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Grodecka-Gazdecka S.,University Medyczny Im Karola Marcinkowskiego | Zaborek P.,Szkola Glowna Handlowa | Didkowska J.,Krajowy Rejestr Nowotworow | Walden-Galuszko K.D.,University of Warmia and Mazury | And 3 more authors.
Nowotwory | Year: 2014

Introduction:Breast cancer (BC) treatment results depend greatly on prompt and efficient diagnostic and therapeutic decisions. This means that the final treatment outcome is determined by the amount of time elapsed from disease onset to treatment implementation. Delays in implementation may be due to patients, physicians or the healthcare system. The aim of this research project was to identify healthcare system-related causes of delayed diagnosis and treatment of BC in Polish women. In our previous study, we presented causes related to patient attitudes. In this paper causes related to the healthcare system are discussed. © Polskie Towarzystwo Onkologiczne.

Grodecka-Gazdecka S.,University Medyczny Im Karola Marcinkowskiego znaniu | Zaborek P.,Warsaw School of Economics | Didkowska J.,Krajowy Rejestr Nowotworow | Handschuh P.,Roche Holding AG | And 2 more authors.
Nowotwory | Year: 2013

Introduction: Time elapsed between the beginning of the illness and the initiation of treatment in breast cancer patients influences the final outcome of treatment. Delays in administration of treatment may result from factors associated with a patient, a doctor, or the healthcare system. A delay resulting from patients' attitudes is defined as the time between the onset of symptoms indicative of cancer and the first medical consultation. The purpose of this study was to establish the determinants of delays in diagnosis and initiation of treatment among women in Poland. In this article, the authors present the delays resulting from patients' attitudes. Materials and methods: The study was based on a survey performed by trained nurses on 1,000 breast cancer patients selected from 10 randomly chosen medical institutions. An electronic form for the survey was saved on a tablet computer. The study included patients who themselves noticed breast cancer symptoms: this constituted 56% of the participants. In the remaining patients suspected signs were found during routine medical examination or at mammography. Results: The mean time of delay in treatment resulting from patients' attitudes was 3.6 weeks. It was positively correlated with patients' ignoring observed symptoms and a lack of trust in the healthcare system, and negatively correlated with the level of fear of the consequences of breast cancer and practicing of self-examination. Fear was experienced more strongly by younger patients (R = -0.147; p = 0.001), patients with a higher level of education (R = 0.109; p = 0.012) and patients who were diagnosed in a privately owned institutions (R = -0.115; p = 0.008). Ignoring symptoms was more common among less educated participants (R = -0.121; p = 0.005), residents of smaller towns with populations < 300 thousand inhabitants (R = -0.116; p = 0.008) and older women (R = 0.104; p = 0.016). The participants who practiced breast self-examinations were usually younger (R= -0.121; p = 0.005), better educated (R = 0.156; p < 0.001) and diagnosed in a privately owned institution (R = -0.126; p = 0.004). The lower the level of education, the higher the indicated level of distrust of the healthcare system and of the chances for successful treatment (R = -0.191; p < 0.001). Conclusions: The decision to visit a doctor results from several psychological and social factors, such as noticing suspected symptoms, patient beliefs regarding their health, level of education, emotional reactions and social connections. Activities aimed at reducing delays in diagnosis and treatment of breast cancer in Poland related to patients attitudes should focus on reducing the impact of factors delaying treatment and on increasing the impact of factors shortening these delays. Such activities should be part of a multilevel health education program. © Polskie Towarzystwo Onkologiczne.

Didkowska J.,Krajowy Rejestr Nowotworow | Wojciechowska U.,Krajowy Rejestr Nowotworow
Current Gynecologic Oncology | Year: 2012

Aim of paper: Epidemiological analysis of malignant tumors developing within the female genital system in Polish population. Material and method: Data concerning incidence were obtained in the National Tumor Registry; data on mortality were obtained at the Head Statistical Bureau. Data on mortality in other European countries come from the WHO database (WHO Statistical Information System). Analysis of time trends was based on coefficients standardized with respect to global population. Results: Malignancies of the female genital system account for about 20% of malignant tumors in Polish females. Most common are: endometrial cancer (over 5000 new cases per year), ovarian cancer (about 3500) and cervical cancer (over 3100). Over the past 4 decades, we are witnessing a rapid increase of incidence of endometrial cancer and a trend towards decreasing mortality. A decline in both incidence and mortality is seen in cervical cancer. Ovarian cancer has reached stable coefficients of morbidity and mortality since about two decades. In Poland, 5-year survival indices are worse than mean values reported in most European countries. Conclusions. In the area of female genital malignancies, reduction of incidence is seen only in cervical cancer, while reduction of mortality - both in cervical and in endometrial cancer. Popularization and reorganization of national screening programs designed to early detection of malignant tumors, combined with promulgation of awareness of risk factors of carcinogenesis are fundamental to control the "tumor epidemic". © Curr. Gynecol. Oncol. 2012.

