Wpływ skrinigu na trendy zachorowalności i umieralności. Polska na tle wybranych krajów Europy Joanna Didkowska MORTALITY TIME TRENDS IN POLAND MALES FEMALES 1
MALIGNANT CANCERS Until the age of 2: the number of incidence cases and deaths <1/1, At the age of 2-4: the number of incidence cases and deaths < 1/1, Above the age of 6 : the number of incidence cases and deaths >1/1, INCIDENCE MORTALITY POLSKA 24 MORTALITY TRENDS OF THE LEADING CANCER SITES FOR MALES, POLAND 8 7 DEATHS / 1, 6 4 3 2 lung colorectum stomach prostate bladder pancreas larynx oesophagus 1 196 197 198 199 2 21 2
MORTALITY TRENDS OF THE LEADING CANCER SITES FOR MALES, POLAND 2 18 16 DEATHS / 1, 14 12 1 8 6 colorectum prostate bladder pancreas larynx oesophagus 4 2 196 197 198 199 2 21 MORTALITY TRENDS OF THE LEADING CANCER SITES FOR FEMALES, POLAND 2 2 DEATHS / 1, 1 1 breast lung colorectum cervix uteri stomach ovary pancreas larynx oesophagus 196 197 198 199 2 21 3
THE OBJECTIVE OF SCREENING FOR CERVICAL CANCER REDUCTION OF DEATHS MINIMALNE WYMAGANIA SKRININGU waŝny problem zdrowotny i społeczny, dobrze poznana i rozumiana naturalna historia choroby, moŝliwość wyleczenia choroby we wczesnym stadium, znacznie lepsze wyniki leczenia we wczesnym stadium, istnienie odpowiednich testów pozwalających wykryć chorobę, istnienie akceptowalnych testów (procedur diagnostycznych), moŝliwość wyleczenia wykrytej choroby, skrining wykonywany w powtarzalnych odstępach czasu, dopóki istnieje ryzyko choroby, korzyści przewyŝszające ryzyko, populacyjne koszty badania nie przewyŝszające kosztów leczenia. zbyt słabe nie zawierają warunku, Ŝe leczenie choroby wykrytej we wczesnym stadium daje lepsze wyniki niŝ choroby wykrytej później kontrowersyjne zawierają warunek poznania naturalnego przebiegu, czego nadal nie moŝna powiedzieć o raku piersi lub raku szyjki macicy, a są to nowotwory, dla których udowodniono empirycznie korzyści wynikające z badań przesiewowych. Screening Wilson's criteria The problem Is the disease an important health problem? Is there a recognisable latent or early symptomatic stage? The natural history of the disease must be known. The screening population Can the population that needs treating be clearly defined, and called for screening? The test and the treatment Are facilities for diagnosis and treatment available? Diagnostic test must be suitable: affordable (ideally cheap, easy to perform, widely available) acceptable to patient specific, sensitive reliable (repeatable, good inter-operator agreement) good positive and negative predictive values Treatment must be suitable: affordable, effective, acceptable to patient Is there an agreed policy on whom to treat as patients? Does treatment confer benefit? The programme Has the cost of the programme been considered in the context of other demands for resources? Overall programme must be: affordable (opportunity cost must be considered), worthwhile, auditable, subject to quality assurance 4
Co moŝe podlegać skrinigowi? Gruźlica (tuberculosis) Kiła (syphilis) Fenyloketonuria (wrodzona, uwarunkowana genetycznie choroba polegająca na gromadzeniu się w organizmie i toksycznym wpływie aminokwasu fenyloalaniny). Nowotwory szyjki macicy (cervix uteri) Nowotwory piersi (breast) Nowotwory jelita grubego (large bowel) Nowotwory płuca (lung) Nowotwory gruczołu krokowego (prostate) WHAT ARE BENEFITS?
