Успехи в ранней диагностике и лечении злокаче-ственных новообразований (ЗН) привели к более дли-тельной продолжительности жизни онкологических больных, что является индикатором эффективности системы здравоохранения в целом. В России 5-летняя выживаемость онкологических больных выросла с 49,1 % в 1998 г. до 52,9 % в 2015 г. [1,2]. Эти данные совпадают с европейскими, согласно которым средняя 5-летняя выживаемость в 1988-1999 гг. немного превышала 50 % [3]. Данные самого большого кооперативного иссле-дования в Европе (EUROCARE) свидетельствуют об из-менениях в диагностике, лечении ЗН, а также в реа-билита ции онкологических больных, что существенно повлияло на их выживаемость. С 1999-2001 по 2005-2007 гг. значительные успехи были достигнуты в вы-живаемости больных раком предстательной железы (81,7 %), неходжкинской лимфомой (НХЛ) (60,4 %), раком прямой кишки (57,6 %). Показатели сильно ва-
The number of healthcare workers is over two million in Russia. Many of them are exposed to hazardous physical, chemical and biological occupational factors acting along with psychological strain. The results of large epidemiological studies carried out in various countries revealed greater cancer risk in physicians and nurses: cancer of the breast, skin, brain and other sites. Higher cancer risk of lung, breast, uterine, ovary, brain is considered to be associated with ionizing radiation. The female healthcare workers who handle antineoplastic drugs showed a greater risk of birth defects in offspring, spontaneous abortions and breast cancer. In Russia, the growing number of accidents among healthcare workers following transmission of infection by carcinogenic biological factors such as HBV and HIV is observed. Higher risk of reproductive impairments, hyperplasia of the breast and uterine tissues, breast cancer are revealed in nurses working the night shift. In Russia, there is lack of epidemiological studies of cancer risk among healthcare workers, the number of medical personal exposed to occupational carcinogens is unknown. That all does not show the actual situation in our country and does not allow setting priorities in cancer prevention among medical workers.
The current estimates of the contribution of the environmental contamination to cancer mortality range from 1 to 20 %, being a function of the ecological conditions, the density of industrial enterprises, occupational composition of the population, and others. Assessment of the impact of environmental contamination on cancer risk includes: •setting research priorities on the local, regional, and on the all-Russian levels; •the selection of the research that may be maximally socially profitable; •the choice of the research method that the most adequately meets the research objectives; •systemic analysis of the planed research to determine the availability of the resources, personnel, and information; •monitoring of atmospheric pollutions with analysis of the fraction composition of the particulate matters; •coordination of available data basis on environment and the population health conditions; •the implementation of the of molecular biology to determine prenosological manifestation of carcinogenesis and development of fine and diverse research methods on relationships between the environment and cancer risk.For effective implementation of the research objectives aimed to decrease the impact of hazard factors with special reference on cancer risk in the Russian population, it is necessary: to create training personnel capable of providing epidemiologic studies, using up-to day methods, publication of methodological materials, text books, and sufficient funding of studies.
Based on the results of cancer monitoring in the staff of a large Cancer Center cancer risk research was performed using the method of nested “case–control” study within a cohort. The cohort comprised 7269 persons who were followed up through the cancer-register of the Cancer Center. Four hundred eighty-four (139 male and 345 female) cancer cases were revealed. For every case a control individual of the same sex and age was randomly selected from the staff who had no cancer as of January 1, 2019. A statistically insignificant increase in the overall cancer risk was observed in male operational staff (odds ratio (OR) being 1.14, 95 % confidence interval (CI) 0.64–2.05) and other doctorsclinicians (OR 1.36; 95 % CI 0.68–2.73). In a combined group of male clinicians and experimenters 4 cases of thyroid cancer were revealed and no members of this group were present in controls. An insignificantly increased risk of hemoblastoses, skin and brain cancer were also observed in this group. In the female stuff an insignificantly increased risk of all cancer sites combined was recorded in operational group (OR 1.28; 95 % CI 0.58–2.87) and nurses (OR 1.21; 95 % CI 0.85–1.72), as well as in the female stuff of experimental scientific units (OR 1.31; 95 % CI 0.90–1.92). An insignificant increase in breast cancer risk was observed in women clinicians and experimenters, exposed to the occupational factors. Female employees of experimental scientific units demonstrated a statistically significant increased risk of digestive organs cancer (OR 2.95; 95 % CI 1.14–7.67) and hemoblastoses (OR 5.71; 95 % CI 1.05–31.07). The results of the study demonstrate the need for epidemiological monitoring and data accumulation on cancer risk in different groups of medical workers.
