1. Breast cancer risk assessment and risk distribution in 3,491 Slovenian women invited for screening at the age of 50 : a population-based cross-sectional studyKatja Jarm, Vesna Zadnik, Mojca Birk, Miloš Vrhovec, Kristijana Hertl, Žan Klaneček, Andrej Studen, Cveto Šval, Mateja Krajc, 2023, original scientific article Abstract: Background. The evidence shows that risk-based strategy could be implemented to avoid unnecessary harm in mammography screening for breast cancer (BC) using age-only criterium. Our study aimed at identifying the uptake of Slovenian women to the BC risk assessment invitation and assessing the number of screening mammographies in case of risk-based screening.Patients and methods. A cross-sectional population-based study enrolled 11,898 women at the age of 50, invited to BC screening. The data on BC risk factors, including breast density from the first 3,491 study responders was col-lected and BC risk was assessed using the Tyrer-Cuzick algorithm (version 8) to classify women into risk groups (low, population, moderately increased, and high risk group). The number of screening mammographies according to risk stratification was simulated. Results. 57% (6,785) of women returned BC risk questionnaires. When stratifying 3,491 women into risk groups, 34.0% were assessed with low, 62.2% with population, 3.4% with moderately increased, and 0.4% with high 10-year BC risk. In the case of potential personalised screening, the number of screening mammographies would drop by 38.6% com-pared to the current screening policy. Conclusions. The study uptake showed the feasibility of risk assessment when inviting women to regular BC screen-ing. 3.8% of Slovenian women were recognised with higher than population 10-year BC risk. According to Slovenian BC guidelines they may be screened more often. Overall, personalised screening would decrease the number of screening mammographies in Slovenia. This information is to be considered when planning the pilot and assessing the feasibility of implementing population risk-based screening.
Keywords: breast cancer screening, personalised screening, risk assessment, mammography
Published in DiRROS: 25.07.2024; Views: 122; Downloads: 139
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2. Impact of the COVID-19 epidemic on cancer burden and cancer care in Slovenia : a follow-up studyTina Žagar, Sonja Tomšič, Vesna Zadnik, Nika Bric, Mojca Birk, Blaž Vurzer, Ana Mihor, Katarina Lokar, Irena Oblak, 2022, original scientific article Abstract: In Slovenia, cancer care services were exempt from government decrees for COVID-19 containment. Nevertheless, cancer control can be impacted also by access to other health services and changes in health-seeking behaviour. In this follow up study, we explored changes in cancer burden and cancer care beyond the first months after the onset of the COVID-19 epidemic.Materials and methods. We analysed routinely collected data for the period January 2019 through July 2022 from three sources: (1) pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor (source: Slovenian Cancer Registry); (2) referrals issued for oncological services (source: e-referral system); and (3) outpatient appointments and diagnostic imaging performed (source: administrative data of the Institute of Oncology Ljubljana – IOL). Additionally, changes in certain clinical and demographic characteristics in patients diagnosed and treated during the epidemic were analysed using the Hospital-Based Cancer Registry of the IOL (period 2015–2021).Results. After a drop in referrals to follow-up cancer appointments in April 2020, in June-August 2020, there was an increase in referrals, but it did not make-up for the drop in the first wave; the numbers in 2021 and 2022 were even lower than 2020. Referrals to first cancer care appointments and genetic testing and counselling increased in 2021 compared to 2019 and in 2022 increased further by more than a quarter. First and follow-up outpatient appointments and cancer diagnostic imaging at the IOL dropped after the onset of the epidemic in March 2020 but were as high as expected according to 2019 baseline already in 2021. Some deficits remain for follow-up outpatients’ appointments in surgical and radiotherapy departments. There were more CT, MRI and PET scans performed during the COVID-19 period than before. New cancer diagnoses dropped in all observed years 2020, 2021 and until July 2022 by 6%, 3% and 8%, respectively, varying substantially by cancer type. The largest drop was seen in the 50−64 age group (almost 14% in 2020 and 16% in 2021), while for patients older than 80 years, the numbers were above expected according to the 2015–2019 average (4% in 2020, 8% in 2021).Conclusions. Our results show a varying effect of COVID-19 epidemic in Slovenia for different types of cancers and at different stages on the patient care pathway – it is probably a mixture of changes in health-seeking behaviour and systemic changes due to modifications in healthcare organisation on account of COVID-19. A general drop in new cancer cases reflects disruptions in the pre-diagnostic phase and could have profound long-term consequences on cancer burden indicators.
