Cervical Cancer in Croatia: State of the Art and Possibilities for Prevention

In Croatia, there are about 355 incident cases and about 100 deaths from cervical cancer every year. The aim of this study is to present the trends of cervical cancer incidence and mortality and to propose preventive strategies for cervical cancer in Croatia. Age-standardised and age-specific cervical cancer incidence rates were calculated for the period 1985–2004. For cervical cancer mortality data, the WHO Mortality Database was used. After an early decrease of cervical cancer incidence and mortality following the introduction of opportunistic screening in Croatia, no further decrease has been observed since the 1990s. An increase in incidence over the last 20 years was observed in the age-groups 40–44 and 45–49 years. To reduce cervical cancer rates, an organised cervical cancer screening programme is essential. In addition, HPV vaccination should be introduced in the school vaccination programme to achieve further reductions in cervical cancer incidence in the future

Urban-rural differences in a population-based breast cancer screening program in Croatia

Aim To investigate urban-rural differences in the distribution of risk factors for breast cancer. Methods We analyzed the data from the first round of the “Mamma” population based-screening program conducted in Croatia between 2007 and 2009 and self-reported questionnaire results for 924 patients with histologically verified breast cancer. Reproductive and anthropometric characteristics, family history of breast cancer, history of breast disease, and prior breast screening history were compared between participants from the city of Zagreb (n = 270) and participants from 13 counties with more than 50% of rural inhabitants (n = 654). Results The screen-detected breast cancer rate was 4.5 per 1000 mammographies in rural counties and 4.6 in the city of Zagreb, while the participation rate was 61% in rural counties and 59% in Zagreb. Women from Zagreb had significantly more characteristics associated with an increased risk of breast cancer (P < 0.001 in all cases): no pregnancies (15% vs 7%), late age of first pregnancy (≥30 years) (10% vs 4%), and the most recent mammogram conducted 2-3 years ago (32% vs 14%). Women from rural counties were more often obese (41% vs 28%) and had early age of first live birth (<20 years) (20% vs 7%, P < 0.001 for both). Conclusion Identification of rural-urban differences in mammography use and their causes at the population level can be useful in designing and implementing interventions targeted at the reduction of inequalities and modifiable risk factors

The Elderly and Cancer

Produženje očekivanog trajanja života i povećanje broja starijeg stanovništva ima za posljedicu veći broj oboljelih i umrlih od raka, što je sada slučaj u Hrvatskoj. Najčešća sijela raka u starijoj dobi jesu u muškaraca bronh i pluća, prostata, debelo crijevo, želudac, mokraćni mjehur i grkljan, a u žena dojka, debelo crijevo, želudac, bronh i pluća i tijelo maternice. Važno je usvajanje, odnosno održavanje zdravih životnih navika jer iste utječu na smanjeni rizik obolijevanja. Uspješnost liječenja ovisi pak primarno o ranom otkrivanju bolesti. Osim samopregleda, što je posebice važno za kožu, postoje testovi za otkrivanje raka dojke, vrata maternice, debelog crijeva i prostate. Šanse za izlječenje u starijih osoba slabije su zbog prisutnih kroničnih bolesti, narušenoga funkcionalnog statusa te težeg podnošenja agresivnih terapija. Prvi korak u donošenju odluke o probiru kao i o terapiji jest sveobuhvatna gerijatrijska obrada pacijenta koja uključuje evaluaciju svih prisutnih komorbidnih stanja, stupanj polifarmacije i prisutnost gerijatrijskih sindroma. S obzirom na specifi čnost problematike malignih bolesti u starijim dobnim skupinama, javlja se potreba za razvojem gerijatrijske onkologije kao posebne kliničke subspecijalnosti.The consequence of the life expectancy getting longer and the number of the elderly increasing is more and more cancer patients and people dying from cancer. This is now the case in Croatia. The leading sites for cancer among male elders are bronchus, lungs, prostate, colon, stomach, urinary bladder and larynx; meanwhile among female population are breast, colon, stomach, bronchus, lungs and uterus. What matters for reducing the risk of cancer is adopting, that is, maintaining healthy habits. The success of the treatment primarily depends on the early detection of the disease. Besides self-examination, particularly important when skin is in question, there are several tests for discovering breast cancer, cervix cancer, colon cancer and prostate cancer. The elderly have less chance for being cured because of the chronic diseases they suffer from, poor functional status and because they do not take the aggressive therapies well. The fi rst step in deciding about screening, as well as therapy, is overall geriatric patient treatment including evaluation of all of the existing comorbide states, the polypharmatic degree and the presence of geriatric syndromes. Regarding the problem specifi city of the malignant diseases affecting the elderly, there is a need for developing geriatric oncology as a separate clinic subspeciality

