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The fraction of colorectal cancer attributable to high red meat and alcohol consumtion in Slovenia
Get PDFHealth related quality of life in Croatian general population in patients with multiple myeloma
No full textIZVLEČEK
Izhodišča
Vpliv bolezni in zdravljenja bolezni na bolnikovo splošno počutje ter vsakodnevno delovanje sta temi, za kateri se zanimanje v vsakodnevni klinični praksi in raziskavah povečuje. Diseminirani plazmocitom je drugo najpogostejše hematološko maligno obolenje, ki predstavlja 1 % vseh rakavih obolenj. Njegova incidenca se povečuje zaradi podaljševanja življenjske dobe, razširjenost pa zaradi izboljšanih metod zdravljenja. V zadnjih desetletjih smo dosegli pomemben napredek pri zdravljenju diseminiranega plazmocitoma. Kljub temu zdravljenje spremljajo številni simptomi in upad v kakovosti življenja, povezan z zdravjem.
Namen
Cilj naše klinične raziskave je bil, pridobiti referenčne podatke o kakovosti življenja v reprezentativnem vzorcu splošne hrvaške populacije, starejše od 40 let, s pomočjo EORTC QLQ-C30, določiti točke z zdravjem povezane kakovosti življenja (HrQoL) z EORTC QLQ-C30 ter EORTC QLQ-MY20 v kohorti hrvaških bolnikov z novoodkritim diseminiranim plazmocitomom in oceniti vpliv bolezni ter sistemskega zdravljenja bolezni na HrQoL.
Hipoteze
1. V splošni populaciji na Hrvaškem, starejši od 40 let, imajo največji vpliv na kakovost življenja spol, starost in kraj prebivališča.
2. Bolniki z diseminiranim plazmocitomom imajo ob postavitvi diagnoze običajno nižje vrednosti QLQ-C30 pri splošni kakovosti življenja, vsakodnevnem delovanju ter simptomih, prav tako pa tudi pri posameznih elementih (razen pri finančnih težavah) v primerjavi s splošno populacijo, starejšo od 40 let, četudi vzorec prilagodimo glede na spol, starost in območje bivanja.
3. Povprečje točk pri simptomih bolezni ter stranskih učinkih zdravljenja in pri samopodobi bolnika se pri vprašalniku QLQ-MY20 statistično pomembno zmanjša tri mesece po presaditev matičih celic pri bolnikih z diseminiranim plazmocitomom.
Metode
V prvem delu študije so bili sodelujoči naključno izbrani posamezniki iz populacije prebivalcev Hrvaške, 310 od njih, starejši od 40 let. V klinični del študije so bili vključeni bolniki z diseminiranim plazmocitomom, 51 od njih, diagnosticirani v zadnjih dveh letih v dveh večjih hrvaških hematoloških centrih. Za oceno HrQoL smo v obeh skupinah uporabili EORTC QLQ-C30, v skupini bolnikov z diseminiranim plazmocitomom pa dodatno še EORTC QLQ-MY20. Statistična razlika je bila določena z uporabo Kruskal-Wallisovega testa, Mann-Whitneyevega U testa in Wilcoxonovega testa predznačenih rangov.
Rezultati
Vprašalnik EORTC QLQ-C30 v splošni populaciji kaže na statistično pomembno razliko pri mnogih dimenzijah kakovosti življenja glede na starost. Število točk pri splošni kakovosti življenja je najvišje pri sodelujočih, starih med 50 ¬– 59 let, ter najnižje pri sodelujočih, starih 70 let in več. Še pomembnejše je, da je število točk pri fizičnem, čustvenem in socialnem delovanju pomembno nižje za sodelujoče, ki so stari 70 let in več. Največ oseb v hrvaški splošni populaciji je bilo starih med 50 in 69 let, bistveno manj pa je bilo starejših od 70 let, kar lahko vpliva na rezultate. Moški ocenjujejo kakovost življenja, fizično ter čustveno delovanje kot tudi vsa ostala delovanja na lestvici, bolje kot ženske. V našem vzorcu populacije je moških pol manj kot žensk.