INCIDENCE, POLAND 27 LUNG 22.8% LARGE BOWEL - 12.4% PROSTATE 11.9% URINARY BLADDER 6.6% STOMACH.3% OTHER 39% BREAST 22.4% LARGE BOWEL - 1.1% LUNG 8.1% CORPUS UTERI 7.2% CERVIX UTERI.3% OTHER 3% Scrining 12% of cancers Scrining 38% of cancers MORTALITY, POLAND 27 LUNG 31.6% LARGE BOWEL - 1.% PROSTATE 7.% STOMACH 6.9% URINARY BLADDER.3% OTHER 41% LUNG 1,% BREAST 14.6% LARGE BOWEL 11.1% OVARY 7.2% CERVIX UTERI.9% OTHER 46% Screening 11% of cancers Screening 32% of cancers 6
CERVICAL CANCER MORTALITY IN SELECTED COUNTRIES 2 1 1 Romania Mexico Lithuania Poland Bulgaria Latvia Izrael (only Jude) Finland 19 196 197 198 199 2 21 CERVICAL CANCER SCREENING IN POLAND 28 - LOGISTIC PROBLEM 7
Average number of Pap smear tests during women s life: GERMANY > FINLAND 7 POLAND ~ 1 Mandelblatt J., Lawrence W., Gaffikin L., Limpahayom K., Lumbiganon P., Warakamin S., King J., Yi B., Ringers P., Blumenthal P. Costs and benefits of different strategies to screen for cervical cancer in lessdeveloped countries. JNCI 94, 19, 1469-1483, 22 ZGONY / 1, TRENDS OF CERVICAL CANCER MORTALITY IN POLAND, GERMANY AND FINLAND 1 9 8 7 6 4 3 2 1 196 197 198 rok 199 2 21 POLAND FINLAND GERMANY TRENDS OF INCIDENCE AND MORTALITY OF CERVICAL CANCER, POLAND 196-27 AGE 2-44 YEARS AGE 4-64 YEARS AGE 6+ 18 16 14 12 1 8 6 4 2 196 197 198 199 2 21 4 4 3 3 2 2 1 1 196 197 198 199 2 21 4 4 3 3 2 2 1 1 196 197 198 199 2 21 INCIDENCE MORTALITY 8
CERVICAL CANCER INCIDENCE AND MORTALITY BY AGE IN POLAND INCIDENCE MORTALITY 1 4 9 4 8 3 7 6 4 3 3 2 2 1 2 1 1 8+ 8-84 7-79 7-74 6-69 6-64 -9-4 4-49 4-44 3-39 3-34 2-29 2-24 1-19 1-14 -9-4 8+ 8-84 7-79 7-74 6-69 6-64 -9-4 4-49 4-44 3-39 3-34 2-29 2-24 1-19 1-14 -9-4 196 198 2 2 27 1963 198 2 2 27 PROBABILITY OF SURVIVAL ACCORDING SIZE OF TUMOR BREAST CANCER PROBABILITY 1.8.6.4.2 1-9 mm 1-14 mm 1-19 mm 2-29 mm 3-49 mm > mm 1 2 3 4 6 7 8 9 1 11 12 13 14 1 16 YEARS FROM DIAGNOSIS Źródło: Duffy S., Hill C., Esteve J. Quantitative methods for the evaluation of cancer screening, London 21 9
BREAST CANCER SCREENING IN POLAND 28 - LOGISTIC PROBLEM THE BREAST CANCER INCIDENCE AND MORTALITY TIME TRENDS, WOMEN AGED -69, POLAND 1963-27 Wiek -69 lat 2 wsp. standaryzowane 18 16 14 12 1 8 6 4 2 INCIDENCE MORTALITY 196 197 198 199 2 21 rok 1
TIME TRENDS OF CERVICAL CANCER MORTALITY BY EDUCATION LEVEL (3-9 years) 2 2 ELEMENTARY 1 VOCATIONAL 1 TOTAL SECONDARY ACADEMIC 1962 1972 1982 1992 22 Źródło: Wojciechowska U. WspółzaleŜność między wykształceniem a umieralnością na wybrane nowotwory złośliwe w Polsce w latach 1994-1996. Centrum Onkologii 2 BREAST CANCER SCREENING AGE -9 2 POLAND AGE -69 18 16 AGE -64 INCIDENCE / 1, 14 12 1 8 6 4 2 196 198 199 21 11
