Analysis of the ratio of mortality and morbidity in the population of the Republic of Belarus due to malignant neoplasms of various localizations. State of population mortality from malignant neoplasms of the skin The most important scientific directions in oncology
The increase in morbidity and mortality for the period from 1991 to 1996 is shown.
By taking into account age, sex, and regional variations, the paper analyzes malignant neoplasm morbidity and mortality in Russia in 1996.
N.N. Trapeznikov, E.M. Axel, N.M. Barmina
Oncological Research Center named after N.N. Blokhin RAMS, Moscow
N.N.Trapeznikov, Ye.M.Axel, N.M.Barmina N.N.Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow
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The number of patients with a newly diagnosed malignant neoplasm increased from 1991 to 1996. by 7% and reached 422 thousand people, which corresponds to the registration of one disease on average every 1.3 minutes. By 2000, the number of new cases of disease is expected to increase to 480 thousand.
Among men with malignant neoplasms, the first places are occupied by lung cancer (26.5%), stomach (14.2%), skin (8.9%), hemoblastosis (4.6%), colon cancer (4.5% ), prostate and bladder (4.0% each), in women - cancer of the breast (18.3%), skin (13.7%), stomach (10.4%), uterine body (6.5 %), colon (6.4%), cervix (5.5%), ovary (5.1%).
Dynamics The structure of morbidity in the population of economic regions of Russia since 1991 in men is expressed in a widespread decrease in the proportion of stomach cancer, a trend towards a decrease or stabilization of lung cancer and, in most regions, cancer of the lip and esophagus. The proportion of non-melanoma skin tumors, prostate cancer, kidney cancer (except for the Northwestern region) and thyroid cancer (except for the Northern and Ural regions) has increased. In women, there is a decrease or a trend towards a decrease in the proportion of cancer of the esophagus, stomach, lung, and cervix (the latter with the exception of the North-Western and East Siberian regions). There was an increase in the proportion of breast cancer (except for the North-Western region and the Kaliningrad region) and in some regions - thyroid cancer.
The incidence of malignant neoplasms per 100,000 male population (in standardized indicators) ranged from 234.9 (North Caucasus region) to 289.6 - 290.5 (Northwestern region and Kaliningrad region); the highest incidence of lip cancer (8.5) - in the Volga region, cancer of the esophagus (13.1) and stomach (42.8) - in the Northern region, liver (8.6) - in the West Siberian region, non-melanoma skin tumors (30 ,0) - in the North Caucasus. Men are 1.2 - 2.3 times more likely than women to get cancer of the stomach, colon and rectum, pancreas, 6.1 - 7.3 times more likely to get cancer of the lip, esophagus and bladder, 9.2 times more likely to get cancer of the lung and 21.9 - laryngeal cancer. In women, the incidence of gallbladder cancer and skin melanoma is 1.2 - 1.3 times higher than in men, and 4.1 times higher for thyroid cancer.
Fluctuations in morbidity rates in women ranged from 158.3 - 158.5 (East Siberian and Volgo-Vyatka regions) to 194.2 - 195.5 (West Siberian and North-Western regions).
The incidence of lip (1.7) and lung (12.6) cancer in women is significantly higher in West Siberian compared to other regions; stomach (19.2), colon (14.6) and mammary gland (43.2) - in North-West; liver (4.1) - in the Far Eastern region, uterine body (13.7) - in the Central region, thyroid gland (7.7) - in the West Siberian region, ovary (11.2) and hemoblastosis (14.0) - in the Kaliningrad region areas.
In certain administrative territories of Russia, the maximum incidence in 1996 was observed in men - in the Saratov (336.5) and Sakhalin (326.9) regions, in women - in the Kemerovo (233.7) region and St. Petersburg (211.0) .
The highest incidence rates of esophageal cancer occurred in the republics of Tuva (23.1 and 22.3, respectively, in men and women) and Yakutia (33.1 and 7.7); stomach - in Tuva (53.9 and 24.3) and Novgorod region (51.8 - in men); rectum - in the Magadan region (17.0 and 15.2), Karelia (21.1 - in men) and the Kaliningrad region (19.2 - in women); lung - among men in the Saratov (98.3) and Tambov (95.8) regions, among women - in Yakutia (23.1) and the Kemerovo region (20.7); breast - in North Ossetia (49.5), cervix - in Tuva (24.1), bladder - in the Jewish Autonomous (17.5) and Kamchatka (17.0) regions - in men; in Samara (2.8) and Kemerovo (2.7) regions - among women.
The increase in standardized incidence rates for the period from 1991 to 1996 in Russia was 2.1 and 10.6%, respectively, for men and women. The most significant indicator was for skin melanoma (35 and 15.4%), prostate cancer (31.4%) and breast cancer (18.5%), hemoblastosis (4.8 and 11.9%), colon cancer (13 .8 and 14.4%) and the body of the uterus (24.2%). The incidence of cancer of the lip (by 14.1 and 9.1%), stomach (by 10.2 and 9.7%), esophagus (by 8.9 and 22.2%), and liver (by 3.3 and 7) decreased. .1%), in men - cancer of the larynx (by 5.1%) and lung (by 5.0%).
In 1991 - 1996 The increase in the number of newly diagnosed diseases with malignant neoplasms in Russia was 4.1% in men and 10% in women. It was most pronounced due to an increased risk of cancer of the kidney (43.6% in men and 40.2% in women), thyroid cancer (16.7 and 51.8%), and bladder cancer (15.2 and 10. 2%) and skin melanoma (31.7 and 20.6%), and in men, in addition, testicular cancer (40.8%) and prostate cancer (34.3%), in women - breast cancer (19 .7%) and the body of the uterus (24.0%). In connection with the change in the risk of getting sick, the number of diseases of stomach cancer in people of both sexes (by 10.3 and 12.3%), esophageal cancer (by 9.5 and 24.2%), in men - malignant neoplasms of the nasal cavity, middle ear and paranasal sinuses (by 11.3%), lips (by 14.3%), in women - liver (9.8%), placenta (by 35.9%), bones and articular cartilage (by 10.2 %).
The probability of developing a malignant neoplasm during the next life for a newborn in Russia in 1996 was 17.4% for a boy and 18.5% for a girl. For boys, the highest risk of developing lung cancer (4.7%), stomach (2.6%), skin (1.6%), for girls - breast cancer (3.5%), stomach cancer (2.1% ), colon (1.3%), skin (2.6%), cervix (1.1%).
The probability of getting sick during working age for people who have lived up to 20 years in Russia is 6.7% for men and 5.4% for women. The share of the probability of getting sick at this age in the overall probability of getting sick with this form of tumor throughout the coming life is highest in Russia in men with malignant neoplasms of the larynx (49.2%), lung (38.3%), bones and soft tissues (47.8 %), hemoblastoses (44.6%), in women - with cancer of the cervix (46.4%), breast cancer (42.9%), bones and soft tissues and hemoblastoses (33.3% each).
The probability for a newborn in Russia in 1996 to die from a malignant neoplasm during the coming life is 14.1% for boys and 11.9% for girls. For all forms of tumors, this figure is higher in men, with the exception of colorectal cancer, as well as malignant skin tumors. In men, it is most pronounced for lung cancer (4.4%) and stomach (2.4%), in women for breast cancer (1.8%), stomach (1.9%) and colon cancer (0.94). %).
At a young age, the likelihood for a patient with a malignant neoplasm to die from this disease is hundreds of times higher than from another cause; at 50 - 54 years old, these differences reach 14-fold, and at 70 - 74 years old they are reduced to 2.5 - 4. In old age, the likelihood of dying from other causes is higher for patients with malignant neoplasms of the skin and breast (at 70 - 74 years old ) or very close for cervical cancer.
In 1996, as in previous years, the average life expectancy of men with malignant neoplasms was lower than that of women, especially with tumors of the skin, bones and soft tissues, rectum, larynx and hematological malignancies.
Average life expectancy is reduced to the greatest extent in people with cancer of the esophagus, stomach and lungs. With colon cancer, the average life expectancy of 40-year-old patients is higher than with rectal cancer, and with cervical cancer it is higher than with breast cancer. The life expectancy of patients with malignant skin tumors aged 40 years and older is approaching similar to that of the general population.
For 1980 - 1996 the number of deaths from cancer increased by 30% and amounted to 291.2 thousand.
Per 100,000 population, the highest mortality rates from malignant neoplasms in 1996 were noted in the North-Western economic region (234.7 and 114.2, respectively, in men and women), from esophageal cancer (12.5 and 2.2) - in the North, colon (15.7 and 11.7), skin (2.6 in men), prostate (9.7) and mammary glands (20.3), leukemia (5.6 in men) - in North-Western region, larynx - in the Central Chernozem region (9.7 in men) and in the East Siberian region (0.74 in women), in women from cancer of the lip, oral cavity and pharynx (1.7), skin (2 ,1), urinary organs (3.8) - in the Far East. In the Kaliningrad region, men more often died from cancer of the rectum (10.3), lung (80.1) and urinary organs (15.8). In certain administrative territories, the maximum mortality rate from malignant neoplasms in 1996 for men was in the Leningrad, Pskov, Novgorod and Sakhalin regions (238.1 - 259.7), for women - in St. Petersburg, the republics of Tuva and Sakha, Magadan region (122.5 - 144.4); from esophageal cancer - in the republics of Sakha (32.4 and 9.7, respectively, in men and women) and Tuva (25.0 and 22.6), as well as in men in the Chukotka Autonomous Okrug (25.6) and the Magadan Region ( 23.4); for stomach cancer - in Tuva (60.4 and 20.0), Pskov (48.3), Chita (46.6) and Novgorod (45.9) regions - in men, Chukotka Autonomous Okrug (18.7), Kaluga (20.4) and Vladimir regions (18.6) - in women; from colon cancer - in St. Petersburg (17.8 and 13.9) and Moscow (16.7 and 12.6); rectum - in the Chelyabinsk, Sakhalin and Jewish Autonomous Regions (12.6 - 14.4) - in men, in the Republic of Khakassia, Kaliningrad and Magadan Regions (8.9 - 10.9) - in women; from lung cancer - in Sakhalin (89.4) and Astrakhan(85.7) regions and Altai Territory (83.9) - for men, in the republics of Sakha (19.1), Tuva (17.7) - for women. Significantly higher than the Russian average (16.4), mortality from breast cancer in the Magadan region (25.0), St. Petersburg and Moscow (22.4 each), and from cervical cancer (4.8 on average Russia) - in Tuva (16.1), Khakassia (11.7), Sakhalin (10.4) and Tomsk (10.2) regions. Mortality from prostate cancer is 2.7 times higher than the Russian average (7.5) in the Chukotka Autonomous Okrug (20.2), 1.6 times- in the Irkutsk, Tomsk, Astrakhan and Jewish Autonomous Regions.
