1. Ocena pridobljenih let življenja v populacijskih presejalnih programih za rakaVesna Zadnik, Maja Pohar Perme, Tina Žagar, Bor Vratanar, Katja Jarm, Katarina Lokar, Maja Jurtela, Sonja Tomšič, 2024, strokovni članek Povzetek: Zaradi možnih negativnih zdravstvenih posledic presejalnih programov in velikih sredstev, vloženih vanje, je pomembno spremljati njihovo učinkovitost. Umrljivost v ciljni populaciji je eden od kazalnikov, ki služi za prikaz dolgoročne učinkovitosti organiziranih populacijskih presejalnih programov – po 10 do 20 letih se pričakuje padec umrljivosti v ciljni populaciji za 20 % do 30 %. Ena od glavnih omejitev kazalnika umrljivosti je, predvsem pri rakih z dobrim preživetjem, da pokaže učinkovitost presejanja šele v daljšem časovnem obdobju. Mnogokrat se zato za oceno učinkovitosti populacijskih presejalnih programov za raka uporablja analiza preživetja, pri kateri so rezultati dostopni prej. Tudi analiza preživetja ima svoje omejitve, saj se lahko v rezultate prikradejo številne pristranosti (npr. pristranost časa trajanja, prednosti in prediagnosticiranja). Nedavno smo slovenski raziskovalci predlagali nov analitični pristop, ki omogoča primerjavo preživetja pri rakih, ki so oz. niso odkriti v presejalnem programu, z upoštevanjem vseh pomembnih pristranosti. Izračunana preživetja so osnova za izračun pridobljenih let življenja, to je mere, ki izraža dodatno število let življenja, ki bi jih osebe preživele zaradi vključitve v presejalni program.V testnem primeru smo ocenili učinke uvedbe Državnega prese-jalnega program za raka dojk DOR A, ki smo ga prvim prebival-kam ponudili leta 2008, na celotno populacijo pa je bil razširjen leta 2018. Ženske, ki so bile povabljene v program DOR A v obdobju 2008–2018, so do leta 2022 pridobile skupaj 90,6 leta življenja, če bi bile v program DOR A že od leta 2008 vključene vse ženske, pa bi pridobile 552,7 leta življenja. Z vsakim dodatnim letom opazovanja, ko posamezne ženske od vključitve v program DOR A preživijo, se seštevek pridobljenih let življenja poveča.Nova metoda bo v pomoč pri upravljanju obstoječih presejalnih programov za raka, njihovi promociji in vrednotenju učinkov pri spremembah presejalnih politik. Ključne besede: presejalni programi, kakovost, register raka Objavljeno v DiRROS: 26.07.2024; Ogledov: 149; Prenosov: 92
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2. 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, izvirni znanstveni članek Povzetek: 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. Ključne besede: breast cancer screening, personalised screening, risk assessment, mammography Objavljeno v DiRROS: 25.07.2024; Ogledov: 121; Prenosov: 139
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3. Estimating exposure to extremely low frequency magnetic fields near high-voltage power lines and assessment of possible increased cancer risk among Slovenian children and adolescentsTina Žagar, Blaž Valič, Tadej Kotnik, Sara Korat, Sonja Tomšič, Vesna Zadnik, Peter Gajšek, 2023, izvirni znanstveni članek Ključne besede: exposure assessment, childhood cancer, extremely low frequency magnetic fields, modelling, high voltage power lines Objavljeno v DiRROS: 25.07.2024; Ogledov: 121; Prenosov: 555
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4. 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, izvirni znanstveni članek Povzetek: 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. Ključne besede: cancer, covid-19, delay in diagnosis Objavljeno v DiRROS: 25.07.2024; Ogledov: 140; Prenosov: 96
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6. Preoperative intensity-modulated chemoradiotherapy with simultaneous integrated boost in rectal cancer : five-year follow-up results of a phase II studyJasna But-Hadžić, Anja Meden Boltežar, Tina Škerl, Vesna Zadnik, Vaneja Velenik, 2021, izvirni znanstveni članek Povzetek: We conducted a phase II study to investigate the feasibility and safety of preoperative radiochemo-therapy experimental fractionation, using intensity-modulated radiation therapy with simultaneous integrated boost (IMRT SIB) to shorten the overall treatment time without dose escalation in intermediate/locally advanced rectal cancer with the aim to improving treatment outcome.Patients and methods. A total of 51 patients with operable stage II–III rectal carcinoma were included between January 2014 and January 2015. Fifty patients completed preoperative IMRT treatment with an elective dose of 41.8 Gy and simultaneously delivered 46.2 Gy to T2/T3 and 48.4 Gy to T4 tumour in 22 fractions, with concomitant capecit-abine (825 mg/m2/12 h, including at weekends). Median follow-up was 70 months (range 11–80 m).Results. Forty-seven patients completed treatment per protocol. Acute toxicity occurred in 2 (4%) patients. R0 resec-tion was achieved in all but 1 and pathologic complete response (pCR) in 12 (25.5%) patients who had 5-year overall survival (OS), disease-free survival (DFS) and local control (LC) of 91.7%, 100% and 100%, respectively. The intention-to-treat analysis showed that the type of surgery significantly moderated OS and DFS, while total downstaging and pN were predictive for DFS only. For treatment per protocol 5-year OS, DFS and LC were 80.9% (95% confidence interval [CI] 69.7–92.1), 77.1% (95% CI 65.1–89.1) and 95.2% (95% CI 88.7–100), respectively. The proportion of patients with severe late (CTCAE G ≥ 3) gastrointestinal, urinary and sexual toxicity was 15%, 2% and 8% respectively, with one reported secondary carcinoma. Ključne besede: rectal cancer, IMRT, simultaneous integrated boost, preoperative radiochemotherapy, acute toxicity Objavljeno v DiRROS: 23.07.2024; Ogledov: 114; Prenosov: 42