Obstaja statistično pomembna razlika glede splošne z zdravjem povezane kakovosti življenja, fizičnega in socialnega delovanja, vloge v vsakdanjem življenju, slabosti, bolečini, izgubi apetita ter finančnih težavah, če primerjamo splošno populacijo in populacijo bolnikov z diseminiranim plazmocitomom. Splošna populacija ter vzorec bolnikov z diseminiranim plazmocitomom nista usklajena glede na spol, starost in območje bivanja. Število točk za splošno z zdravjem povezano kakovost življenja, fizično delovanje, vlogo v življenju ter socialno delovanje je višje v splošni populaciji. Medtem ko so vrednosti pri slabosti, bolečini, izgubi apetita ter finančnih težavah višje pri bolnikih z diseminiranim plazmocitomom.
Med bolniki z diseminiranim plazmocitomom obstaja statistično pomembna razlika pri psihičnem, kognitivnem, socialnem delovanju ter pri slabosti, bruhanju, bolečini, nespečnosti in finančnih težavah, ko opravimo meritve pred in po aplikaciji kemoterapije. Rezultati so slabši pri meritvah po kemoterapiji. Pri bolnikih, zdravljenih s presaditvijo, so bili rezultati slabši glede na splošno populacijo, a boljši v primerjavi z bolniki na kemoterapiji. Po presaditvi je prišlo do izboljšanja rezultatov. Avtologna presaditev hematopoetskih matičnih celic je najučinkovitejši način zdravljenja pri bolnikih z diseminiranim plazmocitomom. Medtem se pri starejših bolnikih, ki imajo poleg simptomov bolezni tudi starostne spremembe, običajno zdravljenje v manjših odmerkih izvaja manj pogosto. Bolniki, ki so bili zdravljeni samo s kemoterapijo, so bili starejši bolniki s slabšo prognozo. Tudi ker sta bili dve meritvi, obdobje 3 mesecev po terapiji, to obdobje ni enako za presajene bolnike in tiste, ki prejemajo samo kemoterapijo, kar lahko vpliva tudi na končne rezultate študije. Odprava simptomov je odvisna od bolnikovega odziva na terapijo in se razlikuje od bolnika do bolnika. Zato se lahko terapija med zdravljenjem spremeni.
V splošnem je bolezen, ki ji sledi izbira terapije, pomembna pri obravnavi z zdravjem povezane kakovosti življenja.
Zaključki
Referenčne populacijske vrednosti HrQoL bodo pomagale klinikom pri interpretaciji HrQoL pri bolnikih in bodo v pomoč pri načrtovanju zdravljenja rakavih obolenj. Starejši bolniki na konvencionalni terapiji imajo nižjo splošno kakovost življenja skupaj s sedanjimi simptomi in stanje sčasoma napreduje, medtem ko imajo mlajši bolniki na ASCT boljše rezultate in odtegnitvene simptome po zdravljenju za določeno obdobje. Vendar je treba opozoriti, da je bilo v naši raziskavi majhno število anketirancev MM.ABSTRACT
Background
The impact of disease and treatment on patients’ overall well-being and functioning is a topic of growing interest in clinical research and practice. Multiple myeloma (MM) is the second most prevalent haematologic malignancy, representing 1% of all cancers, with an increasing incidence due to longer life expectancy and increasing prevalence due to improved treatments. Significant progress has been achieved in the treatment of multiple myeloma in recent decades. However, the treatment is accompanied by numerous symptoms and a decrease in health-related quality of life (HrQoL).
Aim
The aim of our study was to obtain reference data on the quality of life in Croatia in a representative sample of the general population older than 40 years, to measure the HrQoL scores in the cohort of newly diagnosed multiple myeloma patients in Croatia and to assess the impact of disease and its systemic treatment on the patients’ HrQoL.
Hypotheses
1. Age, gender and place of residence have significant impact on the HrQoL in Croatian general population older than 40 years.
