Measuring the Burden of Cancer in Russia

Syöpä on globaalisti yksi kansanterveydellisesti merkittävimmistä tekijöitä. Vaikka syövän hoidossa on saavutettu merkittävää edistystä, syöpäkuolemien määrä kasvaa edelleen. Syöpätaakan suureneminen johtuu ikääntymisestä sekä syövän torjunnan ja resurssien puutteista. Eri maiden välillä on merkittäviä eroja syöpään sairastumisen ja kuoleman riskissä. Venäjä on Euroopan suurin maa, joka kattaa noin 14 % Euroopan väestöstä, ja syöpäkuolemien määrä Venäjällä on eurooppalaisen keskitason yläpuolella. Valitettavasti syöpäepidemiologisia tutkimuksia tehdään Venäjällä vain satunnaisesti. Syöpätaakkaa niissä arvioidaan kattavasti vain harvoin. Syöpätrendien analysointi voisi selittää muutoksia, ennustaa tulevaa kehitystä ja ohjata prioriteetteja ja tavoitteen asettelua. Väestöpohjaiset syöpärekisterit ovat ainutlaatuisia ja luotettavia tietolähteitä syövän seurantaan ja erilaisiin tutkimuksiin. Syöpärekisteröinti alkoi Venäjällä vuonna 1953, osana silloista Neuvostoliittoa. Kuitenkin yksilötason tietoja keräävät ja tallentavat alueelliset syöpärekisterit kattoivat koko Venäjän vasta vuonna 1999. Valitettavasti kaikkien neljän keskeisen laatutekijän: vertailukelpoisuuden, validiteetin, kattavuuden ja ajantasaisuuden, arviointia ei ole Venäjällä koskaan toteutettu kattavasti. Tämän tutkimuksen tavoitteena oli arvioida Luoteis-Venäjän alueiden syöpätilastojen laatua. Aineistona on 10 alueellisen syöpärekisterin tiedot, jotka kattavat noin 13 miljoonan asukkaan väestön. Analyysissa ovat mukana kaikki syöpärekisterien kattamat tapaukset. Kokonaisuutena tiedonkeruu Luoteis-Venäjällä noudattaa kansainvälisiä standardeja, ja vaikka kansalliset syöpärekisteröintiohjeet olivat vanhentuneet, ne olivat yleisesti vertailukelpoisia. Monien primaarien osuus vuosina 2008–2017 vaihteli Vologda Oblastin 6,7 prosentista 12,4 prosenttiin Pietarissa, mikä vastaa useimpia eurooppalaisia syöpärekistereitä. Useimmissa laatuindikaattoreissa oli huomattavia alueellisia eroja. Validiteetti ja kattavuus oli alhaisempaa haima- ja maksasyövässä, hematologisissa syövissä sekä keskushermostokasvaimissa ja vanhoissa ikäryhmissä. Vaikka Luoteis-Venäjän neljän syöpärekisterin tietojen laatu täyttää kansainvälisten standardien vaatimukset. Tutkimuksessa analysoitiin rintasyövän ja kohdunkaulasyövän ilmaantuvuus- ja kuolleisuustrendejä tavoitteenamme ennustaa tulevaa syöpätaakkaa. Rintasyövän ilmaantuvuus oli noussut kahden vuosikymmenen aikana 33,0:sta 47,0:een 100 000:ta kohti ja kohdunkaulan syövän 10,6:sta 14,2:een 100 000:ta kohti (Segi-Doll maailman standardiväestöön vakioituna). Kuitenkin rintasyöpäkuolleisuus oli laskenut 17,6:sta 15,7:een vuonna 2013, kun taas kohdunkaulan syövän kuolleisuus oli noussut 5,6:sta 6,7:een. Käänne tapahtui vuosina 1937-1953 syntyneiden kohortissa, mikä osoittaa, että syntymäkohortteina tarkasteltuna rintasyövän kuolleisuus on laskenut, kun taas kohdunkaulan syövän riski on suurentunut. Ennusteet osoittavat, että kohdunkaulan syövän takia menetettyjen elinvuosien määrä voi saavuttaa 1,2 miljoonaa ja rintasyövän 1,8 miljoonaa vuoteen 2030 mennessä. Nämä trendit korostavat kansallisen kohdunkaulan rokotus- ja seulontaohjelmien tarvetta. Työssä analysoitiin myös kansallisia kuolleisuustrendejä, joita koskevat tiedot kerättiin väestörekisterijärjestelmästä. Syöpätaakan kuvaamisen käytettiin myös menetetty elinvuosia ja tuottavuusmenetyksiä. Kuolleisuus laski useimmissa syöpä- tyypeissä tutkimusjakson aikana. Melanooman, haiman, aivojen ja aivokalvojen syövän, huulen, suun ja nielun, kurkun ja kohdun syövän kuolleisuus nousi vuosina 2001–2015 naisilla ja eturauhassyövän kuolleisuus miehillä. Yleisesti ottaen menetettyjen elinvuosien määrä lisääntyi useimmissa syöpätyypeissä. Syöpäkuolemien aiheuttamat tuottavuusmenetykset ovat Venäjällä huomattavat, vuositasolla noin 8 miljardia dollaria. Kustannusten odotetaan laskevan vuoden 2001 0,28 prosentista bruttokansantuotteesta vuonna 2030 0,14 prosenttiin, pääasiassa kuolleisuuden vähenemisen ansiosta. Suurimmat kustannukset johtuvat naisilla rintasyövästä ja miehillä keuhkosyövästä, mutta eniten lisääntyivät HPV-infektioon liittyvien syöpien aiheuttamista kuolemista johtuvat tuottavuusmenetykset. Tutkimuksen tulokset asettaa standardin syöpätaakan arvioimiseen Venäjällä. Se kattaa syöpärekisterien tiedon laadun systemaattisen seurannan, jonka pohjalta tulee ohjata rekisteröintimenetelmiä ja käytäntöjä. Kansallisia syöpätilastoja voidaan kehittää nykyaikaisen trendianalyysin, ennusteiden ja muiden tekijöiden kuten menetettyjen elinvuosien ja kustannusten analyysin avulla. Tulevien tutkimusprojektien tulisi keskittyä tiettyihin