concluded.

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