2. The MM patients at diagnosis have lower QLQ-C30 scores on global quality of life, all functional and symptoms scales as well as all single items (excluding financial difficulties) compared to the general population older than 40 years even if the sample is adjusted to age, gender and place of residence.
3. The mean scores for the subscales symptoms, side effects and body image of QLQ-MY20 are significantly reduced three months after the stem cell transplantation (ASCT) in MM patients.
Methods
For the first part of the study, respondents were randomly selected individuals in the Croatian population, 310 of them, older than 40 years. In the clinical part of the study, MM patients, 51 of them, were included as prospectively diagnosed within two years in two major Croatian haematological centres. The EORTC QLQ-C30 in both trials and EORTC QLQ-MY20 in MM patients were applied for HrQoL assessment. The statistical difference between groups was determined using the Kruskal-Wallis test, Mann-Whitney U test and Wilcoxon signed rank test.
Results
In the general population there is a statistically significant difference in age for many dimensions of the EORTC QLQ-C30. The scores for general quality of life are highest for respondents aged 50-59 and lowest for respondents aged 70 and older. Furthermore, scores for physical functioning, emotional functioning and social functioning are lower for respondents aged 70 and older. The largest number of respondents in Croatian population was in the age group 50-59, and the smallest in the age group 70 and more. Men reported better quality of life, as well as physical and emotional functioning and better functioning for all items on the symptom scale. In our population sample, there is half as many men as women.
There is a statistically significant difference for global HrQoL, physical, role and social functioning, fatigue, pain, appetite loss and financial difficulties when comparing the general population and MM patients. However, we could not adjust the general population to the MM population by age, gender and place of residence due to the inadequately adjusted sample in the general population. The values for global HrQoL, physical functioning, role functioning and social functioning are higher for the general population while values for fatigue, pain, appetite loss and financial difficulties are higher in MM patients.
Among MM patients, there is a statistically significant difference in physical functioning, cognitive functioning, social functioning, fatigue, pain, insomnia and financial difficulties in the measurements before and after conventional therapy, and results were worse in measurements after conventional therapy. Furthermore, there is a statistically significant difference for global HrQoL role functioning, social functioning, nausea and vomiting, diarrhoea and financial difficulties when measured after ASCT.
When analysing QLQ-MY20 questionnaire, there is a statistically significant difference for body image and disease symptoms in measurements before and after conventional therapy. In post-testing, the results were worse. There is a statistically significant difference for future perspective in measurements before and after ASCT.
For MM patients on conventional therapy, the results showed that in comparison to the general population and transplant patients, their functional scale was worse in the initial testing and further deteriorated in post-testing. For transplant patients, the results were worse in comparison to the general population but better when compared to patients on conventional therapy. In post-testing, the results improved. ASCT is the most effective treatment modality for MM patients, while conventional therapy is frequently in delivered lower dosages in elderly patients who, in addition to the symptoms of the disease, have also age-related symptoms related to a specific organic system. Patients who were treated only with conventional therapy were older patients with a worse prognosis. Withdrawal of symptoms depends on the patient\u27s response to therapy and varies from patient to patient. Therefore, the therapy may change during treatment.
Overall, the disease followed by the choice of therapeutical approach may influence HrQoL determinants.
Conclusion
The normal values will help to interpret HrQoL for clinicians and will aid in planning cancer care interventions. Elderly patients on conventional therapy have lower overall quality of life outcomes along with present symptoms and the condition progresses over time, while younger patients on ASCT have better outcomes and withdrawal symptoms after treatment for a period of time. However, it should be noted that there was a small number of MM respondents in our study
Effects of national population based screening for breast cancer on prognostic factors and health outcomes
No full textUvod
Rak dojk je najpogostejši rak pri ženskah po številu novih primerov in umrljivosti. Incidenca še narašča. Na večino poznanih nevarnostnih dejavnikov težko vplivamo z ukrepi primarne preventive, zato so toliko pomembnejši ukrepi sekundarne preventive, predvsem presejanja. Svet Evropske unije je leta 2003 izdal, leta 2022 pa posodobil priporočila za uvajanje na dokazih temelječih organiziranih presejalnih programov za raka, med njimi tudi za raka dojk. Slovenija je leta 2008 pričela z organiziranim presejanjem z mamografijo za ženske v starosti 50–69 let na dve leti. Državni presejalni program za raka dojk – program DORA se je postopoma do leta 2018 razširil na vso državo.