For 1991 - 1996 in Russia there was an increase in the growth rate of standardized mortality rates from cancer of the lip, oral cavity and pharynx (6.0 and 10.0%), colon (6.8 and 7.5%) and rectum (3.6% in men) , larynx (5% in men), skin (10.5 and 14.3%), urinary organs (14.4 and 10.7%), prostate (18.5%) and mammary (15.4%) glands , cervix (2.0%). There was a decrease in mortality from cancer of the esophagus (by 9.2 and 23.5%, respectively, in men and women), stomach (by 11.3 and 14.5%), lung (by 5.3 and 6.9%) and hematological malignancies (by 6.6 and 6.2%), and in women from cancer of the rectum (by 0.8%), larynx (by 3.9%), bones and soft tissues (by 2.3%).
The conditional elimination of malignant neoplasms as causes of death in the population would increase the average life expectancy of newborns by 2.0 years. The maximum impact on the reduction in the average life expectancy of men is exerted by mortality from lung cancer (by 0.56 years) and stomach cancer (by 0.29 years), hemoblastosis (by 0.13 years); women - from breast cancer (by 0.33 years), stomach (by 0.26 years), colon - (by 0.12 years), hemoblastosis (by 0.13 years) and lung (0.12 years) . On average, one woman who dies from a malignant neoplasm loses more years of life than a man (16.9 versus 14.5 years). The greatest losses are suffered by those who died from hemoblastosis (19.2 and 22.0 years, respectively, men and women), malignant neoplasms of bones and soft tissues (17.3 and 20.4 years), breast cancer (18 .5 years) and cervix (18.4 years).
Due to mortality from malignant neoplasms, the Russian population lost 4.5 million person-years of life in 1996. The greatest damage to society is caused by lung cancer (808.2 thousand person-years), stomach (642.9 thousand), breast cancer (367.0 thousand) and hemoblastosis (287.5 thousand).
Conditional economic losses due to deaths from malignant neoplasms amounted to 3.9 billion rubles in 1996. (in 1990 prices), including 685.9 million rubles. - from lung cancer, 544.8 million rubles. - stomach, 308.1 million rubles. - breast, 375.7 million rubles. - from hemoblastoses.
Analysis and assessment of trends in morbidity, mortality, and their derivatives should be carried out systematically, facilitating the connection between planning and management, on the one hand, and assessment of the effectiveness of measures taken, on the other.
Literature:
1. Dvoirin V.V. Statistics of malignant neoplasms in Russia, 1990 - Bulletin of the Research Center of the Academy of Medical Sciences of Russia. - 1992. - No. 4. - P.3-14.
2. Trapeznikov N.N., Aksel E.M. Morbidity and mortality from malignant neoplasms of the population of the CIS countries in 1996 - M., 1997. - P. 302.
3. Dvoirin V.V., Aksel E.M. Component analysis of the dynamics of incidence of malignant neoplasms: Method. recommendations. - M., 1987.
4. Dvoirin V.V., Aksel E.M. Calculation of the probability of developing malignant neoplasms during the coming life: Method. recommendations. - M., 1988.
Malignant neoplasms are one of the main causes of mortality, affecting the demographic situation in Russia. Despite the continuing increase in mortality in Russia as a whole, its structure does not change significantly (2004-2010).
In first place is mortality from circulatory diseases (42.2%), in second place is mortality from accidents, poisonings and injuries (25.2%), and oncological diseases remain in third place (12.4%).
In the overall structure of population mortality in Russia in 2009 from various causes of death, the proportion of deaths from malignant neoplasms was 14.5%; The male population was 14.9%, the female population – 14.0%. Among those who died of working age (15-59 years), the proportion of those who died from malignant neoplasms reached 14.2%.
Rice. 3.14. Share of causes of mortality in the Russian Federation population in 2009 (%)
It should be noted that in women, malignant neoplasms account for 14.9% of all deaths in the Russian Federation, or second place after cardiovascular pathology (64.8%), in men it is third and accounts for 14.9% in the Russian Federation ( Fig. 3.13,3.14, 3.15.)
Rice. 3.15. Share of deaths from the main causes of death among women in the Russian Federation in 2009 (%)
Consequently, for every sixth woman and every tenth man who died in the republic during the year, malignant tumors are one of the main causes of death.
In the male population, injuries and poisonings (16.5%) moved malignant neoplasms to third place (Fig. 3.16.)
Rice. 3.16. Share of deaths from the main causes of death among men in the Russian Federation in 2009 (%)
In the Russian Federation, there has been a tendency towards worsening mortality rates from malignant neoplasms: the mortality rate per 100 thousand population increased from 192 (in 2004) to 204.9 (in 2009) for men - from 220 to 237.1, for women from 160 up to 171.3. Increase in the mortality rate from malignant neoplasms for the period from 1990 to 2005. amounted to about 6-8%.
In 2004, 287,593 people died from malignant neoplasms in Russia: 53,760 from lung cancer, 39,708 from stomach cancer, 36,062 from colorectal cancer, 23,058 from breast cancer.
In the structure of mortality among men, lung cancer was 29.0%, stomach cancer was 14.5%, in women breast cancer was 17.4%, colon and rectal cancer - 15.0% and stomach cancer - 13.0%.
The average age of men who died from malignant neoplasms was 65 years, women – 67 years. The maximum age was for those who died from cancer of the esophagus, pancreas, prostate glands, stomach, and bladder (67-72 years).
Rice. 3.17. The number of cancer cases and deaths in Russia in 2009.
In the structure of mortality of standardized indicators in Russia for the period from 1990 to 2005. there have been some changes. The first three places in 1990 were occupied by cancer of the lung, stomach, and esophagus. In 2005 in men, colon cancer and liver cancer moved to third and fourth place, respectively; in women, breast cancer moved from fourth to second place, cervical cancer - from 5th to 4th rank place, esophageal cancer - from 3rd to 4th rank. 8th place.
The increase in the number of patients with malignant liver tumors, the difficulties of diagnosis, morphological verification of the diagnosis, the prevalence of viral hepatitis, and the chronicity of the process have brought this pathology to the main positions in the ranking of morbidity and, accordingly, mortality.
The number of deaths from cancer in Moscow in 2004. reached 23,033 people. In men, in the structure of mortality, lung cancer was in 1st place (22.3%), stomach cancer was in 2nd place (14.5%), and colon cancer was in 3rd place (8.3%); in women – cancer of the breast (18.4%), stomach (11.3%) and colon (11.2%), respectively. Every day in Moscow, 63 deaths from malignant neoplasms were registered. The maximum average age of deaths was observed for cancer of the stomach, prostate, bladder, colon and rectum (68-74 years).
Standardized mortality rate from cancer in the male population of Moscow in 2004. amounted to 167.1 per 100 thousand population, female – 107.5 per 100 thousand (7th and 8th places among Russian regions, respectively). High mortality from breast cancer (21.4 per 100 thousand), colon cancer (10.4 per 100 thousand). In men, there was a high mortality rate from prostate cancer (11.0 per 100 thousand) in Moscow. The mortality rate of the male population of Moscow from cancer (37.0 per 100 thousand), larynx (3.7 per 100 thousand) and bladder (5.4 per 100 thousand) was lower than the Russian average. Significantly higher than the average Russian mortality rates for the female population of Moscow from colon cancer (10.5 per 100 thousand in Moscow and 7.3 per 100 thousand in Russia), breast cancer (21.4 per 100 thousand and 6.0 per 100 thousand, respectively), ovarian cancer (7.8 per 100 thousand and 5.8 per 100 thousand, respectively).
In 2008, 23,362 people died from malignant neoplasms in Moscow. In men, in the structure of mortality, lung cancer was in 1st place (21.7%), stomach cancer was in 2nd place (13.2%), and prostate cancer was in 3rd place (8.5%); in women – cancer of the breast (19.2%), stomach (11.0%) and colon (11.0%), respectively. Every day in Moscow, 63 deaths from malignant neoplasms were registered. The maximum average age of deaths was observed for cancer of the lung, esophagus, stomach, prostate, bladder, colon and rectum (68-74 years).
Standardized mortality rate from cancer in the male population of Moscow in 2008. was 150.7 per 100 thousand, female – 106.8 per 100 thousand population (7th and 9th places among 79 regions of Russia, respectively). High mortality among women from cancer of the breast (21.5%), colon (9.9%), and ovarian (6.8%). In men, there was a high mortality rate from prostate cancer (11.0%) in Moscow. The mortality rate of the male population of Moscow from lung cancer (32.8%) and bladder cancer (5.5%) was lower than the Russian average.
From 2003 to 2008 in Moscow, mortality from stomach cancer (by 24.5% in men and 3.5% in women), colon (by 12.5 and 7.8%) and direct (14.6 and 10) decreased. .2%) intestines, lung (by 13% in men), bladder (by 8.3% in men and 18.2% in women). The mortality rate among women from lung and kidney cancer turned out to be stable.
The dynamics of mortality from cancer in the population in the service area of OD No. 2 in Moscow indicates a decrease in the rate from 124.1 per 100 thousand population in 2004. up to 117.6 per 100 thousand population in 2010. (Table 3.6.). High mortality rates were observed for breast cancer (women), cancer of the bronchopulmonary system (mainly men), stomach and colon cancer. (Table 3.7, 3.8.)
