Cancer in women: the most painful problem – diagnosis
Recently, a round table was held in St. Petersburg, which was devoted to the problem of oncological diseases of the female reproductive system. Its organizers were the Association of Oncologists of the Northwestern Federal District and the Federal State Budget Scientific Institution “Research Institute of Oncology named after N. N. Petrov” of the Ministry of Health of Russia. The place chosen is not accidental. It is in the Northern capital that this problem is especially acute.
Participants discussed the results of a pilot project for screening cancer of the reproductive system in women and adopted a resolution on further improving cancer diagnosis.
The North-Western region of Russia is quite unfavorable in terms of the incidence of malignant tumors of the female reproductive sphere. So, in 2012, the standardized incidence rate of cervical cancer (cervical cancer) in the Northwestern Federal District amounted to 14.79 per 100,000 people, and mortality – 4.95 per 100,000 people. In a region with a population of about 14 million people, 608 deaths from this disease were reported. Often the disease is detected at the III-IV stage, when it is already impossible to radically change the prognosis.
At the same time, cervical cancer is one of the nosological forms in which mass screening makes it possible to identify the disease in the initial stages and successfully fight it, which was confirmed during a pilot screening project. A study showed that every 50th Petersburger has a predisposition to cancer. Of the 1000 women examined, sheyt uterine cancer at the earliest stage was detected in 2 cases; 17 people had precancerous conditions. Other abnormalities requiring medical supervision were found in 71 patients.
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To change the current situation, it is necessary to fundamentally change the approach to the diagnosis of cervical cancer: the disease or predisposition to it should not be diagnosed randomly, but should have a targeted systematic population character. Unfortunately, until now, most laboratories in the country do not have modern research quality control systems. About 7 million cytological smears of the cervix are taken in Russia annually, but the detection of cervical cancer in the early stages and precancerous conditions is rather low and is at the level of about 40-60%. The main disadvantages of standard cytological studies are the inability to standardize the method, the influence of the human factor at each stage, and the lack of modern laboratory equipment. Such shortcomings can be avoided with the help of modern computerized technology for liquid cytological examination of the neck. This technique with standardized technology for taking material, transportation and preparation, recommended as the world “gold standard” for diagnosing cervical pathology, minimizes the risk of medical error, and also saves material for 6 months: this makes it possible to conduct repeated molecular, immunocytochemical or genetic research without additional visit of the patient to the doctor.
Following the results of the round table, a resolution was adopted. Leading oncologists in the region decided to create an expert working group at JSC North-West Federal District to develop recommendations in the field of gynecological oncology with the inclusion of representatives of all leading medical institutions in the North-West Federal District. This document presents a model for conducting mass screening of the population of the federal federal state educational institution for early detection of cancer of the reproductive sphere in women and outlines the set of measures necessary for its implementation.
The round table participants emphasized that the introduction of screening and prevention programs in the region should be regulated and centralized. Before beginning the implementation of cancer screening and prevention programs, a quantitative assessment of the ability of the medical network to provide adequate conditions for the diagnosis and treatment of early forms of cancer is necessary. For the introduction of mass screening, it is important to ensure the creation of a single abstract center for cervical cancer screening in the region on the basis of the N. N. Petrov Research Institute of Oncologists of the Russian Ministry of Health. All program participants will be registered on the basis of central and regional cancer registries, and quality control of ongoing programs will be carried out in the central and regional abstract centers. The round table participants recommended using HPV vaccination and liquid technology as a prophylaxis as the most modern diagnostic method in terms and age groups according to recommendations adopted by the expert group.
The executive director of the Cancer Prevention Fund Ilya Fomintsev, summing up the round table, said: “The adoption of a resolution on the need for mass screening in the federal federal health center is a very important step to reduce the disability and mortality of women from reproductive cancer.