Croatian Cancer Registry: Reference for Selestion of Relevant Issues and Application in Epidemiological Studies

Za podatke registara za rak najviše se zna zbog njihova potencijala opisivanja incidencije raka, preživljavanja i prevalencije u nacionalnim i međunarodnim okvirima. Često se za usporedbu rabe mortalitetni podaci, posebice stoga što su dostupniji za mnogo više zemalja nego podaci o morbiditetu. Ispitivanja incidencije raka u svijetu daju spoznaje o etiologiji raka, na primjer, putem opažanja razlika incidencije izme|u pojedinih područja, studija migranata ili specifično izloženih grupa. U epidemiološkim istraživanjima registar koristi za korelacijske studije, za identifikaciju slučajeva u case control studijama, za definiranje kohorte ili krajnje točke praćenja kohorte. Zbog povezivanja podataka na nivou osobe, registri su korisni i za područje genetičke epidemiologije. Cilj ovog rada je na temelju konkretne zemljopisne distribucije incidencije nekih izabranih sijela raka, a koristeći se Registrom za rak, pretpostaviti različito djelovanje uzročnih čimbenika. Primijenjena je analiza za 17 definiranih zemljopisnih područja Hrvatske. Analizirana je dobno-standardizirana prosječna godišnja stopa incidencije za izabrana sijela raka za razdoblje 1991–95. Razlike izme|u pojedinih područja prisutne su gotovo za sva prikazana sijela raka. Rezultati upućuju na potrebu daljnjih istraživanja, etioloških i drugih. Dobivene razlike u incidenciji raka između pojedinih područja Hrvatske odraz su djelovanja mnogobrojnih čimbenika: značajki populacije, makro i mikrookoline.Systematic collection of data on cancer incidence started in the US and Europe in 1930s. Today, cancer registries have an increasingly universal coverage. The application of a cancer registry may extend to include follow-ups, cancer etiology research, and cancer control programs. Of course, the applicability of a cancer registry depends on reliability and utility of the data. Cancer registries are best known for their potential to describe incidence, survival, and prevalence of cancer on a national and international level. Although poorer in quality, mortality data are frequently used in comparisons, as these are more readily available in many countries than the morbidity data. Studies of cancer incidence reveal etiology of cancers, through, for instance, observations of differences in incidence between areas, through migrant studies, or through studies of specific exposed groups (descriptive studies). A registry may serve as a referential point for a hypothesis on the roles of diet, environmental hazards, infections, and so on in the development of cancer. In epidemiological studies, the registry is used for correlational studies, case identification in case control studies, as well as to define cohorts, or the end-point of a cohort followup. Recently, the recording of data has extended not only to the anatomical site, but also to the morphology of a tumour, which serve more adequately to etiological studies. However, the assessment of a specific exposure is of ten poor, as the scarcity of cases often forces the researchers to group the data. Registries may also help to link data on an individual level, that is, in the area of genetic epidemiology. This study made use of the Croatian cancer registry founded in 1959 to investigate specific geographical distribution of cancer incidence by site – esophageal cancer, gastric cancer, colonic cancer, rectal cancer, biliary bladder cancer, lung cancer, cancer of the mammae, melanoma, cancer of the prostate, urinary bladder cancer, renal cancer, thyroid cancer, and myeloic leukemia. The objectives of the study were to see how causative agents differed in impact and to define the scope of investigations in cancer epidemiology. The investigation involved age-standardized average annual incidence rates in 17 geographical areas in Croatia for the period 1991–95. Nearly all geographical areas differed from one another in the incidence by cancer site. Interregional differences in cancer incidence in Croatia may reflect the action of multiple factors such as population characteristics, macroenvironment, and microenvironment. The results indicate a need for further studies and invite the use of epidemiological modelling, given the potentials of information technology