Dynamics of mortality from malignant neoplasms of the population (2004 - 2010)
The absolute number of patients who died in the reporting year by location and by year of recording.
| Malignant neoplasms | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 |
| Lips | 6 | 1 | 2 | 4 | 1 | ||
| Esophagus | 62 | 60 | 61 | 57 | 55 | 50 | 52 |
| Stomach | 439 | 442 | 455 | 440 | 429 | 419 | 384 |
| Colon | 357 | 365 | 380 | 375 | 311 | 345 | 374 |
| Trachea, bronchi, lung | 461 | 452 | 437 | 391 | 422 | 420 | 419 |
| Bones and soft tissues | 17 | 33 | 28 | 25 | 19 | 22 | 25 |
| Melanoma | 41 | 57 | 61 | 73 | 57 | 61 | 71 |
| Other new images. skin | 21 | 30 | 32 | 34 | 26 | 28 | 39 |
| Breast | 417 | 464 | 489 | 420 | 446 | 439 | 437 |
| Cervix | 66 | 71 | 75 | 88 | 77 | 74 | 63 |
| Ovaries | 117 | 128 | 134 | 119 | 106 | 93 | 86 |
| Body of the uterus | 68 | 89 | 111 | 94 | 89 | 83 | 81 |
| thyroid gland | 16 | 27 | 20 | 17 | 15 | 18 | 21 |
| Total | 2285 | 2418 | 2466 | 2341 | 2260 | 2242 | 2226 |
Relative number of patients who died in the reporting year by localization and by year of registration (%)
| Malignant neoplasms | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 |
| Lips | 0.3 | 0.04 | 0.04 | 0.08 | 0.2 | 0.04 | |
| Esophagus | 2.7 | 2.5 | 2.5 | 2.5 | 2.4 | 2.4 | 2.2 |
| Stomach | 19.2 | 18.3 | 18.3 | 18.5 | 18.8 | 19.0 | 18.7 |
| Colon | 15.6 | 15.1 | 15.1 | 15.4 | 16.0 | 13.8 | 15.4 |
| Rectum, rhexigmoid conn. anus | |||||||
| Trachea, bronchi, lung | 20.2 | 18.7 | 18.7 | 17.7 | 16.7 | 18.7 | 18.7 |
| Bones and soft tissues | 0.7 | 1.4 | 1.4 | 1.1 | 1.1 | 0.8 | 0.9 |
| Melanoma | 1.8 | 2.4 | 2.4 | 2.5 | 3.1 | 2.5 | 2.7 |
| Other new images. skin | 0.9 | 1.2 | 1.2 | 1.3 | 1.5 | 1.1 | 1.2 |
| Breast | 18.2 | 19.2 | 19.8 | 17.9 | 19.7 | 19.6 | 19.6 |
| Cervix | 2.9 | 3.0 | 3.0 | 3.8 | 3.4 | 3.3 | 2.8 |
| Ovaries | 5.1 | 5.3 | 5.4 | 5.1 | 4.7 | 4.1 | 3.9 |
| Body of the uterus | 3.0 | 3.6 | 4.5 | 4.0 | 3.9 | 3.7 | 3.6 |
| thyroid gland | 0.7 | 1.1 | 0.8 | 1.7 | 0.7 | 0.8 | 0.9 |
| Total | 100 | 100 | 100 | 100 | 100 | 100 | 100 |
5-year overall survival based on materials from OD No. 2 in Moscow
The five-year survival rate of cancer patients, according to materials from OD No. 2, was 69% for all localizations, which coincides with the data of foreign authors; for some localizations these data are higher (Table 3.9.)
Thus, the analysis of mortality rates in the time interval from 2004 to 2008. in Russia, in Moscow, in the Northern Administrative Okrug and North-West Administrative Okrug of Moscow, indicates that the mortality rate per 100,000 people. in Moscow is lower than in the Russian Federation, and in the Northern Administrative District and North-Western Administrative District it is lower than in Moscow, which can be attributed to the fairly effective work of the oncology clinic No. 2 in Moscow.
730 0
Oncological diseases are currently classified as socially significant diseases. Given the current level of incidence of malignant neoplasms in the population of Russia and the continuing trends towards its growth, the projected economic damage could amount to hundreds of billions of rubles. Therefore, the problem of oncology is becoming increasingly important for society, not only due to the steady increase in the incidence of malignant neoplasms, but also due to the high mortality and disability of patients.
In the structure of population mortality from all cancer diseases malignant neoplasms (malignant neoplasms) skins have an insignificant specific gravity. For 1999-2008 In the Russian Federation, 2 million 853 thousand 706 people died from cancer. Every year from 295,665 (1999) to 247,942 (2008) cancer patients die, of which from 4262 (1999) to 5078 (2008) patients die from skin cancer, which is from 1.44 to 2.04% of all deaths from malignant neoplasms.
In general, over a ten-year period (1999-2008), 45,472 people died from malignant skin tumors in the Russian Federation, which accounted for 1.59% of all deaths from cancer.
Skin melanoma
Skin melanoma, as an invasive aggressive tumor prone to metastasis, is the main cause of death from skin cancer.In the Russian Federation, during the analyzed period, skin melanoma caused the death of 28,333 people out of 45,472 patients who died from malignant skin tumors, which amounted to 62.31% (Table 3.1); average annual growth rate of mortality from skin melanoma for 1999-2008. amounted to 4.04%, the total increase was 41.93%.
Table 3.1. The number of deaths and the proportion of patients with skin cancer and melanoma among all cancer patients in the Russian Federation in 1999-2008.
In the Sverdlovsk region in 1999-2008. 1897 people died from skin cancer (C43, 44), which amounted to 2.14% of all deaths from cancer. Skin melanoma was the cause of death in 56.67% of cases of mortality from all malignant neoplasms of the skin, accounting for 1.21% in the overall structure of cancer mortality (Table 3.2).
Table 3.2. The number of deaths and the proportion of patients with skin cancer and melanoma among all deceased cancer patients in the Sverdlovsk region in 1999-2008.
In Yekaterinburg, over the analyzed ten-year period, 506 people died from skin cancer, which amounted to 2.06% of all deaths as a result of cancer. The cause of death from malignant skin tumors in 79.05% of cases was melanoma, the share of which in the overall structure of cancer mortality was 1.63% (Table 3.3).
Table 3.3. The number of deaths and the proportion of patients with skin cancer and melanoma among all deceased cancer patients in Yekaterinburg in 1999-2008.
The average annual growth rate of mortality in the Sverdlovsk region was 1.15% per year, which is 3.5 times less than in Russia as a whole (+4.04%). In Yekaterinburg, during the analyzed period, this figure was higher than in the region as a whole, but inferior to Russia, amounting to 2.47% per year (Table 3.4).
Table 3.4. Crude mortality rates from skin melanoma in the Sverdlovsk region, Yekaterinburg and the Russian Federation in 1999-2008. (number of cases per 100 thousand population)
The dynamics of crude mortality rates from skin melanoma in the population of the Sverdlovsk region and Yekaterinburg in comparison with the Russian Federation are presented in Fig. 3.1.
Figure 3.1. Dynamics of crude mortality rates from skin melanoma (number of cases per 100 thousand population) in the Sverdlovsk region, Yekaterinburg and the Russian Federation in 1999-2008.
A comparative analysis of the average values of the crude mortality rate for two five-year periods (1999-2003 and 2004-2008) showed that in the Sverdlovsk region it is at a stable level (2.24 and 2.23 cases per 100 thousand population, respectively), in Yekaterinburg tends to decrease (from 3.11 to 2.92 cases per 100 thousand population), while in the Russian Federation it increased by 17.58% (from 1.82 to 2.14 cases per 100 thousand population) - table 3.5.
Table 3.5. Dynamics of crude mortality rates from skin melanoma in the population of the Sverdlovsk region, Yekaterinburg and the Russian Federation in 1999-2008. (number of cases per 100 thousand population)
In the Russian Federation as a whole, from 1999 to 2008, the standardized mortality rate from skin melanoma increased from 1.1 to 1.4 cases per 100 thousand population (+27.3%). Over the last five-year period (2004-2008) in the Sverdlovsk region, the average value of the standardized mortality rate was at the same level as the Russian one (1.43 and 1.42 cases per 100 thousand population, respectively), but had a downward trend (-9.77 %).
Table 3.6. Standardized mortality rates from skin melanoma in the Sverdlovsk region and the Russian Federation in 2004-2008. (number of cases per 100 thousand population)
The average annual rate of decline was 1.26. In the Russian Federation, during the same period, the standardized mortality rate was at a stable level with an average annual growth rate of 0.41% (Table 3.6).
Mortality from epithelial skin cancers in the vast majority of cases is caused by highly invasive and metastasizing squamous cell skin cancer. Included in the category “Other skin malignancies” (C44), adnexal cancer and undifferentiated skin cancer are very rare and therefore have little impact on the incidence and mortality rates of epithelial skin malignancies.
Basal cell carcinoma
Basal cell carcinoma has the greatest epidemiological significance among epithelial skin cancers, but it is an extremely rare cause of death, since in most cases it is characterized by a conditionally favorable course, slow locally destructive growth and extremely rare metastasis (0.00024-1% of cases).However, in the Russian Federation for 1999-2008. Skin cancer (C44) caused the death of 17,139 people, which accounted for 0.6% of all deaths from malignant tumors (Table 3.7).
Table 3.7. The number of deaths and the proportion of patients with epithelial skin cancer among all deceased cancer patients in the Sverdlovsk region, Yekaterinburg and the Russian Federation in 1999-2008.
In the Sverdlovsk region, over the analyzed ten-year period, 822 people died from epithelial malignant neoplasms of the skin. Their share among all deceased cancer patients was 0.92%, which is 1.5 times higher than the average for the Russian Federation (0.6%). In the Russian Federation, mortality from skin cancer in rough indicators ranged from 1.1 to 1.37 cases per 100 thousand population, in standardized indicators - from 0.60 to 0.88.