V nalogi smo skušali ovrednotiti koristi uvedbe organiziranega presejanja za raka dojk v slovenski populaciji in oceniti posledice postopnega uvajanja presejalnega programa.
Metode
V kohortni raziskavi za proučevanje incidence smo uporabili podatke o rakih dojk iz Registra raka v obdobju 1998–2018, ki smo jih za obdobje 2008–2018 nadgradili s podatki presejalnega registra glede vključevanja žensk v program DORA. V ciljni starostni skupini 50–69 let smo analizirali incidenčne trende, primerjali stadije ob diagnozi, starost ob diagnozi, načine prvega zdravljenja in čas trajanja od diagnoze do prvega zdravljenja glede na različne statuse vključevanja v program DORA. V regresijskih modelih smo kot pojasnjevalno spremenljivko vključili tudi socialno-ekonomski položaj.
Za proučevanje umrljivosti smo uporabili podatke o smrtih zaradi raka dojk v obdobju 1998–2019 iz Registra raka, ki smo jih nadgradili s podatki o širjenju programa DORA po občinah. Proučili in primerjali smo časovne trende umrljivosti ter absolutne in relativne razlike pred, med in po uvedbi presejalnega programa na različnih območjih glede na širitev programa DORA. Pripravili smo tudi analize čistega preživetja po stadijih in izračun do sedaj pridobljenih let življenja zaradi uvajanja presejanja na populacijski ravni.
Rezultati
V časovnih trendih incidenčnih stopenj je v starostni skupini 50–69 let opaziti naraščanje omejenega stadija raka dojk ob diagnozi, pri razširjenem stadiju je po predhodni rasti po letu 2008 opaziti upad, pri razsejanem stadiju je nakazan trend upadanja. Ženske, vključene v program DORA, imajo ob diagnozi nižji stadij in so okoli dve leti mlajše. Povprečen čas do operacije je bil krajši pri ženskah, ki niso bile vključene v program DORA, vendar kaže veliko variabilnost, kar je verjetno posledica odsotnosti ustaljenih in predvidenih procesov obravnave, ki pri organiziranih programih zagotavljajo višjo kakovost. To se odraža tudi pri izračunu preživetja, kjer imajo v vseh stadijih ženske, vključene v program DORA, značilno boljše preživetje kot tiste, ki niso bile vključene v program, ali neodzivnice.
Trend umrljivosti kaže upad v celotnem obdobju, primerjava v obdobju uvajanja programa med občinami, ki so imele program DORA ali ne, ne pokaže razlik med skupinama, kar je najverjetneje posledica še prekratkega časa opazovanja. Umrljivost po popolni razširitvi programa je za 17,5 odstotkov nižja (95 % interval zaupanja 3,6–29,5) kot pred uvedbo programa. Tega upada sicer ne moremo pripisati uvedbi programa DORA, sledi pa pričakovanemu trendu zmanjševanja umrljivosti po uvedbi organiziranega presejanja. Gibanje trenda bo potrebno v prihodnje še spremljati. Z uvedbo presejanja smo do leta 2018 prihranili 90,6 let življenja, če bi program DORA na območju vse države uvedli leta 2008, pa bi prihranili 552,7 let (95 % interval zaupanja 106,4–999,0).