syöpätyyppeihin jotta syöpäepidemiologisen tutkimuksen avulla voidaan kehittää näyttöön perustuvia syöväntorjuntatoimia.Cancer is a major global health threat. Despite progress in cancer management, the number of deaths is increasing. The growing cancer burden is driven by population ageing and suboptimal approaches to cancer control, but there are marked differences in cancer incidence and mortality globally. Russia is the largest country in Europe, representing about 14% of the European population with cancer mortality above the average European rates. Unfortunately, cancer epidemiologic studies are carried out sporadically in Russia. They rarely include comprehensive cancer burden analysis. The cancer trends analysis could explain historical changes, predict future burdens, and set cancer control goals. Well-validated population-based cancer registries (PBCRs) are reliable and unique sources of structured information for cancer surveillance and multiple research purposes. Russia, then part of the USSR, introduced compulsory cancer registration in 1953. However, regional PBCRs, which collect and store individual-level data, were fully established nationally only in 1999. The four key aspects of quality: comparability, validity, completeness, and timeliness, were never applied to evaluate the quality of cancer registration in Russia. This study aimed to assess the quality of cancer statistics in regions of Northwest Russia. Data from ten Russian PBCRs from regions with a population of approximately 13 million were processed and analysed. Overall, data collection in Northwest Russia was according to international standards; even though national instructions for cancer registration were outdated, it was generally comparable. The proportion of multiple primaries ranged from 6.7% in Vologda Oblast to 12.4% in St. Petersburg (between 2008 and 2017), similar to most European PBCRs. Substantial regional heterogeneity for most indicators of quality was observed. Certain cancer types (e.g., pancreas, liver, haematological malignancies, and CNS tumours) and cancers in older age groups showed lower validity and completeness. The overall quality of PBCRs data of at least four Northwest regions meets international standards. The study covered the incidence and mortality trends of two cancer types in women in Russia, breast and cervical cancer, and predicted the future burden. Breast and cervical cancer incidence age-standardised rates (Segi-Doll world standard population) increased from 33.0 to 47.0 per 100,000 and 10.6 to 14.2 per 100,000, respectively. Breast cancer mortality ASRs declined from 17.6 to 15.7 per 100,000 in 2013. At the same time, cervical cancer mortality ASRs increased steadily from 5.6 to 6.7 per 100,000. Changes in the risk in cohorts born between 1937-1953 indicated a recent generational decrease in breast cancer mortality and an increase in cervical cancer incidence and mortality. The annual years of life lost to cervical cancer mortality could reach 1.2 million, and years of life lost to breast cancer could decline to 1.8 million by 2030. These changes highlight the need to prioritise national screening and vaccination programs. This study also focused on national mortality trends collected through the centralised state civil registration system. Cancer burden related to mortality data was approached through years of life lost and productivity losses. Mortality for most cancer types decreased between 2001 and 2015. There was an upward trend for melanoma, pancreas, brain and CNS cancer mortality. In addition, larynx, lip, oral and pharynx, and cervical cancer mortality increased only in women and prostate cancer mortality in men. Overall, years of life lost increased for most cancer types. Productivity losses due to premature cancer mortality amounted to $8 billion. The losses were expected to drop from 0.28% of GDP in 2001 to 0.14% in 2030, primarily because of a decline in cancer mortality. The increase in productivity losses was highest for HPV-related cancer mortality. The losses in absolute terms were highest for breast cancer in women and lung cancer in men. This study sets a standard for measuring the burden of cancer in Russia. It includes a comprehensive assessment of PBCRs data quality, which is supposed to guide changes in cancer registration procedures and practices. National cancer statistics can be enhanced through contemporary trend analysis, predictions, and additional measures like years of life lost and costs. Future research projects should focus on specific cancer types to guide a pragmatic approach to evidence-based cancer control activities supported by cancer epidemiologic research