Rough mortality rate in the Sverdlovsk region during 1999-2008. varied from 0.7 to 3.4 cases per 100 thousand population, standardized - from 0.40 to 2.33, while a persistent decrease in the mortality rate from skin cancer was recorded. Over a ten-year period, mortality decreased by 76.43% (in rough terms) with an average annual rate of decline of 4.44%. In the Russian Federation, the crude mortality rate decreased by only 12.4%, while the average annual rate of decline was 3 times lower - 1.35% (Table 3.8, Fig. 3.2).
Rice. 3.2. Dynamics of crude mortality rates per 100 thousand population from epithelial skin cancers in 1999-2008. in the Sverdlovsk region and Yekaterinburg in comparison with the Russian Federation
The standardized mortality rate in the Sverdlovsk region over a ten-year period decreased by 81.22% with an average annual rate of decrease of 6.00%; in the Russian Federation, the same indicator decreased by only 31.81% with an average rate of decrease of 4.05% per year (Table 3.9 ).
Table 3.9. Standardized mortality rates from epithelial skin cancers in the Sverdlovsk region and the Russian Federation in 1999-2008. (number of cases per 100 thousand population)
In Yekaterinburg, there was an intensive rate of population mortality from epithelial malignant neoplasms of the skin in 1999-2008. was significantly lower than throughout the Sverdlovsk region, varied from 1.44 to 0.29 cases per 100 thousand population and on average over 10 years amounted to 0.79, which is 2 times lower than in the Sverdlovsk region (1.72 ), and 1.5 times lower than in the Russian Federation (1.18). The crude mortality rate of the population of Yekaterinburg from skin cancer decreased by 35.55%.
N. V. Kungurov, N. P. Malishevskaya, M. M. Kokhan, V. A. Iglikov
ANALYSIS OF MORBIDITY AND MORTALITY FROM MALIGNANT NEOPLASMS OF THE FEMALE REPRODUCTIVE ORGANS IN THE MOSCOW REGION (FOR THE PERIOD 2011-2015)
Sergey Minakov
MD, PhD, The Ministry of Health of Moscow Region
Krasnogorsk, Russia
ANNOTATION
An analysis of morbidity and mortality in the Moscow region from malignant neoplasms of the female reproductive system was carried out. A comparative assessment with similar indicators in the Russian Federation and the Central Federal District is given.
ABSTRACT
The analysis of morbidity and mortality in the Moscow region from malignant neoplasms of the female reproductive system. A comparative assessment with those in the Russian Federation and the Central Federal District.
Key words: diseases of the female reproductive system; morbidity; mortality; prevalence; uterine cancer; cervical cancer; breast cancer; ovarian cancer.
Keywords: diseases of the female reproductive system; morbidity; mortality; incidence; uterine cancer; cervical cancer; breast cancer; ovarian cancer.
The existing stable trend of growth in cancer incidence, both throughout the world and in the Russian Federation (hereinafter referred to as the Russian Federation), determines increased attention to this medical and social problem. To truly improve the health status of the population, it is necessary to increase the effectiveness of existing federal and introduce new, including regional, programs aimed at prevention and timely early diagnosis of precancerous diseases and malignant neoplasms (hereinafter referred to as malignant neoplasms).
As a result of the implementation in the European Union of the “Europe against Cancer” program, the main components of which were measures aimed at combating smoking, rationalizing nutrition by increasing the consumption of plant products and reducing the share of animal products, preventing the negative effects of ultraviolet rays, as well as strict implementation recommendations for screening and early diagnosis of malignant neoplasms, mortality from cancer decreased by 15% over 10 years.
At the same time, according to medical statistics in the Russian Federation, there is a steady increase in the incidence of cancer. Thus, in 2015, the incidence rate was 241.35 per 100,000 population, which is 10.8% higher than the level in 2006 (217.88). The leading localizations in the overall morbidity structure are: skin (12.5%, with melanoma - 14.2%), mammary gland (11.4%), trachea, bronchi, lung (10.2%), colon (6. 6%), stomach (6.4%).
At the same time, tumors of the reproductive system (20.7%) took first place in the structure of cancer incidence.
In the Moscow region (hereinafter – MO) in 2015, 6449 cases of cancer of the female reproductive system (hereinafter – FRS) were registered. More than half of the cases were breast cancer 3526 (54.7%). Uterine cancer – 1369 cases (21.2%), cervical cancer – 875 cases (13.6%). Ovarian cancer was diagnosed in 679 cases (10.5%) (Fig. 1).
Figure 1. Structure of the incidence of malignant tumors of the organs of ironclad workers in the Moscow Region
For the period 2011 – 2015 For these nosologies in the Moscow Region, an increase in morbidity rates is observed. The highest growth rate occurs with ovarian cancer of 13.8%, which significantly exceeds the same figure in the Russian Federation and the Central Federal District (hereinafter referred to as the Central Federal District) (2.9% and 3.8%, respectively). The incidence rate of cervical cancer during this period increased by 7.4% (RF - 9.6%, Central Federal District - 7.2%). Cancer of the breast and uterine body - 5.8% (RF - 10%, Central Federal District - 7.8%) and 4.7%, respectively (RF - 9.8%, Central Federal District - 10.8%).
In the structure of mortality of the Russian population, cancers occupy second place (15.5%) after diseases of the circulatory system (48.7%). In the structure of mortality of the population of the Russian Federation from cancer, the largest share is made up of diseases of the trachea, bronchi, lung (17.3%), stomach (10.3%), colon (7.9%), breast (7.8%), pancreas (5.9%).
In the structure of female mortality in the Russian Federation, the largest share is caused by cancer of the breast (16.7%), colon (9.8%), stomach (9.3%), diseases of the trachea, bronchi, and lung (6.8%). In the Russian Federation, the share of mortality from malignant neoplasms of the organs of women with breast cancer in the overall structure of female mortality is 32.0%
Among the causes of mortality among the population, malignant neoplasms occupy second place (17%) after diseases of the circulatory system (61%). In 2015, 7841 women died from cancer. Among all causes of death from malignant tumors, the share of malignant neoplasms of the organs of the female breast cancer was 31.5% (2473 cases).
In the structure of mortality from cancer of the organs of female breast cancer in the Moscow Region, breast cancer has the largest share - 51.5% (1268 cases). Uterine cancer and cervical cancer account for 18.7% and 18.1% (464 and 450 cases), respectively. Ovarian cancer accounts for 11.7% (291 cases) (Fig. 2).
Figure 2. Mortality structure of malignant tumors of the organs of ironclad workers in the Moscow Region
Overall, mortality rates from breast, cervical and ovarian cancer are trending downwards. Standardized mortality rates in 2015 from these nosologies were:
- breast cancer – 9.65 (RF – 9.09; Central Federal District – 9.19), which is 11.9% lower than in 2011;
- cervical cancer – 4.5 (RF – 5.39; Central Federal District – 4.74), which is 4.5% lower than the same indicator in 2011;
- ovarian cancer – 5.92 (RF – 5.33; Central Federal District – 5.52), which is 2.6% lower than in 2011.
Against the background of this decrease, there is an increase in the mortality rate from uterine cancer by 6.8% from the 2011 level (in 2015 - 5.53; Russian Federation - 4.24; Central Federal District - 4.44).
Thus, the morbidity and mortality rates from malignant neoplasms of the organs of the iron ore organs in the Moscow Region generally correspond to similar indicators in the Central Federal District and the Russian Federation.
One of the main reasons for the high mortality rate in cancer pathology is untimely diagnosis due to the insufficient prevalence of screening programs for the early detection of cancer, including female reproductive organs, despite the fact that effective preclinical diagnostic methods have now been developed and tested in practice, requiring widespread implementation in medical practice.
In the Russian Federation, the Concept of Healthcare Development until 2020 has been formed and is being implemented, which provides for a gradual expansion of screening coverage of the population, improving the quality and availability of diagnostics and treatment, and promoting a healthy lifestyle. The implementation of the Concept’s measures will allow us to achieve a reduction in mortality, including from cancer, and an increase in life expectancy.
References:
- Healthcare in Russia, 2015: Stat. Sat./Rosstat. – M., 2015. – 174 p.
- Malignant neoplasms in Russia in 2011 (morbidity and mortality). Ed. V.I. Chisova, V.V. Starinsky, G.V. Petrova. – M., FSBI “MNIOI im. P.A. Herzen" Ministry of Health of Russia, 2013. – 289 p.
- Malignant neoplasms in Russia in 2015 (morbidity and mortality). Ed. HELL. Kaprina, V.V. Starinsky, G.V. Petrova. – M., MNIOI im. P.A. Herzen - branch of the Federal State Budgetary Institution "FMIC named after. P.A. Herzen" Ministry of Health of Russia, 2017. – 250 p.
- Public health and healthcare [Electronic resource]: textbook / Lisitsyn Yu.P., Ulumbekova G.E. - 3rd ed., revised. and additional - M.: GEOTAR-Media, 2013.
MORTALITY AND MORTALITY FROM MALIGNANT NEOPLASMS
The main statistical indicators indicating the prevalence of malignant neoplasms are morbidity and mortality rates. For the first time in the world, recording of these data was organized in the USSR in 1948. The study and analysis of quantitative indicators of the incidence of malignant neoplasms in various population groups and mortality from them allows health care authorities to develop and improve cancer control programs.
Annually, based on the main sources of information from the primary documents “Notifications of a patient with a first-time diagnosis of cancer or other malignant neoplasms” (form? 090/у) and “Control cards for follow-up of patients with malignant neoplasms” (form? 030-6/ s) is a “Report on diseases of malignant neoplasms” compiled according to the form? 7 and “Report on patients with malignant neoplasms” according to the form? 35. Based on the report on the form? 7, the structure of morbidity is determined, incidence rates of malignant neoplasms are calculated, and features of the prevalence of cancer are identified.