Keywords: cancer, covid-19, delay in diagnosis
Published in DiRROS: 25.07.2024; Views: 140; Downloads: 96
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3. Incidenca raka v prvem letu epidemije covida-19Vesna Zadnik, Tina Žagar, Nika Bric, Mojca Birk, Amela Duratović Konjević, Ana Mihor, Katarina Lokar, Sonja Tomšič, 2023, professional article Abstract: Uvod: Število novih diagnoz raka (incidenca) se v Sloveniji v zadnjem desetletju povečuje za povprečno 1,6 % na leto. V letu 2020, prvem letu omejitvenih ukrepov zaradi epidemije covida19, smo s platformo OnKOvid predvideli 3–8-odstotni padec novih diagnoz raka. Namen je predstaviti uradno incidenco raka za Slovenijo za leto 2020 in ugotoviti, kolikšen je bil dejansko manko novih diagnoz raka. Metode: V Registru raka Republike Slovenije smo v skladu z mednarodnimi pravili registrirali vse nove primere raka pri prebivalcih s stalnim prebivališčem v Sloveniji. Primerjali smo jih z registrirano incidenco za 2019, modelno incidenco za 2020, preliminarnimi rezultati OnKovida in dostopnimi rezultati incidence iz registrov raka iz drugih držav. Rezultati: V letu 2020 je za rakom zbolelo 15.096 oseb v Sloveniji (7.034 žensk, 8.002 moška). Glede na modelno oceno incidence za leto 2020 gre za manko 1.854 oseb (10,9 %; 11,6 % žensk, 10,4 % moških). Pri tem je za 10,5 % manj ugotovljenih rakov v omejenem stadiju, najbolj izrazito v starosti 50–69 let (za 13,2 %). Upad je primerljiv s poročili iz Anglije, ZDA in Kanade ter deloma večji kot na Škotskem in Švedskem. Najbolj izrazit upad novih diagnoz raka ugotavljamo pri nemelanomskem kožnem raku (23 %, najbolj po 50. letu), raku prostate (15,9 %, najbolj v omejenem stadiju), pljučnem raku (8,9 %, 60–64 let, v razširjenem stadiju), raku dojk (8,3 %, 45–64 let), ne-Hodgkinovem limfomu (9 %) in levkemijah (11,6 %). Pri kožnem melanomu, raku debelega črevesa in danke ni bilo primanjkljaja. Zaključek: Upad incidence raka v letu 2020 gre verjetno na račun omejitvenih ukrepov, reorganizacije zdravstva in z zdravjem povezanega vedenja med epidemijo covida-19, beležijo jo v več državah. Med epidemijami je potrebno nemoteno izvajanje onkologije.
Keywords: rak, incidenca, register raka, epidemija, covid-19
Published in DiRROS: 26.02.2024; Views: 370; Downloads: 90
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4. Vpliv radona na pojavljanje pljučnega raka v SlovenijiMojca Birk, Tina Žagar, Sonja Tomšič, Katarina Lokar, Ana Mihor, Nika Bric, Miran Mlakar, Vesna Zadnik, 2022, original scientific article Abstract: Izhodišče: Svetovna zdravstvena organizacija je opredelila radon v bivalnem okolju kot enega izmed 19 okoljskih karcinogenov. Radon je poleg tobačnega dima eden izmed najpomembnejših dejavnikov tveganja za razvoj pljučnega raka ter predstavlja približno 10-odstotni delež vseh primerov pljučnega raka. V naši raziskavi smo prvič preučili, kako radon vpliva na pojavljanje pljučnega raka v Sloveniji. Metode: Za 40-letno obdobje od leta 1978 do leta 2017 so bili na ravni naselij povezani trije viri podatkov: zboleli za pljučnim rakom (Register raka Republike Slovenije), prebivalci (Statistični urad Republike Slovenije) in Radonski zemljevid Slovenije. V modele prostorskega glajenja z Bayesovimi hierarhičnimi modeli je kot pojasnjevalna spremenljivka vključen radon v bivalnem okolju in izračunan pripisljivi delež raka. Relativno tveganje je ocenjeno s standardiziranim količnikom incidence. Rezultati: V Sloveniji za pljučnim rakom zaradi izpostavljenosti radonu v bivalnem okolju (analiza na ravni naselij) zboli približno 60 oseb letno, kar predstavlja 5 % vseh s to boleznijo. Analiza relativnega tveganja po spolu kaže, da imajo v Sloveniji zaradi izpostavljenosti radonu v bivalnem okolju povečano tveganje pljučnega raka predvsem moški. Ženske, ki bivajo na območjih, bolj obremenjenih z radonom, nimajo povečanega relativnega tveganja za nastanek pljučnega raka. Zaključek: Izpostavljenost radonu v bivalnem okolju je poleg kajenja med najpomembnejšimi nevarnostnimi dejavniki pljučnega raka v slovenski populaciji. Na območjih, kjer je radona veliko (predvsem južna in jugovzhodna Slovenija), je z javnozdravstvenega vidika ključno izvajanje preventivnih ukrepov, v prvi vrsti pa ozaveščanje in poučevanje prebivalstva o nevarnosti ter možnostih za preprečitev bolezni.
Keywords: radon, pljučni rak, pripisljivi delež, ocena tveganja
Published in DiRROS: 06.12.2022; Views: 726; Downloads: 249
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