Comparability and validity of cancer registry data in the northwest of Russia

Background: Despite the elaborate history of statistical reporting in the USSR, Russia established modern population-based cancer registries (PBCR) only in the 1990s. The quality of PBCRs data has not been thoroughly analyzed. This study aims at assessing the comparability and validity of cancer statistics in regions of the Northwestern Federal District (NWFD) of Russia. Material and methods: Data from ten Russian regional PBCRs covering ∼13 million (∼5 million in St. Petersburg) were processed in line with IARC/IACR and ENCR recommendations. We extracted and analyzed all registered cases but focused on cases diagnosed between 2008 and 2017. For comparability and validity assessment, we applied established qualitative and quantitative methods. Results: Data collection in NWFD is in line with international standards. Distributions of diagnosis dates revealed higher variation in several regions, but overall, distributions are relatively uniform. The proportion of multiple primaries between 2008 and 2017 ranged from 6.7% in Vologda Oblast to 12.4% in Saint-Petersburg. We observed substantial regional heterogeneity for most indicators of validity. In 2013–2017, proportions of morphologically verified cases ranged between 61.7 and 89%. Death certificates only (DCO) cases proportion was in the range of 1–14% for all regions, except for Saint-Petersburg (up to 23%). The proportion of cases with a primary site unknown was between 1 and 3%. Certain cancer types (e.g., pancreas, liver, hematological malignancies, and CNS tumors) and cancers in older age groups showed lower validity. Conclusion: While the overall level of comparability and validity of PBCRs data of four out of ten regions of NWFD of Russia meets the international standards, differences between the regions are substantial. The local instructions for cancer registration need to be updated and implemented. The data validity assessment also reflects pitfalls in the quality of diagnosis of certain cancer types and patient groups.acceptedVersionPeer reviewe

Breast and cervical cancer screening practices in nine countries of Eastern Europe and Central Asia : A population-based survey