Based on the form report? 35 identifies the contingents of patients with malignant neoplasms who are registered, information about those who died from malignant neoplasms, information about the treatment of patients with malignant neoplasms who are subject to special treatment. Based on the data obtained, the following is calculated:
1. Incidence rates of malignant neoplasms:
Intensive - newly diagnosed patients with malignant tumors (in absolute numbers)/average annual population of the territory (calculated per 1000, 10 thousand, 100 thousand population);
Standardized - calculated to equalize the impact of different age structures on morbidity.
The incidence rate characterizes the frequency of occurrence of new cases of the disease over a certain time. The cumulative incidence rate characterizes the category of people who fell ill with a given disease over a certain period of time, the size of the entire group at the beginning of the period.
2. Mortality rates from malignant neoplasms:
Intensive - deceased patients with malignant tumors (in absolute numbers)/average annual population of the territory (calculated per 1000, 10 thousand, 100 thousand population);
Standardized - calculated to equalize the impact of different age structures on mortality.
Features of the prevalence of cancer are identified through a comparative study of the influence of relevant indicators, their frequency, structure on morbidity (mortality). The prevalence of cancer as an indicator allows us to estimate what proportion of the population in a certain period of time has this pathology.
In the Russian Federation, there is a tendency towards an increase in the incidence of malignant neoplasms and mortality from them.
Morbidity rate of the population of the Russian Federation with malignant neoplasms
In Russia, from 2000 to 2005, the number of patients diagnosed with a malignant neoplasm for the first time in their lives increased by 4.6% and reached 469,195 people.
The intensive incidence rate in Russia in 2007 was 341.3 per 100 thousand population (in 1997 - 293.07 per 100 thousand population). In the structure of cancer incidence in the Russian Federation as a whole, malignant neoplasms of the following localizations predominated: tumors of the trachea, bronchi, lung (13.8%), skin (11.0%;
together with melanoma - 12.4%), stomach (10.4%), breast (10.0%), colon (5.9%), rectum, rectosigmoid junction and anus (4.8%), lymphatic and hematopoietic tissues (4.4%), uterine body (3.4%), kidneys (3.1%), pancreas (2.9%), cervix (2.7%), ovaries (2. 6%), bladder (2.6%).
The intensive incidence rate of malignant neoplasms in the male population of the Russian Federation in 2007 was 343.5 per 100 thousand population. In the structure of morbidity among the male population of Russia, the leaders were lung cancer (21.9%), stomach cancer (11.3%), non-melanoma skin tumors (9.3%), prostate cancer (7.7%), and colon cancer (5. 2%) and rectum (5.2%) of the intestine.
The intensive incidence rate of malignant neoplasms in the female population of the Russian Federation in 2007 was 339.4 per 100 thousand population. In women, breast cancer (19.8%), non-melanoma skin tumors (13.3%), stomach cancer (7.5%), colon cancer (7.0%), body cancer (6.8%) were most often observed. %) and cervix (5.2%) of the uterus.
The number of registered new cases of malignant neoplasms in children in 2005 was 2382 (in 2001 - 2571). The first place in the structure of cancer incidence in the Russian children population is occupied by leukemia (33.0%), followed by tumors of the brain and other parts of the nervous system (18%), kidneys (7.5%), bones and articular cartilage (6%), mesothelial and soft tissues (5.1%). Among hemoblastoses, lymphocytic leukemia (56.5%), lympho- and reticulosarcoma (17.1%), and lymphogranulomatosis (9.5%) are most common. The maximum incidence of boys and girls is observed at 0-4 years of age (14.3 per 100 thousand population). This age group accounts for the peak incidence of malignant neoplasms of soft tissues, bladder, liver, testicle, kidney and acute lymphocytic leukemia. With age, the incidence of tumors of bones and articular cartilage, ovaries, and thyroid gland increases. Approximately the same incidence in all age groups is observed for malignant neoplasms of the central nervous system. On average in 2001-2005. The maximum incidence of malignant neoplasms in children was observed in the Altai Republic, Penza and Kaliningrad regions (6.8-7.1 per 100 thousand children).
Mortality of the population of the Russian Federation from malignant neoplasms
In 2005, 285,402 people died from malignant neoplasms in Russia: 52,787 from lung cancer, 38,429 from stomach cancer, 36,393 from colorectal cancer, 22,830 from breast cancer. The average age of those who died from malignant neoplasms was 65 years. Among Russian regions, the maximum standardized mortality rate was observed in Magadan (249.7 per 100 thousand men and 137.4 per 100 thousand women), Sakhalin regions (233.4 per 100 thousand men) and Chukotka Autonomous Okrug (193.8 per 100 thousand women).
The standardized mortality rate for men is 2.2 times higher than that for women (1532.3 and 683.5 per 100 thousand population, respectively). In the structure of mortality among men, the first 3 places were occupied by cancer of the lung (28.7%), stomach (14.3%), and colon and rectum (10.5%). From 2000 to 2005 in Russia, mortality from malignant neoplasms in men decreased by 2.6%. There was an increase in the mortality rate of the male population from cancer of the colon (by 13.5%) and rectum (by 7.5%), kidney (by 11.1%), pancreas (by 8.6%), and liver (by 1. 8%) and bladder (by 1.5%). The first place in terms of growth was occupied by prostate cancer (29.5%). The maximum impact on the reduction in the average life expectancy of men is exerted by mortality from lung cancer (0.42 years), stomach cancer (0.21 years) and hematological malignancies (0.11 years).
From 2000 to 2005 in Russia, mortality from malignant neoplasms in women decreased by 0.8%, while it remained stable from cancer of the oral cavity, pharynx, rectum, cervix and bladder. The first place in terms of mortality increase was occupied by pancreatic cancer (12.2%). Mortality from malignant neoplasms reduces life expectancy in women by 1.9 years, in men - by 1.7 years. The maximum impact on the reduction in the average life expectancy of women is caused by mortality from breast cancer (0.35 years), stomach (0.2 years), colon (0.13 years) and hemoblastosis (0.13 years). A woman who dies from a malignant neoplasm loses more years of life than a man (16 and 14 years, respectively).
In 2005, 1048 children aged 0 to 14 years died from malignant neoplasms in Russia. In the structure of mortality of the child population from malignant neoplasms in 2005, 33.1%
accounted for leukemia, 26.1% for tumors of the central nervous system, 10.6% for lymphomas, 7.3% for tumors of mesothelial and soft tissues, and 4.8% for tumors of bones and articular cartilage.
Age and gender characteristics
Malignant neoplasms occur in all age groups without exception. The structure of morbidity and mortality is different for each sex and age, which is primarily determined by the physiological characteristics of the body and exposure to risk factors.
During the aging process and during periods of crisis, all cells of the body that are in a normal tissue environment are subject to rhythmic physiological changes. In a person’s life, the most dangerous critical periods for health occur at 7, 14, 21, 29-30, 36, 42, 59-60, 63, 68 years. The frequency of rhythmic changes in body functions and compensatory micromolecular changes in cells in certain phases of rhythmic oscillations lead to an increase in the sensitivity of membranes and structural units of cells to the action of carcinogenic substances. Between the time of exposure to a carcinogenic agent and cancer manifestation, a certain latent period passes, the duration of which depends on the sex and age of the individual characteristics of the body (type of nervous system, state of the immune and endocrine systems) and the body’s susceptibility to modifying factors. Age and sex differences in the structure of statistical indicators are associated not only with sex and age characteristics of the occurrence and development of malignant neoplasms, but also with changes observed recently in the population, as well as random fluctuations and differences associated with the diagnosis and registration of malignant neoplasms.
In 2007 in Russia, the number of patients diagnosed with a malignant neoplasm for the first time in their lives reached 485,387 people (53.4% women, 46.6% men).
Analysis of statistical data on the structure of morbidity of all age groups of the male and female population shows that in women tumors of the breast (19.8%), colon and rectum (11.8%), stomach (7.5%), uterine body (6.8%), cervix (5.2%), and in men - tracheal tumors,
bronchi, lung (21.9%), stomach (11.3%), colon and rectum (10.7%), prostate gland (7.7%), bladder
The incidence rates are significantly higher in elderly and senile people.
Regional features of the spread of malignant neoplasms
Oncoepidemiology deals with regional features of the spread of malignant neoplasms. Natural environmental conditions, genetic characteristics of ethnic groups inhabiting a certain geographical area, religious traditions, traditional eating habits - this is not the entire list of factors affecting the population and determining age patterns and structural relationships of various forms of malignant neoplasms. Many risk factors for the occurrence and development of neoplasms are determined by regional characteristics of the living conditions of the population. It has been noted that people living in warm climates are more likely to experience systemic diseases (leukemia, malignant lymphoma). According to researchers, they are caused by the initiating influence of viruses and microorganisms, which is associated with favorable conditions for the habitat and reproduction of initiating agents. Morbidity rates also reflect the lifestyle and rules of behavior of people associated with their religious beliefs. Thus, among Mormons and Adventists, who have given up the use of tobacco and alcohol for religious reasons, there is a low incidence of malignant neoplasms of certain localizations.
FACTORS CONTRIBUTING TO THE FORMATION OF TUMORS
Heredity
The hereditary factor in the occurrence of malignant neoplasms does not mean that cancer is inherited from generation to generation. When burdened with malignant neoplasms
history, inherited increased sensitivity to the effects of certain carcinogenic agents. Hereditary susceptibility has been studied and proven only for some diseases, for which the probability of getting sick in the presence of a genetic predisposition is 80-90%. These are rare forms of malignant neoplasms - retinoblastoma, skin melanoma, choroidal sarcoma and benign neoplasms, such as xeroderma pigmentosum, carotid body tumors, intestinal polyposis, neurofibromatosis. The scientific literature contains a lot of experimental data on the role of heredity in the origin of cancer. Among the first forms of neoplasms that attracted the attention of researchers were tumors of the female genital organs. Many families have been described where three or more blood relatives had cancer of the same location (in particular, uterine cancer or ovarian cancer). It is known that for blood relatives of patients the risk of developing the same form of cancer is slightly higher than in a family where there was not a single case of cancer. An in-depth study of malignant neoplasms associated with hereditary predisposition revealed the presence of an inherited genetic defect, which, under conditions of disturbed homeostasis, under the influence of modifying environmental factors and the body's lifestyle, contributed to the development of cancer or sarcoma. Inherited mutations in genes and abnormal characteristics of homeostasis largely determine the likelihood of genetically predisposed individuals to develop cancer. Currently, 38 gene mutations have been identified BRCA1 closely associated with the development of breast tumors.