Zaključki
Rezultati glede stadija in starosti ob diagnozi so pričakovani in kažejo na srednjeročno učinkovitost uvedenega organiziranega presejalnega programa. Pričakujemo, da bodo v bodoče, po popolni uvedbi, rezultati še boljši. Kljub temu da je bil čas od diagnoze do operacije v programu DORA nekoliko daljši kot ta čas zunaj programa, so bili izidi v preživetju boljši pri ženskah, vključenih v program DORA, tudi znotraj omejenega stadija.
Kljub različnim omejitvam in možnim pristranostim, rezultati raziskave kažejo na dobrobiti organiziranega presejanja za raka dojk v populaciji. Uvajanje novih presejanj ali morebitnih sprememb v presejanju naj bo uvedeno v čim krajšem obdobju na celotnem območju, saj s tem zagotovimo največje koristi brez začasnih sistemskih neenakosti.Introduction
Breast cancer is the most common cancer in women, both in terms of new cases and mortality. The incidence is still increasing. Most of the known risk factors are difficult to address through primary prevention measures, which makes secondary prevention measures, especially screening, all the more important. In 2003, the Council of the EU issued recommendations for the introduction of evidence-based organized cancer screening programmes, including for breast cancer, which were updated in 2022. In 2008, Slovenia started with organized mammography screening for women aged 50–69 every two years. Slovenian Breast Cancer Screening Programme DORA was gradually expanded to cover the entire country by 2018.
In this work, we aimed to evaluate the benefits of the introduction of organized screening for breast cancer in the Slovenian population and assess the consequences of the step-wise introduction of the screening programme.
Methods
In the cohort study, incidence data on breast cancer cases from population-based Slovenian Cancer Registry in the period 1998–2018 was used. For the period 2008–2018 we used also the data on enrollment in the screening programme obtained from the screening registry of the DORA programme. In the target age group of 50–69 years, incidence trends were analyzed, comparing stage at diagnosis, age at diagnosis, first treatment modalities and time from diagnosis to first treatment stratified according to screening programme enrollment status. We also included socio-economic status as an explanatory variable in the regression models.
To study mortality, we used data on breast cancer deaths in the period 1998–2019 from the Slovenian Cancer Registry, which we supplemented with data on the roll-out of the DORA programme across municipalities. We examined and compared temporal trends in mortality and the absolute and relative differences before, during and after the introduction of the screening programme between different areas according to the expansion of the DORA programme. We also analyzed net survival by stage and calculated years of life gained during the roll-out period as a result of the introduction of population screening.
Results
In the 50–69 age group, the time trend analysis of incidence shows an increase in the localized stage of breast cancer, a decline in the regional stage of disease after 2008, following a previous increase, and a downward trend in the distant stage. Women included in the DORA programme have a lower stage at diagnosis and are around two years younger. The mean time to surgery was shorter for women outside the DORA programme, but shows high variability, possibly due to the absence of established treatment processes that ensure higher quality of care in organized screenings. This is also reflected in the calculation of survival, where at all stages, women enrolled in the DORA programme have significantly better survival than those not enrolled in the programme or non-responders.
The mortality trend shows a decline throughout the entire period. Comparison of mortality during the roll-out period between municipalities with and without the DORA programme shows no differences between the two groups, most likely due to the follow-up time being too short. The mortality rate after the full roll-out of organized screening is 17.5% lower (95% confidence interval 3.6–29.5) than before the introduction of the programme. This fall can not be directly attributed to introduction of organized screeningthus, it is moving in the expected direction. Trends in mortality should be observed also in the future. The introduction of screening has saved 90.6 years of life by 2018, and if the DORA programme had been implemented nationwide in 2008, it would have saved 552.7 years (95% confidence interval 106.4–999.0).
Conclusions
The results regarding the stage and age at diagnosis are expected and indicate the medium-term effectiveness of the organized screening programme. We expect that positive results will be even more pronounced in the future, now that organized screening has been fully implemented. Despite the fact that the time from diagnosis to surgery was slightly longer in the DORA programme, survival outcomes were better for women enrolled in the DORA programme, which suggests that the quality of treatment is more important than the speed.