Background: Eastern Europe and Central Asia (EECA) countries have higher cervical and breast cancer mortality rates and later stage at diagnosis compared with the rest of WHO European Region. The aim was to explore current early detection practices including “dispensarization” for breast and cervix cancer in the region. Methods: A questionnaire survey on early detection practices for breast and cervix cancer was sent to collaborators in 11 countries, differentiating services in the primary health setting, and population-based programs. Responses were received from Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation (Arkhangelsk, Samara and Tomsk regions), Tajikistan, Ukraine, and Uzbekistan. Results: All countries but Georgia, Kyrgyzstan, and the Russian Federation had opportunistic screening by clinical breast exam within “dispensarization” program. Mammography screening programs, commonly starting from age 40, were introduced or piloted in eight of nine countries, organized at national oncology or screening centres in Armenia, Belarus and Georgia, and within primary care in others. Six countries had “dispensarization” program for cervix cancer, mostly starting from the age 18, with smears stained either by Romanowsky-Giemsa alone (Belarus, Tajikistan and Ukraine), or alternating with Papanicolaou (Kazakhstan and the Russian Federation). In parallel, screening programs using Papanicolaou or HPV test were introduced in seven countries and organized within primary care. Conclusion: Our study documents that parallel screening systems for both breast and cervix cancers, as well as departures from evidence-based practices are widespread across the EECA. Within the framework of the WHO Initiatives, existing opportunistic screening should be replaced by population-based programs that include quality assurance and control.Peer reviewe

The economic impact of cancer mortality among working-age individuals in Brazil from 2001 to 2030

Background: About half of cancer deaths in Brazil occur among individuals of working-age (under 65 years for men, under 60 for women), resulting in a substantial economic impact for the country. We aimed to estimate the years of potential productive life lost (YPPLL) and value the productivity lost due to premature deaths from cancer between 2001 and 2015 and the projected to 2030. Methods: We used the Human Capital Approach to estimate the productivity losses corresponding to YPPLL for cancer deaths in working age people (15–64 years). Mortality data were obtained from the Mortality Information System from 2001 to 2015 and projected between 2016 and 2030. Economic data were obtained from the Continuous National Household Sample Survey and forecasted to 2030. Productivity lost was calculated as the monetary value arising from YPPLL in Int$(2016). Results: Between 2001 and 2030, a total of 2.3 million premature deaths from all cancers combined were observed and forecasted in Brazil (57$141.3 billion in productivity losses (men: Int$102.5 billion, women: Int$38.8 billion). Between 2001 and 2030, among men, lung (Int$12.6 billion), stomach (Int$ 10.6 billion) and colorectal (Int$9.4 billion) cancers were expected to contribute to the greatest productivity losses; and among women, it will be for breast (Int$ 10.0 billion), cervical (Int$6.4 billion) and colorectal (Int$ 3.2 billion) cancers. Conclusions: Many preventable cancers result in high lost productivity, suggesting measure to reduce smoking prevalence, alcohol consumption, physical inactivity and inadequate diet, improving screening programs and increasing vaccination coverage for human papillomavirus and hepatitis B would have a positive impact on the economy, as well as reducing morbidity and mortality from cancer.Peer reviewe

Seroprevalence of SARS-CoV-2 antibodies in Saint Petersburg, Russia: a population-based study