The presence of inherited mutations in the genome of human cells determines genetic predisposition as evidence of the possibility of developing a malignant neoplasm with a higher probability than in the case of its absence. Ontogenetic syndromes have been described in which the risk of cancer does not exceed 10%.
1. Hamartomatous syndromes: multiple neurofibromatosis, multiple exostosis, tuberous sclerosis, Hippel-Lindau disease, Peutz-Jigers syndrome. These syndromes are inherited in an autosomal dominant manner and are manifested by impaired differentiation with the development of tumor-like processes in several organs.
2. Genetically determined dermatoses: xeroderma pigmentosum, albinism, congenital dyskeratosis, Werner's syndrome. These syndromes are inherited in an autosomal recessive manner and determine a predisposition to malignant skin tumors.
3. Syndromes with increased chromosome fragility: Bloom's syndrome, Fanconi aplastic anemia, inherited in an autosomal recessive manner, determining a predisposition to leukemia.
4. Immunodeficiency syndromes: Wiskott-Aldrich syndrome, ataxia-telangiectasia, X-linked recessive trait, etc. determine a predisposition to the development of lymphoreticular tissue neoplasms.
Modern views on the etiology and pathogenesis of malignant neoplasms, taking into account heredity and predisposition genes, must be taken into account when forming high-risk groups and monitoring them in order to prevent the occurrence and development of cancer.
Endocrine disorders
In accordance with modern views, the development of tumors in an organ or tissue is determined by the following triad of factors (Balitsky K.P. et al., 1983):
1) decrease in the immunological reactivity of the body;
2) the effect of a carcinogenic agent of exogenous or endogenous nature;
3) dysfunction of an organ or tissue.
The normal functioning of the body's functional systems depends on the proper functioning of the hypothalamic-pituitary-adrenal and sympathetic-adrenal systems.
All endocrine organs are closely related to each other, and dysfunction of one of them has a direct or indirect effect on all others. Endocrine balance directly depends on the regulatory function of the nervous system. Pathological activity of peripheral endocrine glands, disruption of the regulatory function of the nervous system and a shift in metabolic processes in the tissues and organs of the body contribute to the formation of endogenous carcinogens.
V.M. Dilman (1983) considered an important pathogenetic factor in the occurrence of cancer to be an increase in the threshold of sensitivity of the hypothalamus to the effects of endogenous factors. When the threshold is raised
sensitivity of the hypothalamus, a compensatory increase in the activity of the peripheral endocrine glands develops with the production of excess amounts of hormones, which leads to disruption of metabolic processes in the tissues and cells of the body. The active metabolites formed in this process help to increase the threshold of sensitivity of tissues and cells to various types of carcinogenic substances. The blastomogenic properties of endogenously formed metabolites of tryptophan, tyrosine, estrogens and other substances have been proven. But the specific mechanism of the carcinogenic effect of hormones remains poorly understood. When studying hormonal carcinogenesis, it was revealed that estrogens under certain conditions not only enhance proliferative processes in tissues, but also have a genotoxic effect. Damage to the cell genome occurs under the influence of estrogen metabolites formed during the activation of hydroxylase enzymes. According to the theory of N. Burnet (1970), the constancy of the genetic composition of the body is controlled by the immune system.
The preservation of gene homeostasis and the antigenic composition of the body is carried out by immune mechanisms controlled by the hypothalamus.
The ability of a malignant cell to give rise to a tumor process, die immediately after a negative impact, or remain for a long time in a latent state depends on the individual protective mechanisms of the body (the state of the endocrine system, metabolism, immunological reactivity, the state of the nervous system, connective tissue characteristics, etc.) .
Metabolic disorder with excess levels of cortisol, insulin, cholesterol in the blood, affecting the course of the tumor process, V.M. Dilman called it “cancrophilia syndrome.” Cancrophilia syndrome is characterized by increased proliferation of somatic cells and inhibition of lymphocyte division, which causes metabolic immunosuppression, which contributes to the development of malignant neoplasms.
The importance of smoking in the occurrence of malignant neoplasms
Smoking is classified as an absolute carcinogen by the International Agency for Research on Cancer. Over 90% of all lung cancer cases in men and 78% in women are associated with smoking. In active smokers, cigarette smoking masks chronic nonspecific
cue, and often specific inflammatory tracheobronchitis, which with frequent exacerbations causes atypia of epithelial cells. During active and passive smoking of cigarettes, tobacco smoke containing the most active PAHs (3,4-benzpyrene), aromatic amines, nitroso compounds, inorganic substances - radium, arsenic, polonium and radioactive lead, in direct contact with the inner wall of the bronchi and alveoli, contributes to the interaction of carcinogens with the membrane of cells sensitive to carcinogens, increasing the likelihood of tumor transformation. Some carcinogens enter the stomach with saliva, and carcinogens with inert ability diffuse into the interstitial fluid and dissolve in the blood, increasing the content of carcinogenic substances in the body. Experts from the International Agency for Research on Cancer (Lyon) determined that smoking is associated with 85% of deaths from lung cancer, 30-40% from bladder and kidney cancer, 50-70% from cancer of the esophagus, pharynx and oral cavity . It has been proven that nicotine, by specifically blocking sympathetic ganglia, causes a decrease in local immunity in the respiratory tract, but does not itself have a carcinogenic effect.
Some scientists believe that carcinogens from tobacco smoke and air act synergistically. According to statistical indicators, giving up smoking would reduce the incidence of cancer by 25-30%, which for Russia amounts to 98-117 thousand cases of malignant neoplasms per year.
Meaning of ultraviolet radiation
in the occurrence of malignant neoplasms
The ultraviolet (UV) part of sunlight, which occupies the range of 2800-3400 A, has the ability to penetrate human tissue through the skin and damage cells of various layers of the skin depending on the wavelength. The carcinogenic effect of UV rays was first described and proven by G. Findlay in 1928. It is now known that up to 95% of skin cancer cases occur in exposed areas of the body exposed to long-term exposure to UV rays. But at the same time, epidemiological studies have shown that with adequate photoreception, the carcinogenic effect of solar radiation does not manifest itself, but, on the contrary, the reverse development of precancerous skin changes occurs. Such opposite results from exposure to sunlight are explained by the physical properties of its constituent spectra. Sunlight consists
from visible radiation (light itself) and invisible (infrared and UV radiation). The most active is UV radiation, which consists of long-wave (ultraviolet A), medium-wave (ultraviolet B) and short-wave (ultraviolet C) spectra. Long-wave spectrum A radiation has the ability to penetrate deeply into skin tissue and damage the structure of connective tissue, creating a favorable background for the development of cancer. Mid-wave spectrum B is characterized by an even greater ability to damage skin cells than spectrum A, but its active effect appears only in the summer (from 10 a.m. to 4 p.m.). Spectrum C acts mainly on the epidermis, increasing the risk of melanoma. UV rays have not only a local immunosuppressive effect, damaging Langerhans cells, but also a general immunosuppressive effect on the body (Gallardo V. et al., 2000).
The skin's resistance to the carcinogenic effects of solar radiation is determined by the content of the pigment in it - melanin, which, by absorbing UV rays, prevents their penetration into the depths of tissues. Melanin is formed as a result of successive photochemical reactions in melanocyte cells. Under the influence of UV radiation, melanocytes not only synthesize melanin, but also begin to multiply. During the division phase, melanocytes, like all cells of a living organism, become very sensitive to various negative factors and are themselves at risk of carcinogenic effects of solar radiation. The ability to synthesize and accumulate melanin in the cells of the body manifests itself differently in people and determines a person’s predisposition and resistance to a malignant tumor. It has been noted that the resistance of people with darker skin (brunettes) to the carcinogenic effects of UV rays is associated with the abundance of melanin in the cells of the basal, spinous and supraspinous layers of the epidermis, and the predisposition to the occurrence of tumors in people with lighter skin (blonds) is associated with the pigment content only in the cells of the basal layer of the epidermis.
Among environmental factors with carcinogenic potential, UV radiation makes up 5%.
Radioactive radiation
The problem of studying radiation effects on humans and taking precautions against possible exposure are becoming increasingly urgent. This is due to the massive practical
the use in all spheres of human activity of modern means of scientific and technical achievements based on the action of ionizing radiation according to the principle of quantum amplification. Radiation causes ionization in cells, splitting cell molecules into ions, causing some atoms to lose electrons and others to gain them, forming negatively and positively charged ions. According to the same principle, radiolysis of water contained in cells and intertissue spaces occurs, with the formation of free radicals that are highly reactive towards various macromolecular compounds of the cell and nuclear structures. The changes that occur in tissues during radiation exposure largely depend on the type of tissue and the radiation dose. Tissues are most sensitive to the effects of ionizing factors during the period of cell proliferative activity, active growth and development.
Ionizing radiation with active carcinogenic potential includes:
1) large α-particles that carry a positive electrical charge and are highly toxic to living cells; α-particles have almost zero penetrating force. But when α-emitters are introduced into the body by alimentary or parenteral routes, they are able to be released in deep-lying tissues;
2) β-particles, which carry a negative charge and, penetrating to a depth of 5 mm, have a destructive effect on living cells;
3) γ-rays, the effect of which on cells is less toxic, and their penetrating ability depends on the intensity of irradiation;
4) neutrons produced as a result of nuclear decay have the ability to penetrate deeply into living cells. When active substances collide with neutrons, they begin to emit α-, β-particles and (or) γ-rays a second time.