Despite limitations and possible biases, results of this research point to the benefits of organized screening for breast cancer in the population. Any changes in screening should be introduced in the shortest possible period across the entire area, as this will ensure the greatest benefit without causing temporary systemic inequalities
THE EVALUATION OF CANCER INCIDENCE AFTER TOTAL HIP OR KNEE ARTHROPLASTY
Get PDFŠtevilo pacientov z vstavljeno endoprotezo kolka (TEKk) ali kolena (TEKn) se zaradi staranja populacije povečuje. Iz materialov, ki sestavljajo TEKk in TEKn, se izločajo delci, ki so lahko tudi rakotvorni. Namen dela je bil raziskati, v kolikšni meri na zbolevanje za rakom vplivajo vsadek in njegove lastnosti, tj. obremenilni sklop med glavico in ponvico ter material stegneničnega debla TEKk in kombinacije materialov stegneničnega in goleničnega dela TEKn ter fiksacija totalnih kolčnih in kolenskih endoprotez (TKKE) s kostnim cementom.
V retrospektivno kohortno študijo smo vključili 11.230 pacientov s TKKE iz obdobja od 1. 9. 1997 do 1. 12. 2009. Povezali smo tri zbirke podatkov – iz Ortopedske bolnišnice Valdoltra, Registra raka Republike Slovenije in Centralnega registra prebivalstva. Izračunali smo standardizirane količnike incidence ter s Poissonovo analizo še relativna tveganja za vse in za posamične rake.
Splošno tveganje raka je bilo v kohorti TEKk in TEKn primerljivo s populacijskim. V združeni kohorti TKKE je bilo splošno tveganje nekoliko nižje od populacijskega. V kohorti TEKk smo ugotovili presežek raka prostate ter ledvičnega raka. Nižje je bilo tveganje raka limfatičnih in krvotvornih tkiv, raka prebavne cevi ter pljučnega raka. Relativno tveganje vseh rakov ter raka prostate in nemelanomskega kožnega raka je bilo višje, ko smo skupino z obremenilnim sklopom KOV-KOV (kovina-na-kovino) primerjali s skupino neKOV-KOV. V kohorti TEKn je bil v presežku ledvični rak, manj je bilo raka prebavne cevi ter pljučnega raka. Rak prostate je bil v presežku pri cementiranih TEKn. V združeni kohorti TKKE so se v presežku pojavljali rak prostate, ledvični rak ter raki centralnega živčnega sistema. Opazili smo manj raka limfatičnih in krvotvornih tkiv, prebavne cevi, pljučnega raka, manj raka trebušne slinavke ter nemelanomskega kožnega raka. Skupina pacientov z zgolj TEKn je imela nižje relativno tveganje za vse vrste rakov v primerjavi s skupino z zgolj TEKk
Pomembna ugotovitev opravljene raziskave je, da je najbolj tvegana lastnost TEKk endoprotez obremenilni sklop KOV-KOV. Predlagamo, da bi ortopedi pred vstavitvijo tovrstne endoproteze skrbno pretehtali njene prednosti in slabosti. V sklopu študije smo tudi potrdili, da je Register artroplastike Valdoltra lahko učinkovita strokovna podlaga za Register endoprotetike Slovenije.The number of patients with total hip replacements (THRs) and total knee replacements (TKRs) has increased. The materials which prostheses are made of, release particles with possible carcinogenic effect. The purpose was to investigate the influence of the implant itself and its specific features ─the bearing surface and the material of the stem of THRs itself, and the combination of the material of femoral and tibial components of TKRs, and finally the use of bone cement ─on cancer incidence.
In the retrospective cohort study we identified 11.230 patients with total hip and knee replacements (THKRs), performed at the Valdoltra Orthopaedic Hospital from September 1st 1997 to December 31st 2009. The patient data were linked to the national cancer and population registries. The standardized incidence ratios (SIR) and the Poisson regression relative risks (RR) were calculated for all and specific cancers.
