Medicinski vjesnik, Vol. 39 No. (1-4), 2007.
Pregledni rad
National program of prevention and early detection of cancer in Croatia
Zdravko Ebling
Marija Strnad
Mirko Šamija
Sažetak
Cancer is the second most frequent cause of death (a quarter of all deceased) in Croatia. Number of cases increased in the period 1988- 2005 from 303,9 to 466,8 out of 100.000, and number of the dead increased from 217,7 to 284,8 out of 100.000. There are almost 21 000 new cancer patients (skin cancer excluded) diagnosed every year (year 2005) and almost 13 000 die. The most frequent cancer sites in men are lungs, colorectum, prostate, urinary bladder and stomach and in women breasts, colorectum and ovaries. Although these organs are easily available for both diagnosis and therapy and even though today we posses modern equipment for diagnosis, survival stretches up to a short period of 5 years. In the year 2003 the European Council invited the member countries to create and start implementing programs for cancer prevention and early detection. Tests, which were recommended (with adequate quality in performance) were: mammography for detecting breast cancer in women aged 50-69, occult fecal blood test for detecting large intestine cancer from the age of 50 to 74 and the Pap test for detecting cervical cancer, which should not be performed in women younger than 20, but should definitively be done before they are 30 years old.
Proposal of the National Program for Cancer Prevention and Early Detection in Croatia was presented at the 2nd Congress of the Croatian Oncologic Association in 2004 and published in Croatian and English language. A somewhat reviewed program was published in 2007 under the title "How to Prevent and Early Detect Cancer?". Aims of the Program:
1. to reduce prevalence of known risk factors in the population by different promotional activities and health education (control of smoking, healthy diet, physical activity and avoiding excessive body weight, promoting moderate consuming of alcohol, reducing the exposure to carcinogens at work and in the environment, immunisation against hepatitis B, avoiding sun exposure and health education regarding sexual and reproductive factors connected to cancer;
2. to reduce total cancer mortality by 15% five years after the implementation of the program;
3. to increase percentage of patients, who were diagnosed with this malignant disease in preclinical and in situ stage, to increase success of treatment and survival and to reduce expenses of costly treatment and improve life quality of patients.
Aims of early detection of breast cancer are the following: to reduce mortality from breast cancer by 25% five years after implementation of the program; target group are women aged 50-69 every two years with the scope of at least 70% of the population. Screening test: high quality mammography, clinical examination between screenings, as well as for women, who are not going to participate in the program. It is to be expected that after mammography 4% of women would have to be subjected to further treatments. Aims of early detecting a colorectal cancer are to reduce mortality from the colorectal cancer by 15% five years after implementation of the program with the scope of 75% of the population until 2010. Screening test: occult fecal blood test (FOBT) or immunochemical test (FIT) once a year (or once every two years, i.e. at least once every three years); with persons who were tested positive to occult fecal blood haemorrhage, colonoscopy should be performed, in order to determine the cause of occult haemorrhage and possible colorectal cancer (with endoscopic therapy - polypectomy performed at the same time, if needed). Expected number of people positive to occult fecal blood test is from 2 to 3%. By applying the program for early detection of cervical carcinoma, reduction by 60% of invasive carcinoma for women aged 25 to 64 is to be expected nine years after the program implementation and for women aged 25 to 69 the reduction of mortality by 80% after 13 years. Screening test: the Pap test for women aged 25 to 64 every three years. Ideal scope would be 85%. We should try to accomplish the following screening methods: for women aged 25 to 30 to use the Pap test (conventional or current cytology, with quality control in cytological laboratories pursuant to the EU instructions) every three years, and for women aged 31 to 64 to use a combination of the Pap test and HPV- testing every 5 years. In women, who were tested positive, the Program included also colposcopy and target biopsy. It is to be expected that the future programs for cervical cancer prevention will include the whole prevention system, which will include vaccination against HPV. The aim of early detection of prostate cancer is to reduce prostate cancer mortality five years after the program implementation. Target group: men older than 40 with a positive family prostate cancer history (approximately 10% of them), men older than 50 with symptoms of prostatism, as well as men of the same age without symptoms, who want to be examined for early detection of prostate cancer. Screening tests: digital-rectal examination, determining of prostate serum antigen (PSA) once a year. Those who were tested positive are referred to further diagnostic tests (approximately 5-10%). Participants in the screening program are determined according to cancer site and obligatory intensive promotional activities in all fields. Monitoring as well as evaluation of the screening is performed by public health institutes. Croatian Public Health Institute coordinates activities and informs the Ministry of Health and Social Welfare on regular basis. The program of early detection of breast cancer - mammography started at the end of 2006 (October) by inviting women born in 1937, 1954 and 1955, and in the year 2007 women born in 1938, 1939-1943, as well as those born 1948-1953 were invited. Until November 2007, 330 000 women were invited, the response of the first women invited was 51,9% and the number of detected cancers was 353. The Program for early detection of colorectal cancer by FOBT as well as invitation of people born in 1933 and 1937 started at the end of the year 2007.
Ključne riječi
Neoplasms - prevention and control; National health programs; Croatia
Hrčak ID:
191345
URI
Datum izdavanja:
1.12.2007.
Posjeta: 4.166 *