Regardless of the type and method of exposure, the carcinogenic effect of ionizing radiation is based on damage to the genetic apparatus.
The International Commission on Radiological Medicine (ICRP) recommends the maximum permissible dose of ionizing exposure to humans - 1 mEv/year (0.1 rem/year) [Vladimirov V.A., 2000].
Viral carcinogenesis
Viral carcinogenesis is a complex process of tumor formation based on the interaction of the genomes of a cell and an oncogenic virus. According to the viral genetic theory of L.A. Zilber, any cell can potentially form a virus, since it contains the information necessary for this; it is located in the genetic apparatus (in the DNA chromosomes) of the cell. Genes encoding the formation of components of endogenous viruses are part of the normal cellular genome and are called proviruses or virogens. They are inherited according to Mendelian laws as the most common genes and, when exposed to certain modifying factors, are capable of initiating the occurrence of cancer. The same cell can have several virogens in its genetic apparatus and form several different endogenous viruses. The latter contain RNA and reverse transcriptase - an enzyme that catalyzes “reverse” transcriptase, i.e. DNA synthesis on an RNA template. Along with endogenous ones, exogenous oncogenic viruses have now been discovered. The etiological significance of exogenous oncogenic viruses has already been proven for some forms of malignant neoplasms.
Oncogenic viruses, according to the molecular structure of the genome they contain, are divided into DNA- and RNA-containing (Fenner F., 1975):
Representatives of certain families of viruses have been identified as etiological agents of a number of malignant neoplasms.
1. Human papillomaviruses are one of the leading etiological factors in the occurrence of cervical intraepithelial neoplasm (CIN) and cervical cancer. About 74 genotypes of HPV are known. Among them are:
Benign (types 6 and 11), which are associated with the appearance of genital warts of the anogenital area and other benign lesions;
Malignant (types 16, 18, 31, 33, 35, 52), which are more often detected in patients with cervical epithelial neoplasm and genital cancer.
Human papillomavirus (HPV), type 16, is associated with the development of cancer of the vulva, vagina, anus, esophagus, and tonsils.
About 300 thousand new cases of cervical cancer in the world are associated with HPV.
2. Herpesviruses(EBV).
The long-term persistence of herpes viruses in the human body creates conditions for the action of initiating and promoting factors for the occurrence of malignant neoplasms (Struk V.I., 1987). The pathogenesis of tumors associated with herpesvirus is very complex and depends on many interrelated and diverse factors (hormonal, immune, genetic). Virological and electron microscopic methods have made it possible to identify human tumors associated with herpesvirus: Burkitt's lymphoma, nasopharyngeal cancer and cervical cancer. The target cells for EBV are human B lymphocytes. The mechanism of the malignant effect of herpes viruses on B-lymphocytes has not yet been established, but the possibility of their mutagenic effect has already been proven: all viruses of the herpes group induce chromosomal aberrations and translocations of chromosome sections in the cells they infect, which is evidence of the carcinogenic danger of herpes virus infection.
3. Hepatitis virus(hepadnavirus - HBV).
The hepatitis virus, damaging hepatocytes, is a common factor in the development of hepatocellular cancer. WHO estimates that about 80% of all primary malignant liver tumors are induced by these viruses. About 200 million people on the planet are carriers of HBV viruses. Every year, several hundred thousand new cases of hepatocellular cancer associated with HBV are detected worldwide. In Asian and African countries, where chronic infection with the hepatitis B virus is common, up to 25% of cases of primary liver cancer are associated with hepatitis B or C virus.
4. Human T-cell leukemia virus(HTLV) was first identified in 1979-1980. from tumor cells of adults, patients
T-cell lymphoma-leukemia (ATL). According to epidemiologists, the area of distribution of pathology associated with this virus is limited to the southern regions of Japan and India. The viral etiology of acute lymphocytic leukemia in adults is evidenced by studies of American and Japanese scientists, which show that in 90-98% of cases with typical manifestations of this pathology, antibodies to HTLV are detected in the blood. Currently, there are strong arguments in favor of the viral origin of lymphogranulomatosis, Kaposi's sarcoma, melanoma, and glioblastoma.
Depending on the type of virus-cell interaction, it is assumed that the main role in initiating damage to the genetic material of the cell belongs to lytic enzymes of viral or cellular origin or to the direct interaction of the genomes of the cell and the virus at the level of nucleic acids. If a cell is resistant to the virus, then neither reproduction nor transformation of the cell occurs. When a virus comes into contact with a cell sensitive to it, deproteinization of the virus is observed with the release of nucleic acid, which is sequentially introduced first into the cytoplasm, then into the cell nucleus and the cellular genome. Thus, a virus or part of it that has entered the cellular genome causes cell transformation.
Of particular note is the role of microbial agents, in particular bacteria, in carcinogenesis Helicobacter pylori (H. pylori). Epidemiological studies confirming an increase in the incidence of gastric cancer associated with H. pylori determined their initiating role in the process of carcinogenesis. In 1994, the International Agency for Research on Cancer classified this bacterium as a Class 1 carcinogen and identified it as a cause of gastric cancer in humans.
Currently, the connection between infection has also been proven H. pylori and gastric MALT lymphoma. H. pylori As a microbe, it does not have pronounced pathogenic properties, but is capable of persisting in the host’s stomach throughout its life, continuously irritating the gastric mucosa. Long-term colonization H. pylori in the gastric mucosa creates a favorable background for the effects of carcinogenic substances on the cells of the germinal zones and the ability of the bacteria themselves to induce proliferative changes in the epithelium with the activation of proto-oncogenes and genetic
instability of stem cells, which leads to the development of mutations and genomic rearrangements.
It is possible that different strains may also play a role in the pathogenesis of stomach cancer. H. pylori: the risk of developing this disease is significantly increased by strains H. pylori associated with the proteins CagA (cytotoxin-associated gene A) and VacA (vacuolating cytotoxin A).
WITH H. pylori are associated with a manifold increase in the risk of cancer. According to D. Forman (1996), based on epidemiological data, with contamination H. pybn may be associated with up to 75% of stomach cancer cases in developed countries and about 90% in developing countries.
Chemical compounds
All living and nonliving components of nature consist of chemical elements and compounds that have different properties depending on the structure of their atom and the structure of their molecules. To date, about 5 million chemical substances have been registered, of which 60-70 thousand are substances with which humans come into contact.
The US Environmental Protection Agency (EPA) has proposed the following questions to determine whether chemicals are carcinogens.
Is the chemical compound dangerous for humans and under what conditions?
What is the degree and nature of the risk when contacting it?
What should be the exposure and dose of the substance?
These questions served as a kind of characterization for the possible carcinogenic properties of certain chemicals. Currently, an extensive group of chemical elements and compounds with carcinogenic effects is known, representing organic and inorganic compounds widely varying in structure with species and tissue selectivity of a non-viral and non-radioactive nature. Some of these substances are of exogenous origin: carcinogens that exist in nature, and carcinogens that are products of human activity (industrial, laboratory, etc.); part is of endogenous origin: substances that are metabolites of living cells and have carcinogenic properties.
According to U. Saffiotti (1982), the number of carcinogens is 5000-50,000, of which 1000-5000 people come into contact with.
The most common chemicals with the greatest carcinogenic activity are the following:
1) PAHs - 3,4-benzpyrene, 20-methylcholanthrene, 7,12-DMBA;
2) aromatic amines and amides, chemical dyes - benzidine, 2-naphthylamine, 4-aminodiphenyl, 2-acetylaminofluorene, etc.;
3) nitroso compounds - aliphatic cyclic compounds with an obligatory amino group in the structure: nitromethylurea, DMNA, diethylnitrosamine;
4) aflatoxins and other waste products of plants and fungi (cycasin, safrole, etc.);
5) heterocyclic aromatic hydrocarbons - 1,2,5,6- and 3,4,5,6-dibenzcarbazole, 1,2,5,6-dibenzacridine;
6) other (epoxies, metals, plastics).
Most chemical carcinogens are activated in the body during metabolic reactions. They are called true or ultimate carcinogens. Other chemical carcinogens that do not require preliminary transformations in the body are called direct.
According to the International Agency for Research on Cancer, up to 60-70% of all cancer cases are in one way or another associated with harmful chemicals in the environment that affect living conditions. Taking into account the degree of their carcinogenicity for humans, according to the IARC classification, there are 3 categories for assessing chemical compounds, groups of compounds and production processes.
1. The chemical compound, group of compounds and manufacturing process or occupational exposure are carcinogenic to humans. This rating category is used only when there is robust epidemiological evidence demonstrating a causal relationship between exposure and cancer. This group includes environmental pollutants such as benzene, chromium, beryllium, arsenic, nickel, cadmium, dioxins, and some petroleum products.
2. A chemical compound, group of compounds and manufacturing process or occupational exposure is possibly carcinogenic to humans. This category is divided into sub-
groups: with a higher (2A) and lower (2B) degree of evidence. Cobalt, lead, zinc, nickel, petroleum products, 3,4-benzpyrene, formaldehyde are the most well-known genotoxicants of this group, which largely determine the anthropogenic load on nature. 3. The chemical compound, group of compounds and manufacturing process or occupational exposure cannot be classified with respect to their carcinogenicity to humans.
Ecological aspects of the circulation of carcinogens in the external environment
The human environment is represented by countless chemicals. Carcinogenic substances have the ability to interact with each other, become active in favorable chemical conditions, interconvert and persist for a long time in any organic and inorganic environment. The main sources of distribution of carcinogens are enterprises of ferrous and non-ferrous metallurgy, chemical, petrochemical, oil, gas, coal, meat, pulp and paper industries, agricultural and public utilities. An environment contaminated with carcinogenic substances determines the nature of human contact with them and the routes of their entry into the body. The content of pollutants in the atmospheric air, the air of industrial premises, homes and public buildings primarily determines the inhalation effect of substances on the body. Water pollutants affect the body through ingestion through drinking water and through the skin when water is used for personal hygiene. In addition, oral intake of substances into the body occurs when eating fish, seaweed, as well as agricultural plants and animal meat (chemicals enter them when the soil is polluted). Lead, mercury, arsenic, various pesticides, nitrogenous compounds and other substances can enter the human body with contaminated food. In everyday life, people come into contact with chemicals, the sources of which are construction and finishing materials, paints, household chemicals, medicines, products of incomplete combustion of natural gas, etc.