The general cancer risk in our cohort was comparable to the population risk. The united cohorts showed even lower risk. In comparison with the whole population the risks of prostate cancer and of kidney cancer were higher in the THRs cohort. In the same cohort there were lower risks of hematopoietic and lymphatic tumors, and the risks of gastrointestinal and lung cancers. The risk for all cancers combined as well as for the prostate and skin cancers, shown by Poisson analysis, was higher in the metal-on-metal (MoM) group compared to nonMoM group. The risk of kidney cancer was higher in TKRs cohort. However, there was a lower risk of gastrointestinal and lung cancers. The risk of prostate cancer was statistically significantly higher in cemented TKRs. The Poisson analysis did not show significant differences between TKRs features.
The risk of prostate, kidney and central nervous system cancers was higher in the united THKRs cohort. In this group, there were lower risks of hematopoietic and lymphatic tumors, and the risks of gastrointestinal, lung, pancreatic and skin cancers. The risk for all cancers combined as well as for lung and skin, shown by Poisson analysis, was lower in patients with only TKRs. The Poisson analysis did not show significant differences between patients with both, THR and TKR, and those with only THRs.
We found a positive association between metal-on-metal bearings of the THRs, and specific cancers. That is why the orthopedic surgeon should thoroughly reconsider the decision of implanting the THR with this kind of bearing couple. In this study, we also confirmed that the Valdoltra Arthroplasty Registry can be an effective and professional template for the proposed National Arthroplasty Registry of Slovenia
Zdravstvena nega hematološkega bolnika po presaditvi krvotvornih matičnih celic z boleznijo presadka proti gostitelju
Get PDFStomach cancer burden in Slovenia with the estimation of the fraction attributable to high salt intake and low consumtion of fruits and vegetables
Get PDFInfluence of changes in parameter estimates within the Tyrer-Cuzick model on the calculation of individual breast cancer risk
Get PDFTyrer-Cuzickov model napoveduje tveganje za raka dojk v določenem časovnem obdobju, natančneje verjetnost, da posameznica zboli za rakom dojk do neke starosti, če do sedaj še ni zbolela. Model sloni na populacijski funkciji preživetja in funkcijah preživetja nosilcev mutacij genov BRCA1 in BRCA2. Segregacijski del modela upošteva starost posameznice in genetske dejavnike tveganja, ki jih pridobimo iz družinske anamneze raka dojk in jajčnikov ali genetskega testiranja. V regresijskem delu modela upoštevamo še ostale osebne dejavnike tveganja, kot so starost ob menarhi, rojstvo otrok, starost ob rojstvu prvega otroka, menopavzni status, prejemanje hormonske nadomestne terapije, gostota dojk idr.
Avtorji Tyrer-Cuzickovega modela so v program IBIS Risk Evaluator v8 vključili tudi incidenco raka dojk v slovenski populaciji. V magistrskem delu nas je zanimalo, ali sprememba populacijske funkcije preživetja in sprememba funkcij preživetja nosilcev mutacij genov BRCA1 in BRCA2 prinese strokovno pomembne razlike v izračunu tveganja za raka dojk.
Podrobno smo preučili članka o Tyrer-Cuzickovem modelu, v katerih marsikateri del modela ni natančno razložen. V programskem okolju R smo implementirali izračun tveganja za raka dojk in primerjali izračune tveganja po programu IBIS Risk Evaluator v6 z našimi izračuni. Implementacija modela nam je omogočila, da smo spremenili ocene parametrov znotraj modela, natančneje funkcije preživetja splošne populacije in nosilcev mutacij genov BRCA1 in BRCA2. Razlike v izračunu tveganja samo preučili na vzorcu 350 posameznic, ki so bile vključene v preventivno obravnavo v Centru za bolezni dojk in torej še niso zbolele za rakom dojk. Primerjali smo porazdelitev tveganj in porazdelitev posameznic v splošno, zmerno ter visoko kategorijo ogroženosti z rakom dojk. S pomočjo paketa Shiny smo v programskem okolju R ustvarili interaktivno spletno aplikacijo za izračun tveganja za raka dojk.