Background Estimates from initial SARS-CoV-2 serological surveys were likely to be biased due to convenience sampling whereas large-scale population-based serosurveys could be biased due to non-response. This study aims to estimate the seroprevalence of SARS-CoV-2 infection in Saint Petersburg, Russia accounting for non-response bias. Methods We recruited a random sample of adults residing in St. Petersburg with random digit dialling. Computer-assisted telephone interview was followed by an invitation for an antibody test with randomized rewards for participation. Blood samples collected between May 27, 2020 and June 26, 2020 were assessed for anti-SARS-CoV-2 antibodies using two tests — CMIA and ELISA. The seroprevalence estimates were corrected for non-response bias, test sensitivity, and specificity. Individual characteristics associated with seropositivity were assessed. Findings 66,250 individuals were contacted, 6,440 adults agreed to be interviewed and were invited to participate in the serosurvey. Blood samples were obtained from 1038 participants. Naive seroprevalence corrected for test characteristics was 9.0% [95% CI 7.2–10.8] by CMIA and 10.8% [8.8–12.7] by ELISA. Correction for non-response bias decreased seroprevalence estimates to 7.4% [5.7–9.2] for CMIA and to 9.3% [7.4–11.2] for ELISA. The most pronounced decrease in non-response bias-corrected seroprevalence was attributed to the history of any illnesses in the past 3 months and COVID-19 testing. Besides that seroconversion was negatively associated with smoking status, self-reported history of allergies and changes in hand-washing habits. Interpretation These results suggest that even low estimates of seroprevalence in Europe’s fourth-largest city can be an overestimation in the presence of non-response bias. Serosurvey design should attempt to identify characteristics that are associated both with participation and seropositivity. Further population-based studies are required to explain the lower seroprevalence in smokers and participant reporting allergies. Funding Polymetal International pl

Evaluation of the performance of SARS-CoV-2 antibody assays for the longitudinal population-based study of COVID-19 spread in St. Petersburg, Russia

Background An evident geographical variation in the SARS-CoV-2 spread requires seroprevalence studies based on local tests with robust validation against already available antibody tests and neutralization assays. This report summarizes the evaluation of antibody tests used in the representative population-based serological study of SARS-CoV-2 in Saint Petersburg, Russia. Methods We used three different antibody tests throughout the study: chemiluminescent microparticle immunoassay (CMIA) Abbott Architect SARS-CoV-2 IgG, Enzyme-linked immunosorbent assay (ELISA) CoronaPass total antibodies test, and ELISA SARS-CoV-2-IgG-EIA-BEST. Clinical sensitivity was estimated with the SARS-CoV-2 PCR test as the gold standard and specificity in pre-pandemic sera samples using the cut-off recommended by manufacturers. Paired and unpaired serum sets were used. Measures of concordance were also calculated in the seroprevalence study sample against the microneutralization test (MNA). Findings Sensitivity was equal to 91.1% (95% CI: 78.8–97.5) and 90% (95% CI: 76.4–96.4) for ELISA Coronapass and ELISA Vector-Best respectively. It was equal to 63.1% (95% CI (50.2–74.7) for CMIA Abbott. Specificity was equal to 100% for all the tests. Comparison of ROCs for three tests has shown lower AUC for CMIA Abbott, but not for ELISA Coronapass and CMIA Abbott. The cutoff SC/O ratio of 0.28 for CMIA-Abbott resulted in a sensitivity of 80% at the same full level of specificity. In less than one-third of the population-based study participants with positive antibody test results, we detected neutralizing antibodies in titers 1:80 and above. There was a moderate correlation between antibody assays results and MNA. Interpretation Our validation study encourages the use of local antibody tests for population-based SARS-CoV-2 surveillance and sets the reference for the seroprevalence correction. Available tests are sensitive enough to detect antibodies in most individuals with previous positive PCR tests with a follow-up of more than 5 months. The Abbott Architect SARS-CoV-2 IgG’s sensitivity can be significantly improved by incorporating a new cut-off. Relying on manufacturers’ test characteristics for correction of reported prevalence estimates may introduce bias to the study results. Funding Polymetal International pl

Atrial fibrillation: real-life experience of a rhythm control with electrical cardioversion in a community hospital