The circulation of carcinogens in nature between various environments: water, soil, air, as well as their consumption, accumulation and transfer in these environments by living organisms lead to changes in the conditions and nature of natural processes and an imbalance of energy and substances in the ecological system. 3,4-benzpyrene, a common product of incomplete combustion with a high carcinogenic potential, was adopted as an indicator of contamination.
The concept of primary and secondary prevention
Carrying out preventive measures in oncology is complicated by the variety of putative etiological factors of carcinogenesis. Numerous epidemiological and experimental studies have shown the relationship between certain environmental factors (chemical, physical and biological) and human lifestyle.
A set of social and hygienic measures aimed at minimizing the impact of carcinogenic environmental factors on the cells of a living organism that are sensitive to them, as well as stabilizing the immunological status of the body through nonspecific effects on humans (promoting a healthy lifestyle, proper nutrition, giving up bad habits, etc.) d.) is called primary prevention of malignant neoplasms.
A set of medical measures aimed at identifying patients with precancerous diseases, followed by their improvement and monitoring them is called secondary prevention. The organization and implementation of activities for the early diagnosis of cancer are also considered as a component of secondary prevention, and the prevention of cancer recurrence as tertiary cancer prevention.
Individual protection of the body from malignant neoplasms should include:
1) compliance with personal hygiene rules;
2) immediate therapeutic correction of impaired body functions;
3) proper balanced nutrition;
4) giving up bad habits;
5) optimization of the functions of the reproductive system;
6) maintaining a healthy active lifestyle;
7) high human self-awareness - clear knowledge of the factors of carcinogenic effects on the body and precautions, knowledge of the characteristics of the course, stages and dependence of the effectiveness of tumor treatment on the timeliness of their detection.
Important measures in social and hygienic prevention are the promotion of a healthy lifestyle, the creation and operation of sports recreation complexes.
Food hygiene
Among the factors contributing to the occurrence of malignant neoplasms, nutritional factors account for 35%. With food, the body receives not only nutrients, but also an indefinite amount of carcinogenic substances, antigenic foreign proteins that have the ability to directly or indirectly influence carcinogenesis.
In some cases, a person who feels completely healthy, not suspecting that he is a potential tumor carrier due to the long latent period of the disease, eats food containing active stimulating and high-calorie ingredients that are beneficial for a healthy body. However, this creates favorable conditions for stimulating the progression of pathologically altered (atypical) cells. Thus, the content of certain components of consumed food covers the energy costs associated with the functional activity of various systems, and in the body of a tumor carrier, i.e. subjectively healthy person, can serve as an irreplaceable substrate, which tumor tissue really needed.
Numerous experimental data make it possible to identify food components that stimulate or inhibit the occurrence of cancer in humans and animals. There are known biochemical substances with anti-carcinogenic effects that can suppress enzyme activity, neutralize excess estrogens, adsorb and inactivate carcinogenic agents in the body. Antioxidants and selenium salts have an anti-carcinogenic effect. Antioxidants include a wide range of biologically active substances, the content of which in food is very important for the prevention of cancer - tocopherol, phospholipids, ubiquinones, vitamins K, flavonoids. Biooxidants determine the antioxidant capacity of tissues, which is important for the regulation of lipid peroxidation (LPO) and the prevention of damage to the cell membrane, which is an essential link in the malignant transformation of cells (Burlakova E.B. et al., 1975).
Considering the anticarcinogenic effect of the listed ingredients and the importance of their content in the food consumed to reduce the risk of cancer, it is necessary to consume more products of plant origin containing a wide range of biologically active substances: phytosterols, indoles, flavonoids,
new, saponins, bioflavonoids, β-carotene, enzyme inhibitors, vitamins, trace elements, minerals and fiber. Food products have the potential ability to influence carcinogenesis: some of them reduce metabolic activity or enhance the detoxification of carcinogens, others protect DNA during electrophilic carcinogenesis or themselves have an antitumor effect on cells. Fats, components formed during food processing, hydrolysis products have a carcinogenic effect. A preventive measure to reduce the risk of cancer is the exclusion from the diet (or limitation) of foods containing large amounts of carcinogens - smoked meats, marinades, food prepared with previously used fat, canned food.
The European Cancer Program provides the following dietary recommendations:
1. The likelihood of developing cancer in different individuals is largely determined genetically, but the current level of knowledge does not allow us to identify people at high risk. Recommendations should be applied to the entire population for persons over 2 years of age.
Calorie intake from fat burning should not exceed 30% of the total energy value of food, including less than 10% should be provided by saturated fats, 6-8% by polyunsaturated fats, 2-4% by monounsaturated fats;
You should consume a variety of fresh vegetables and fruits several times a day;
It is necessary to balance physical activity and diet to maintain normal body weight;
Limit your intake of salt, food preserved with nitrites, nitrates and salt. The salt intake rate is no more than 6 g per day;
Limit your consumption of alcoholic beverages.
The most important scientific directions in oncology
Important and promising scientific directions in oncology include research on the prevention of malignant neoplasms, optimization of palliative care, rehabilitation, organization of oncological care in modern
socio-economic conditions, the possibilities of computer technology, telemedicine, the Internet, etc.
Promising areas in the field of diagnostics of malignant neoplasms include:
Improving the algorithm for diagnosing tumors and their relapses;
Introduction of ultrasound (US), computer (CT) and magnetic resonance (MRI) tomography and other methods in differential diagnosis and clarification of the stage of the tumor process;
Improving interventional radiology methods;
Development of intracavitary sonography and endoscopy methods to assess the prevalence of tumor infiltration of hollow organs;
Introduction of methods of immunomorphological diagnostics and molecular biological research of neoplasms, assessment of their biological aggressiveness and sensitivity to therapeutic effects.
In the field of treatment of malignant neoplasms, the following scientific and practical directions are promising:
Further study of the adequacy and validity of endoscopic and economical methods of treating cancer patients;
Substantiation of indications for performing extended, super-extended, combined, simultaneous operations, as well as lymphadenectomy for cancer;
Performing and scientific analysis of the results of cytoreductive operations for advanced forms of cancer;
Search and testing of new chemo- and hormonal drugs, immunomodulators, antioxidants, modifiers and protectors of antitumor therapy;
Development of new schemes of combined chemotherapy, hormones and immunotherapy for independent, adjuvant and neoadjuvant treatment;
Development of comprehensive programs to improve the quality of life of patients receiving antitumor drug treatment;
Development of new technologies of radiation therapy for localized, locally advanced and generalized forms of cancer;
Further development of radiomodifiers of various directions of action and their combinations;
Search for optimal options for radiation therapy using various types and energies of ionizing radiation beams for organ-preserving and functionally sparing operations.
In the field of fundamental research, the following scientific areas remain highly relevant:
Development of methods for assessing genetic predisposition to cancer;
Study of mechanisms of tumor growth regulation;
Research and introduction into the clinic of new laboratory methods for assessing the prognosis of the course of oncological diseases and their sensitivity to anti-blastic effects;
Experimental substantiation of pathogenetic approaches to the treatment of cancer patients;
Experimental development of methods and routes for targeted delivery of cytostatics;
Improving methods of tumor biotherapy.
To highlight scientific achievements, summarize cooperative research, observations, and discussions, journals are published in Russia - “Oncology Issues”, “Russian Oncology Journal”, “Children’s Oncology”, “Practical Oncology”, “Palliative Medicine and Rehabilitation”, “Siberian Oncology Journal” , "Clinical Oncology". Oncosurgeons can find a lot of useful information in the journals “Surgery”, “Bulletin of Surgery named after. I.I. Grekova", "Creative surgery and oncology". Recent years have been marked by the development of computer technology, the Internet, websites, cancer servers and other achievements of scientific and technological progress have appeared.
Dynamics of cure rates for cancer patients
The main statistical indicators characterizing the effectiveness of the treatment component of the oncology service are the number of patients registered in oncology institutions and their survival rate.
By the end of 2005, the number of oncology patients registered in specialized institutions in Russia amounted to 2,386,766 people (2,102,702 in 2000). Predominated
patients with cancer of the skin (13.2%), breast (17.7%), cervix (6.6%) and body (6.9%), uterus, stomach (5.6%). The proportion of patients with malignant neoplasms of the esophagus (0.4%), larynx (1.7%), bones and soft tissues (1.6%), prostate (2.6%), and leukemia (2%) was insignificant.
The cumulative indicator, reflecting many private indicators of cancer care to the population, in 2005 was 0.64. It increased compared to 2000 (0.54) due to a decrease in the proportion of patients with stages III-IV of the disease, an increase in the accumulation index of registered cancer patients, and a decrease in mortality.
Questions for self-control
1. What are the main statistical indicators characterizing the prevalence of malignant neoplasms among the Russian population?
2. How can we explain gender and age differences in statistical indicators in the dynamics of the incidence of malignant neoplasms and mortality from them?
3. List the factors that contribute to the occurrence of tumors. Describe the importance of a person’s lifestyle and environmental factors in the occurrence and development of malignant neoplasms.
4. What is the role of hereditary factors in the occurrence and development of malignant neoplasms?
5. Indicate the main sources of chemical carcinogens and possible routes of circulation of chemical carcinogens in the external environment.
6. Define the concepts of “primary prevention” and “secondary prevention”.
7. List and justify individual and social-hygienic measures for cancer prevention.
8. Formulate the main provisions of the fight against smoking.
9. What is included in the concept of “basics of food hygiene”? What is the importance of antioxidants in preventing cancer?
10. What are the main scientific directions that determine the relevance of research in oncology?
11. Describe the dynamics of cure rates for cancer patients.