Pokazali smo, da pri spremembi populacijske funkcije preživetja z britanske na slovensko pride do strokovno pomembnih razlik, medtem ko sprememba funkcij preživetja nosilcev mutacij genov BRCA1 in BRCA2 ne prinese strokovno pomembne razlike v porazdelitvi tveganj ali v porazdelitvi posameznic v kategorije ogroženosti.
V spletno aplikacijo za izračun tveganja za raka dojk vnesemo osebne dejavnike tveganja za raka dojk in anamnezo raka dojk ter jajčnikov v družini. Aplikacija poda izračun osebnega in populacijskega desetletnega tveganja za raka dojk ter verjetnosti, da je oseba nosilka mutacije gena BRCA1 ali BRCA2. Podatke o posameznici in njenem tveganju za raka dojk shranimo v Excelovo datoteko, kar nam omogoča lažjo nadaljnjo analizo podatkov.The Tyrer-Cuzick model predicts the risk of developing breast cancer in a certain age interval, i.e. the probability of developing breast cancer until a certain age if one has not yet developed breast cancer. The model is based on the population survival function and the survival functions of BRCA1 and BRCA2 gene mutation carriers. Segregation part of the model includes age and genetic risk factors obtained from the individual\u27s family history of breast and ovarian cancer or results of genetic tests. The regression part of the model considers the other personal risk factors such as age at menarche, age at first childbirth, menopausal status, receiving hormone replacement therapy, breast density, etc.
In the program IBIS Risk Evaluator v8, authors of Tyrer-Cuzick model included also the incidence of breast cancer in Slovenian population. In this master\u27s thesis, we were interested whether changing population survival function and survival functions of BRCA1 and BRCA2 gene mutation carriers brings clinically significant differences in the calculated risk of developing breast cancer.
We have studied two articles on the Tyrer-Cuzick model, where several parts of the model are not explained in detail. We implemented the model in R software environment and compared risk values according to the IBIS Risk Evaluator v6 program with our calculations. The implementation of the model gave us the ability to change the estimates of the parameters within the model, more precisely the population survival function and the survival functions of the BRCA1 and BRCA2 gene mutation carriers. Differences in risk calculation were examined on a sample of 350 individuals who were included in a preventive screening at the Breast Disease Center and had not yet been diagnosed with breast cancer at the time of screening. We compared the distributions of risk of developing breast cancer and the distribution of individuals into the general, moderate, and high risk category for breast cancer. With the use of the package Shiny, we created an interactive web application in the R software environment for calculating the risk of developing breast cancer.
We showed that differences in risks are clinically significant if we change the population survival function from British to Slovenian, whereas the change in the survival functions of BRCA1 and BRCA2 gene mutation carriers did not lead to clinically significant differences in the distribution of risk or the distribution of individuals into risk categories.
Our application for calculating the risk of developing breast cancer enables entering information about personal risk factors for breast cancer and family history of breast and ovarian cancer. The application returns an estimate of the risk of developing breast cancer in a 10 year period and the probability that the individual is a BRCA1 or BRCA2 gene mutation carrier. Data on the individual woman and her risk can be saved in an Excel file, which enables further data analysis
Advances in Cancer Data and Statistics
No full textCancer registries—both population- and hospital-based—collect data on cancer patients, including diagnoses, treatments, and outcomes. These data serve not only to track the cancer burden and trends but also to evaluate the effectiveness of cancer control efforts. Beyond their traditional uses, registry data are increasingly being applied in cancer epidemiology, public health, healthcare research, and clinical practice. This broader application is driving improvements in data infrastructure, statistical methodologies, and analytical approaches. Expanding the linkages between cancer registries and non-health databases will present new opportunities to explore the risk and prognostic factors influencing cancer outcomes. This Special Issue highlights the current progress and emerging trends in cancer epidemiology, emphasizing innovative uses of cancer registry data as well as the development of new epidemiological and statistical approaches
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