Calcium and malignant neoplasms

Nekoliko je istraživanja upozorilo na povezanost između kalcija, vitamina D, uzimanja mlijeka i smrtnosti od raka debelog crijeva. Mlijeko je pritom, kao najbogatiji izvor kalcija u hrani, prepoznato kao protektivni čimbenik. Nedostaci većine tih istraživanja mogli su utjecati na rezultate. Zaštitna uloga kalcija bila bi u tome što ioni kalcija smanjuju izloženost epitela debelog crijeva mastima i žučnim kiselinama, stvarajući s njima netopljive kalcijeve sapune. Smatra se da masti i lipidi stimuliraju rad tumora iz stanica izloženih inicijalnoj karcinogenezi. Pretpostavka da vitamin D može djelovati protektivno kod raka debelog crijeva temelji na opažanju da je smrtnost od tog raka veća u područjima s manje sunčanog svjetla. Uloga vitamina Dje pritom usko povezana s njegovom funkcijom u metabolizmu kalcija. Dokazi o uzročnoj povezanosti između kalcija i raka debelog crijeva još su nedovoljno čvrsti. Značajni su oni koji upozoravaju na povezanost s osteoporozom i hipertenzijom. Važno je stoga hranom osigurati dovoljan dnevni unos kalcija u organizam.Several studies have shown that there is a link between calcium, vitamin D, milk consumption and colon cancer mortality. They recognized milk, as the richest source of food calcium, as a protective factor. Most of them have flaws capable of affecting the results. Purportedly, the protective role of calcium consists in calcium ions reducing the exposure of colonic epithelium to fats and gallbladder acids by binding with them into insoluble calcium soaps. Fats and lipids are considered to simulate tumor growth in the cells exposed to the initial carcinogenesis. The observation that in colonic cancer the action of vitamin D may be protective is based on the reports of areas with less sunlight having a higher mortality from this cancer. At it, the role of vitamin D is closely related with its function in calcium metabolism. The evidence for a causal relationship between calcium and colonic cancer is not strong enough yet. More significant is that indicating its relationship with osteoporosis and hypertension. It is thus important to insure a sufficient daily calcium intake thorough food

Mediteranska prehrana u prevenciji raka (The role of Mediterranean diet in cancer prevention)

Međunarodna agencija za istraživanje raka (IARC) procjenjuje da je rak najvećim dijelom uzrokovan čimbenicima koji se povezuju sa stilom življenja i okolišem. Posebice se to odnosi na duhan, kronične infekcije i prehranu. Hipoteza je da se u razvijenim zemljama odgovarajućom prehranom i fizičkom aktivnošću, kao i održavanjem odgovarajuće tjelesne težine može prevenirati 30% od svih slučajeva raka. U zemljama u razvoju veliki je broj karcinoma uzrokovan prehranom siromašnom svježim voćem i povrćem kao i s previše soli. Najnoviji rezultati EPIC studije (European Prospective Investigation into Cancer and Nutrition) koja se provodi u 22 centra u 9 zemalja ukazuju na smanjeni rizik za rak kod veće konzumacije voća i povrća te povećani rizik kod prehrane s mnogo mesa i soli (1). Velik je broj istraživanja ukazao na utjecaj prehrane, te mogućnost djelovanja specifičnih čimbenika u procesu karcinogeneze u različitim organima i tkivima. U eksperimentalnim, ali i humanim epidemiološkim istraživanjima učinke su modulirali: makronutrienti (masti, ugljikohidrati, bjelančevine i vlakna), vitamini te minerali. Mijenjanje rizika za rak čimbenicima prehrane može se dogoditi u raznim stadijima razvoja raka. Prehrana može smanjiti učinke karcinogena iz okoliša, oštetiti DNK direktno ili indirektno, te promovirati ili inhibirati progresiju raka. Tradicionalna mediteranska prehrana svojim sastavom te načinom pripreme odgovara postulatima zdrave prehrane, odnosno prehrani kakva se preporuća u prevenciji raka