Abstract Background Atrial fibrillation is the most prevalent sustained cardiac arrhythmia. Electrical cardioversion, a well-established part of the rhythm control strategy, is probably underused in community settings. Here, we describe its use, safety, and effectiveness in a cohort of patients with atrial fibrillation treated in rural settings. Methods It is a retrospective cohort study. Data on all procedures from January 1, 2016, till December 1, 2022, in Tarusa Hospital, serving mostly a rural population of 15,000 people, were extracted from electronic health records. Data on the procedure’s success, age, gender, body mass index, comorbidities, previous procedures, echocardiographic parameters, type and duration of arrhythmia, anticoagulation, antiarrhythmic drugs, transesophageal echocardiography, and settings were available. Results Altogether, 1,272 procedures in 435 patients were performed during the study period. The overall effectiveness of the procedure was 92%. Effectiveness was similar across all prespecified subgroups. Electrical cardioversion was less effective in patients undergoing the procedure for the first time (86%, 95% CI: 82-90) compared to repeated procedures (95%, 95% CI: 93-96), OR 0.39 (95% CI: 0.26-0.59). Complications were encountered in 13 (1.02%) procedures but were not serious. Conclusions Electrical cardioversion is an immediately effective procedure that can be safely performed in community hospitals, both in inpatient and outpatient settings. Further studies with longer follow-up are needed to investigate the rate of sinus rhythm maintenance in these patients

Cancer screening simulation models : a state of the art review

Background: Nowadays, various simulation approaches for evaluation and decision making in cancer screening can be found in the literature. This paper presents an overview of approaches used to assess screening programs for breast, lung, colorectal, prostate, and cervical cancers. Our main objectives are to describe methodological approaches and trends for different cancer sites and study populations, and to evaluate quality of cancer screening simulation studies. Methods: A systematic literature search was performed in Medline, Web of Science, and Scopus databases. The search time frame was limited to 1999–2018 and 7101 studies were found. Of them, 621 studies met inclusion criteria, and 587 full-texts were retrieved, with 300 of the studies chosen for analysis. Finally, 263 full texts were used in the analysis (37 were excluded during the analysis). A descriptive and trend analysis of models was performed using a checklist created for the study. Results: Currently, the most common methodological approaches in modeling cancer screening were individual-level Markov models (34% of the publications) and cohort-level Markov models (41%). The most commonly evaluated cancer types were breast (25%) and colorectal (24%) cancer. Studies on cervical cancer evaluated screening and vaccination (18%) or screening only (13%). Most studies have been conducted for North American (42%) and European (39%) populations. The number of studies with high quality scores increased over time. Conclusions: Our findings suggest that future directions for cancer screening modelling include individual-level Markov models complemented by screening trial data, and further effort in model validation and data openness.publishedVersionPeer reviewe

A pragmatic approach to tackle the rising burden of breast cancer through prevention & early detection in countries 'in transition'

Among the emerging economies Brazil, Russia, India, China and South Africa (together known as the BRICS countries) share collectively approximately 40 per cent of the global population and contribute to 25 per cent of the world gross domestic products. All these countries are facing the formidable challenge of rising incidence of breast cancer and significant number of premature deaths from the disease. A multidimensional approach involving prevention, early detection and improved treatment is required to counteract the growing burden of breast cancer. A growing trend in the prevalence of major preventable risk factors of breast cancer such as obesity, western dietary habits, lack of physical activity, consumption of alcohol and smoking is contributing significantly to the rising burden of the disease in BRICS nations. Specific interventions are needed at the individual and population levels to mitigate these risk factors, preferably within the broader framework of non-communicable disease control programme. Population-based quality assured mammography-based screening of the 50-69 yr old women can reduce breast cancer mortality at least by 20 per cent. However, none of the BRICS countries have been able to implement population-based organized screening programme. Large scale opportunistic screening with mammography targeting predominantly the younger women is causing harms to the women and wasting precious healthcare resources. There are recent national recommendations to screen women with mammography in Brazil and Russia and with clinical breast examination in China (along with ultrasound) and India. Given the challenges of implementing systematic screening of the population, the BRICS countries should prioritize the early diagnosis approach and invest in educating the women about the breast cancer symptoms, training the frontline health providers to clinically detect breast cancers and appropriately refer for diagnostic confirmation, and creating improved access to good quality diagnostic and treatment facilities for breast cancer. The early diagnosis approach has been proved to achieve downstaging and improve survival at a fraction of the resources needed for population screening. The countries also need to focus on improving the services and capacity for multidisciplinary treatment of breast cancer, histopathology and immunohistochemistry, safe administration of chemotherapy and palliative care.publishedVersionPeer reviewe