Theoretically, there is a real prospect for full eradication of cervical cancer by cytology screening. In several countries the burden of cervical cancer significantly decreased due to regular screening of the population. In Hungary, the complex "gynecological screening", including colposcopic examination, has a long tradition, however, the efforts of several decades are not reflected in the mortality: about 500 women are killed by cervical cancer each year. The screening protocol represents a compromise between the traditional "gynecological screening" and the internationally recommended organized screening: taking sample for cytology is an essential element of the gynecological examination. The National Public Health Programme has established the technical and organizational preconditions of an organized screening programme. The early experiences with the "call-and-recall" organized screening -- started at the end of 2003 -- are unfavourable, because the compliance rates are unacceptably low. The majority of the women receive screening in a traditional way, i.e. outside the programme; another proportion of them simply ignores the invitation, and does not accept the offered screening. To improve the current situation, following the recommendation of "the-state-of-the-art", an attempt is made to intensify the involvement of the primary care personnel. There is a need to revise the current financing system by the political decision-makers in the health field. The access to the screening facilities needs to be improved, the attitude of the medical community changed, and the efficiency of the communication with the public significantly improved.
The "gynecological screening" that is composed of complex gynecological examination including colposcopy and cytological examinations has traditionally been incorporated into the gynecological protocol and practice. Over the past few decades, unfortunately, this screening practice has entrenched in the mind both of the gynecological community and the general public. As a result, the government-supported, organized cervical screening program of the population has come to a standstill. In order to adjust the cervical screening practice to the international public health recommendations in which cytology is the only screening test applied, the authors decided to involve primary care nurses and health visitors in smear taking, and to refer those with abnormal findings to a gynecologist for further clinical examination.
A WHO Nemzetközi Rákkutatási Ügynöksége a közelmúltban adta közre az Európai Rákellenes Kódex negyedik, átdolgozott kiadását. Ebben a rosszindulatú daganatos betegségek előfordulásának mérséklésére szolgáló, személyre szóló tanácsokat 12 pontban foglalja össze. A tanácsok egy része a daganatkeletkezésben bizonyítottan szerephez jutó, többségükben a mindennapi életmóddal összefüggő kockázati tényezők kivédésére szolgál, más része pedig az egészségügyi ellátórendszer által nyújtott szolgáltatások elfogadására buzdít. A szerzők úgy vélik, a Rákellenes Kódex hazánkban ez ideig nem kapott érdeme szerinti nyilvánosságot az egészségügyi szolgáltatók körében. Minthogy az idő előtti halálozásért legnagyobb mértékben okolható nem fertőző idült betegségek nagy hányadának kialakulásá-ban közös kockázati tényezők is részt vesznek, a kódex tanácsai egyszerre szolgálják a keringési rendszer betegségeinek és a daganatos betegségek megelőzésének ügyét. Orv. Hetil., 2016, 157(12), 451-460. Kulcsszavak: életmód, egészségtudatosság, egészségnevelés European Code against Cancer: 12 ways to reduce your cancer riskRecently, the Word Health Organization/International Agency for Research on Cancer published the 4th edition of European Code against Cancer with 12 personal advices on how to diminish the risk of development of cancer. A proportion of advices refers to risk factors which are connected to our everyday lifestyle; an other admonishes to comply with the services offered by the health care system. In Hungary, the European Code has not received adequate publicity so far. As common risk factors play a major role in the development of chronic non-communicable diseases, the advices may contribute to the prevention of both cardiovascular diseases and cancer. A rosszindulatú daganatok által okozott, az egyes személyekre és a társadalom egészére háruló betegségteher egyre súlyosabb. 2012-ben világszerte 14,1 millió új megbetegedést regisztráltak, és 8,2 millió személy halt meg rákbetegségben [1]. Európában, 2012-ben (nem számítva a bőr nem festékes daganatait) a rákos megbetegedések számát 3,45 millióra, a bekövetkezett halál-esetek számát 1,5 millióra becsülik [2]. A rák miatt bekövetkezett halálozás -a szív-és érbetegségek mögött -a halálokok között a második helyen áll. Az EURO-STAT adatközlése szerint a 2000−2010 közötti évtized-ben az EU-28 országaiban a korábbi évekhez viszonyítva a rák okozta halálozás 7,2%-kal emelkedett [3]. Magyarországon 2012-ben a Nemzeti Rákregiszter 65 116 új megbetegedést, a Központi Statisztikai Hivatal pedig 33 790 halálesetet jelentett. A rákbetegség által okozott emberi szenvedés és a társadalomra nehezedő teher szá-mokkal nem fejezhető ki. KeywordsA rák okaira vonatkozó ismereteink mindmáig hiányo-sak; csak a betegség kialakulásában szerepet játszó kockázati tényezőket ismerjük. Mai tudásunk szerint a daganatos betegségeknek, így az azokból következő halálozásnak csak kis hányada vezethető vissza genetikailag meghatározott, tehát öröklődő, "belső" tényezőkre, jelentős hányadát külső, környezeti tény...
Following the recommendation of the Council of the European Union, almost all governments made a policy statement on the introduction of cytology-based cervical screening for the health care system. However, the status of implementation is uneven. In the majority of the developed countries an organised model of screening recommended by the relevant international professional organisations are in use, while occasional screening is applied in some other countries. Screening strategies (i.e. age range, screening intervals), coverage of the target population, and compliance rates vary significantly. The screening activities are in a planning phase is some less developed Central-Eastern and South European countries. In Hungary, the transition from the traditional "gynaecological cancer screening" into the recommended organised cervical screening is in progress; the active involvement of the district health visitors in the cervical screening would provide further improvement.
Hungary carries a heavy burden of cancer. At present, the organized screening of symptomless people seems to be the most promising strategy. According to the state-of-the art, those are the mammography-based breast screening, the cytology screening of cervix uteri, and the colorectal screening using immunochemical detection of the fecal occult blood satisfy the criteria of organized screening. The screening for cancers of the oral cavity, and the methods suitable for early detection of prostate cancer are not based on epidemiological evidence, therefore can only be applied opportunistically, as part of the medical practice. For the time belong, there are no suitable methods for detection of early lung cancer. The organized screening which applies personal call-and-recall has been incorporated in the National Public Health Programme. The concepts underlying the organized screening are fully in accordance with the recommendations by the European Union. The Chief Medical Officers' Office (OTH) is being charged with the organization, coordination and evaluation of organized screening programmes for the above screening modalities. In the past few years, an appropriate system for administration and information (including a country-wide screening registry) has been established, in addition to a regional coordination system based on the institutes of National Public Health and Medical Officers' Service (ANTSZ) and a nation-wide network of mammography and cytological laboratories, capable of meeting the requirements. This publication is to summarize the problems yet to be solved and the results expected from the organized screening programmes.
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