Scientific research in recent years has revealed a significant role of the human microbiome in carcinogenesis. These data served as a rationale for the inclusion of polymorphic microbiomes in the key characteristics of carcinogenesis as an important mechanistic determinant of cancer, in addition to other fundamental biological processes manifested during multi-stage carcinogenesis. The microbiome of the gastrointestinal tract is most actively involved in the pathogenesis of malignant neoplasms of the digestive system due to changes in the quantitative and qualitative composition of the microbiota, and increase in the production of genotoxic bacterial metabolites as factors of carcinogenesis. This review also addresses the changes in the microbiome in lung cancer, associated mainly with the production of short-chain fatty aicids, and in breast and endometrial cancers with specific changes in the composition of the bacterial community towar)ds species involved in the metabolism of estrogen precursors. The probable mechanisms of microorganisms participation in the development of prostate cancer (the effect of lipopolysaccharides, antibiotics and deconjugated estrogen) are considered.Data on the relationship between the composition and metabolic characteristics of the microbiome in various cancer sites open up perspectives for its use in the diagnosis, treatment and prevention of malignant neoplasms and justify the need for further research in this area.
There are considered special social and economic aspects of the epidemiology of Helicobacter pylori. These aspects acquired the particular importance for the last time due to the fact that the provision of the people with pure water has been becoming the focus of the attention of geopolitical and socio-economic interests in a number of countries. The availability ofpure drinking water serves a marker of the socio-economic state of the territory and the population living there. In Russia where different climatic conditions are deposited by considerable regional differences in the conditions of communal services caused both by various level of the socio-economic development of the territory, the supplementation with pure drinking water serves as the social determinant of the ecological conditions of the population’s life. This particularly has impact on the unfeasible technical state of the water distribution systems, microorganism ecology of which can substantially affect public health. The performed by authors a specialized screening ofpresented at the official web site of the joint-stock company «Mosvodokanal» current data concerning the quality of drinking water consumed by 2500 Moscovites, tested for the Helicobacter pylori infection revealed no deviations from the sanitary standards in the water received by the consumers. Along with that, the comparison of the map documents of the distribution of the Helicobacter pylori infection in Moscow with the distribution of citizens’ complaints of the decline of the quality of tap water has revealed a territorial fastening of the high values of the population infection rate of n^ylori and the urban sites with the greatest number of complaints. In the microbial ecology of water-distribution systems there are tightly aligned problems of their epidemiological safety, technical state and economic damage caused by corrosion as a result of microbiotic activity. In contrast to acute bacterial and viral infections which are deemed of the greatest importance when assessing the sanitary condition of water sources and water-distribution systems, the consequences of infection with H. pylori may not be manifestedfor a long time but some years later they may be manifested as serious chronic diseases (from gastritis to adenocarcinoma of the stomach and a wide range of extraintestinal pathologies), which causes great social and economic losses. Thus, the socio-economic aspect of the epidemiology of helicobacteriosis includes at least two components: the technic - the maintenance of the feasible technic and sanitary state of the water distribution systems and the medico-social - expenditures for screening and treatment of infected patients. In total they are an inseparable part of the prevention of socially-important diseases in the public health system.
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