Wojciechowska U.,Krajowy Rejestr Nowotworow | Didkowska J.,Krajowy Rejestr Nowotworow
Nowotwory | Year: 2013

Introduction. Cancer is an increasing health problem in Poland and the number of cases has been growing steadily during the last three decades. Cancer has now become the second most common cause of death (24% of deaths in 2010). In this report we present the latest estimates of morbidity and mortality from cancer in Poland in 2012 and also a wide range of information on the occurrence of cancer in 2010, by gender, age, tumor location and administrative region of Poland. The report also includes long-term time trends in incidence and mortality which help to assess changes in the risk of cancer in Poland in recent decades. Material and methods. Data on cancer cases are derived from the National Cancer Registry, and are collected based on a unified protocol for the whole country. This allows us to maintain the same cancer registration rules throughout Poland. The source of data on deaths from cancer is the Central Statistical Office. In this report the basic statistical indicators were used. These are absolute numbers, percentages, crude and age-standardized (ASW) rates, cumulative risk and lifetime risk of developing and dying from cancer. Estimates number of incidence and of deaths for the year 2012 are calculated on the basis of the AP (age-period) model. Annual percentage changes in incidence and mortality trends were analyzed by the Joinpoint Regression Program, allowing up to 3 joinpoints. Results. A total of 145,890 new cancer cases and 98,500 deaths from cancer are estimated to occur in Poland in 2012. These estimates indicate that the most frequently detected cancer in men in 2012 are lung cancer (20%), prostate cancer (15%) and colorectal cancer (13%). The most common causes of death in men were lung cancer (31%) and colorectal cancer (12%). Among women the most commonly diagnosed cancers in 2012 were breast cancer (23%), colorectal cancer (10%) and lung cancer (9%). The most common causes of death among women were lung cancer (15%), breast cancer (13%) and colorectal cancer (12%). In 2010, in Poland, more than 140,500 new cases of cancer were registered and more than 92,500 persons died from cancer. Cancer is the second leading cause of death in Poland, with 26% of deaths in men and 23% of deaths among women. Over the past 30 years, both the number of cases and number of deaths in Poland have grown for both sexes. In recent years there has been a decrease in cancer incidence rates in men by 0.2% per year and an increase in incidence rates in women by 1% per year. For mortality a decline has been observed of 1.9% per year in men and 1.5% per year in women. The most frequently diagnosed cancer in 2010 in men was lung cancer (21%) followed by prostate cancer (13%) and colorectal cancer (12%). The most common causes of death in men were lung cancer (12%) and prostate cancer (8%). In the female population the most frequently diagnosed cancer in 2010 was breast cancer (22%), followed by colorectal cancer (10%) and lung cancer (9%). The most frequent causes of cancer deaths in women were lung cancer (15%), breast cancer (13%) and colorectal cancer (12%). Analysis of regional differences revealed that the incidence rates in Poland vary (from 209/105 to 303/105 in males and from 176/105 to 249/105 in females) depending on administrative region. Regional differences are also observed in the level of mortality. In the male population mortality rates range from 151/105 to 209/105 and in the female population from 75/105 to 119/105. Summary. This report presents the latest data on incidence and mortality from cancer in 2010 and the estimates for 2012. In comparison to previous years, in 2010 there is still a dominant position for lung cancer in men (both in incidence and mortality), although the incidence is decreasing. In men, there is observed increasing importance of colorectal and prostate cancers. In the population of women in Poland there is observed a growing importance for lung cancer, which is reflected by its dominant position in cancer deaths. In incidence, as in previous years, the most common are breast cancer and colorectal cancer. According to estimates, a significant change in the structure of morbidity and mortality from cancer in 2012 is not expected. © 2013, Polskie Towarzystwo Onkologiczne.

Didkowska J.,Krajowy Rejestr Nowotworow | Wojciechowska U.,Krajowy Rejestr Nowotworow
Nowotwory | Year: 2013

Breast cancers are the most common cancers in the developed countries. In Poland, they are responsible for about one fourth of cancer cases (in 2010 over 15700 cases). It is estimated that within the next 15 years the number of new cases will exceed 21000 and the risk of this cancer, although still lower, will be comparable to observed in Europe (roughly 90/105). The increase of a risk of breast cancer is related to many factors, jointly described as factors of affluence. In the Polish population particular importance is given to the lengthening of the average life expectancy and changes connected to fertility rates among women. Materials and methods: The data come from publicly available sources or publications. Data concerning Poland come from the National Cancer Registry and the Central Statistical Office. The most frequently applied indicators used were: incidence ratios, mortality and survival ratios. Results: In Poland, population-based breast cancer screening was launched about 20 years later than in some European countries. The classical effects of population-based screening (the decline of mortality) in the Polish population are not visible yet due to low participation of women and an enormous increase in incidence in the group covered by screening. In consequence to the introduction of screening, the stage at diagnosis has been modified - the percentage of patients with the highest stage of cancer has decreased (by 7% in 2010), the number of cancers in situ has increased (by 7% in 2010); locally advanced disease was diagnosed for half of the patients. Conclusion: In Poland, despite visible improvements in the fight with breast cancer, the mortality level is still alarming - the countries with 1.5-2 times higher incidence than in Poland have identical levels of mortality.

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