BREAST CANCER SCREENING wiek -9 wiek -64 1978 1982 1986 199 1994 1998 22 12 1 BREAST CANCER MORTALITY WOMEN AGED -69 1978 1983 1988 1993 1998 23 DEATHS/ 1, 8 6 4 1987 -wprowadzenie screeningu w UK Finlandia W. Brytania Polska 2 196 197 198 199 2 INCIDENCE RATES DUE TO BREAST CANCER IN SWEDEN IN -YEAR PERIODS DEPENDING ON THE NUMBER OF ADMINISTRATIVE UNITS TAKING PART IN SCREENING On the left: periods after the introduction of population mammographic screening program in 1986. 12
INCIDENCE OF BREAST CANCER BY AGE GROUPS IN POLAND 2 2 27 INCIDENCE/1 1 1 2 22-24 1994-1996 199-1992 198-1989 2-29 3-34 3-39 4-44 4-49 -4-9 6-64 6-69 7-74 7-79 8-84 8+ THE EARLY EFFECTS OF OPPORTUNISTIC SCREENING IN POLAND 2 2 INCIDENCE 27 CASES/1 1 1 INCIDENCE 22-24 INCIDENCE 1994-1996 DEATHS 1994-1996 DEATHS 22-24 DEATHS 27 3-34 3-39 4-44 4-49 -4-9 6-64 6-69 7-74 7-79 AGE GROUPS 13
BREAST CANCER MORTALITY IN SELECTED COUNTRIES 3 3 2 DENMARK GREAT BRITAIN HUNGARY CANADA RUSSIA 2 1 1 USA POLAND FINLAND 19 196 197 198 199 2 21 UMIERALNOŚĆ NA NOWOTWORY PIERSI W GRUPACH WIEKU, POLSKA 1963-26 1 9 7 lat i więcej 8 7 6-69 lat 4 3 2 1 2-49 lat 196 197 198 199 2 21 14
Trendy umieralności i zachorowalności na nowotwory piersi w grupach wieku, Polska AGE 2-49 YEARS AGE -69 YEARS AGE 7+ 3 INCIDENCE 2 INCIDENCE 1 INCIDENCE 3 16 wsp. standaryzowane 2 2 1 1 12 8 1 MORTALITY 196 198 2 4 MORTALITY 196 198 2 MORTALITY 196 198 2 Holandia, wiek 3-84 lat, zachorowalności i umieralność na inwazyjnego raka piersi Int. J. Cancer Vol.123, 8 Pages: 1929-1934 1
THE EFFECT OF INTRODUCTION OF BREAST CANCER SCREENING IN NEW YORK 1982 http://www.health.state.ny.us/diseases/chronic/screening.htm COLORECTAL CANCER RECOMENDATION FOR COLORECTAL CANCER SCREENING IN POLAND TARGET GROUP -69 YEARS OF AGE SCREENING TEST - COLONOSCOPY INTERVAL - 1 YEARS 16
COLORECTAL CANCER MORTALITY IN EUROPE Boyle, P., Smans, M. Atlas of cancer mortality in the European Union and the EEA. 1993-1997 IARC 28 IARC Scientific Publication, No 19 TIME TREND OF COLORECTAL CANCER (C18-C2) MORTALITY, SELECTED COUNTRIES MALES FEMALES 3 4 3 CZECH 3 3 2 2 SWISS USA 2 CZECH USA 2 1 SWEDEN POLAND 1 SWISS DENMARK 1 FINLANDIA GREECE 1 FINLAND POLAND 19 196 197 198 199 2 19 196 197 198 199 2 17
TIME TRENDS OF COLORECTAL CANCER MORTALITY AND INCIDENCE IN POLAND MALES FEMALES 3 3 3 3 wsp. standaryzowane 2 2 1 1 wsp. standaryzowany 2 2 1 1 zachorowalność umieralność 196 1966 1976 1986 1996 26 zachorowalność umieralność 196 1966 1976 1986 1996 26 UMIERALNOŚĆ NA NOWOTWORY JELITA GRUBEGO POLSKA 196-27 3 MALES 2 FEMALES 3 2 2 196-1969 197-1974 198-1984 199-1994 27 2 1 196-1969 197-1974 198-1984 199-1994 27 1 1 1 8-84 7-74 6-64 -4 4-44 3-34 2-24 '1-14 -4 8-84 7-74 6-64 -4 4-44 3-34 2-24 '1-14 -4 18
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