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7. Trends in population-based cancer survival in SloveniaVesna Zadnik, Tina Žagar, Katarina Lokar, Sonja Tomšič, Amela Duratović Konjević, Branko Zakotnik, 2021, izvirni znanstveni članek Ključne besede: cancer burden, cancer survival, time trend, cancer registry Objavljeno v DiRROS: 22.07.2024; Ogledov: 111; Prenosov: 71
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8. Socioeconomic inequalities in cancer incidence in Europe : a comprehensive review of population-based epidemiological studiesAna Mihor, Sonja Tomšič, Tina Žagar, Katarina Lokar, Vesna Zadnik, 2020, pregledni znanstveni članek Povzetek: Background. Since the end of the previous century, there has not been a comprehensive review of European studies on socioeconomic inequality in cancer incidence. In view of recent advances in data source linkage and analytical methods, we aimed to update the knowledge base on associations between location-specific cancer incidence and individual or area-level measures of socio-economic status (SES) among European adults. Materials and methods. We systematically searched three databases (PubMed, Scopus and Web of Science) for articles on cancer incidence and SES. Qualitative synthesis was performed on the 91 included English language studies, published between 2000 and 2019 in Europe, which focused on adults, relied on cancer registry data and reported on relative risk (RR) estimates. Results. Adults with low SES have increased risk of head and neck, oesophagogastric, liver and gallbladder, pancreatic, lung, kidney, bladder, penile and cervical cancers (highest RRs for lung, head and neck, stomach and cervix). Conversely, high SES is linked with increased risk of thyroid, breast, prostate and skin cancers. Central nervous system and haematological cancers are not associated with SES. The positive gap in testicular cancer has narrowed, while colorectal cancer shows a varying pattern in different countries. Negative associations are generally stronger for men compared to women. Conclusions. In Europe, cancers in almost all common locations are associated with SES and the inequalities can be explained to a varying degree by known life-style related factors, most notably smoking. Independent effects of many individual and area SES measures which capture different aspects of SES can also be observed. Ključne besede: socioeconomic status, socioeconomic inequality, cancer incidence Objavljeno v DiRROS: 16.07.2024; Ogledov: 133; Prenosov: 62
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9. Influence of concurrent capecitabine based chemoradiotherapy with bevacizumab on the survival rate, late toxicity and health-related quality of life in locally advanced rectal cancer : a prospective phase II CRAB trialVaneja Velenik, Vesna Zadnik, Mirko Omejc, Jan Grosek, Mojca Tuta, 2020, izvirni znanstveni članek Povzetek: Few studies reported early results on efficacy, toxicity of combined modality treatment for locally advanced rectal cancer (LARC) by adding bevacizumab to preoperative chemoradiotherapy, but long-term data on survival, and late complications are lacking. Further, none of the studies reported on the assessment of quality of life (QOL). Patients and methods. After more than 5 years of follow-up, we updated the results of our previous phase II trial in 61 patients with LARC treated with neoadjuvant capecitabine, radiotherapy and bevacizumab (CRAB study) before surgery and adjuvant chemotherapy. Secondary endpoints of updated analysis were local control (LC), disease free (DFS) and overall survival (OS), late toxicity and longitudinal health related QOL (before starting the treatment and one year after the treatment) with questionnaire EORTC QLQ-C30 and EORTC QLQ-CR38. Results. Median follow-up was 67 months. During the follow-up period, 16 patients (26.7%) died. The 5-year OS, DFS and LC rate were 72.2%, 70% and 92.4%. Patients with pathological positive nodes or pathological T3%4 tumors had significantly worse survival than patients with pathological negative nodes or T0%2 tumors. Nine patients (14.8%) developed grade % 3 late complications of combined modality treatment, first event 12 months and last 87 months after operation (median time 48 months). Based on EORTC QLQ-C30 scores one year after treatment there were no significant changes in global QOL and three symptoms (pain, insomnia and diarrhea), but physical and social functioning significantly decreased. Based on QLQ-CR38 scores body image scores significantly increase, problems with weight loss significantly decrease, but sexual dysfunction in men and chemotherapy side effects significantly increase. Conclusions. Patients with LARC and high risk factors, such as positive pathological lymph nodes and high pathological T stage, deserve more aggressive treatment in the light of improving long-term survival results. Patients after multimodality treatment should be given greater attention to the regulation of individual aspects of quality of life and the occurrence of late side effects. Ključne besede: rectal cancer, bevacizumab, preoperative chemoradiotherapy Objavljeno v DiRROS: 15.07.2024; Ogledov: 141; Prenosov: 52
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10. Impact of COVID-19 on cancer diagnosis and management in Slovenia : preliminary resultsVesna Zadnik, Ana Mihor, Sonja Tomšič, Tina Žagar, Nika Bric, Katarina Lokar, Irena Oblak, 2020, izvirni znanstveni članek Ključne besede: covid-19, oncology, oncology diagnosis, pandemic Objavljeno v DiRROS: 12.07.2024; Ogledov: 176; Prenosov: 89
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