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Lviv National Medical University named after Danylo Galitsky, Ukraine
Oksana Stadnyk, chief of the organizational & methodological department
Markiyan Povkh, urologist
Lviv regional clinical hospital
Orest Tril , chief of the organizational & methodological department
Lviv regional cancer treatment and diagnostics center
Championship participant: the National Research Analytics Championship - "Ukraine";
the Open European-Asian Research Analytics Championship;
We introduce the project of joint implementation of complex screening methods for early diagnostics of some cancer types on the base of three leading institutions in Lviv region − Lviv Regional Cancer Center, Lviv Regional Clinical Hospital and Lviv National Medical University.
Key words: cancer screening, early diagnostics, life quality.
Noncommunicable diseases (cardiovascular diseases, cancer, diabetes and chronic respiratory diseases) are the leading killers today and are increasing. NCDs killed 63% of people, who died worldwide in 2008. This equals 36 million people. About 30% of people, dying from NCDs in low-and middle-income countries are aged under 60 years and are in their most productive period of life. The mortality from noncommunicable diseases is high in Ukraine and Eastern Europe. In ranking causes of persistent health violations for Ukrainians and lost years of life cancers occupy the 4th place for men (9,3% DALY-Disability Adjusted Life Years) and the 3rd place for women (10,4% DALY).
Recently the question of cancer growth becomes relevant in the world. Statistics research shows the negative impacts of technogenic and environmental factors on the quantitative increase in the incidence of malignant neoplasm. Despite the continuous development of medical technology (diagnostics and treatment) remains the difficulty of early detection of some cancer forms.
According to the WHO recommendations, millions of deaths can be prevented by stronger implementation of measures, existing today. They include:
- Stronger anti-tobacco control;
- Promotion of healthy diets;
- Improving people's access to essential health care;
- Cancer screening.
The use of cancer screening gives the most significant results in improving survival of cancer patients and saving years of life.
Based on the GLOBOCAN 2008 about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in the world.
Cancer structure in Europe for both sexes /all ages (scheme1).
Incidence and mortality from different cancer types in Europe for both sexes /all ages (scheme 2).
We conducted the study of cancer pathology level on adjacent territories of Ukraine and Europe in order to: identify common patterns of morbidity, identify locations that are at this level of medicine need to improve methods of diagnosis and optimize treatment regimens, searching solutions to similar problems.
The subjects of our research were the localization of cancer of bladder, prostate, kidney, stomach and colon. Nowadays the applicable diagnosis scheme does not allow in all cases to detect tumor processes in the early stages, resulting in later diagnosis leads to increased cost of the next treatment (invasive surgery, specific pharmacotherapy), reducing the effectiveness of treatment and decline in the length and quality of life.
Strategies for overcoming of the digestive and urological cancers are very attractive.
The structure of the cancer incidence in Europe is dominated by such types of cancer as: colorectal, breast, lung, prostate, stomach, bladder and kidney cancer.
Our proposal involves a complex screening of all these cancers, except breast cancer (already developed separate mammography screening) and lung cancer, for which well-proven preventive anti-tobacco measures exist.
Analyzing cancer incidence and mortality in the Eastern Europe, one can see the similar cancer structures in the European countries and Ukraine. Structure of the cancer incidence in Ukraine and Europe are similar, although Ukraine has lower lung and prostate cancer, but higher stomach cancer.
Screening of colorectal, stomach, bladder, kidney, prostate cancers is very relevant for the Eastern Europe region to reduce mortality from these cancer types. Summing of selected cancers we get a picture of extremely relevant for Central and Eastern Europe, because these types of cancer are in our region most death rating among similar regions.
The gastric cancer incidence in our region is the highest in Europe. Colorectal cancer in Central and Eastern Europe has the highest mortality. In Central and Eastern Europe there is high incidence of stomach cancer and the highest death rate from colorectal cancer, indicating the significant relevance of these cancers of the digestive tract for the implementation of screening programs.
So, the Idea is: an introduction of complex screening methods for early diagnostics of most death rating cancer types and the Aim is:
- to improve diagnostics of colorectal and stomach cancer using one test;
- to apply the test for occult blood for urological field.
Application of a combined test for determining hidden "high" and "low" bleeding in the gastrointestinal tract, and using the same test for "high" and "low" bleeding in urologic field displays this type of screening in a very interesting and economically appropriate rank.
Rapid test for occult blood specific for human hemoglobin and transferrin is more sensitive than traditional test for iron levels, that is freely available in the pharmacy network, economically priced and easy to use, gives results on “cito”.
Our clinical and organizational decisions: the use of screening in the hospital means using a complex method of screening by the test for occult blood screening only for pathology of the digestive tract, and for urological cancers - traditional screening (PSA, NMP22, USD). For ambulance patients for quickly cover screening and selection of risk group for closer and additional examination - complex examination of occult blood as cancer of the digestive tract and urological cancers. The implementation of the two clusters will allow to evaluate the effectiveness and economic feasibility of such screening algorithm.
Cluster 2 (prehospital)
Estimated project budget includes expenses for the purchase of tests for occult blood and endoscopic equipment to verify evidence of pathology. Patients with positive screening test would be examined by routine methods (endoscopy, USD, Rtg, CT). The equipment and professional staff of the two largest specialized hospitals in Lviv region (LRCH and LRCC) would be used for additional examination of patients, "positive" in the screening tests.
· Implementation of effective complex screening methods for numerous gastrointestinal and urological cancers
· Improvement of early diagnostics of the oncologycal pathology for weighing cancer types
· Reduce mortality from these cancer types
· To share the experience among hospitals in our regions
· To engage foreign hospitals in other countries to join the project, learning experience and using of acquired results.
Proved efficiency of the screening algorithm would become a basis for changing the national standard of medical care in Lviv region and Ukraine in general and, we hope so, for important information global screening programs in Central and Eastern Europe.
Our previous experience
The result of cervical cancer screening – the reduce of neglect and a year-mortality in Lviv region. For several years, oncologists and gynecologists of Lviv region introduced screening of cervical pathology, and near 5 years an annual large-scale public events were realized to maximize the involvement of women in this type of screening. This activity gives results in reducing of cervical cancer to 15% and 1 year- mortality to 7-10%. Near 45% of cervical cancer cases in Lviv region are at the stage of Ca in situ (stage 0). Gained experience became the basis for further development of screening programs.
Our new experience
The project is under implementation. An information and consulting work with staff and patients was carried out. Some patients are using tests purchased at their own expense. Healthcare facilities have began using tests purchased by the institution. Now the results of the test use data in 2012 are analyzed. The test data need for 2013 is studied.
1. Rebecca Siegel. The Impact of Eliminating Socioeconomic and Racial Disparities on Premature Cancer Deaths. Cancer Statistics, 2011
2. Global Cancer Facts & Figures 2nd Edition. Atlanta: American Cancer Society; 2011.
3. Colorectal Cancer Facts & Figures 2011-2013.
4. Zon R.American Society of Clinical Oncology Policy Statement: The Role of the oncologist in cancer prevention and risk assessment. Journal of clinical oncology 27:986-993.
5. Tarasenko YN. Colorectal cancer screening among rural Appalachian residents with multiple morbidities. Rural and Remote Health 11: 1553. (Online), 2011
6. Hoffman R. Barriers to Colorectal Cancer Screening: Physician and General Population Perspectives, New Mexico, 2006 Preventing Chronic Disease 2011;8(2).