[Possibilities and prospects of the development of an automated cancer registry network system].
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Biomedical subjects
Publications and source records attributed to N N Vinogradova.
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AIM: To improve early diagnosis of renal carcinoma (RC) in the course of check-ups. MATERIAL AND METHODS: Regular checkups performed in 1980-1999 detected 715 cases of renal carcinoma. Among the patients were 452 male (60.2%) and 263 female (39.8%) patients. Mean age was 66 years. Screening methods for healthy examinees and risk group examinees, RC incidence rate, 1 year lethality and survival were assessed. RESULTS: Mean RC incidence rate in men was 80.9, in women 34.9 per 100,000. Early diagnosis of RC stage I and II made up 58.4 in men and 59.4% in women. Significantly more patients with RC stage I and II were diagnosed at checkup than among those seeking medical advice. 5-year corrected survival in males was 80%, 10-year survival--74%, in females--84 and 80%, respectively. CONCLUSION: Check-up raised early diagnosis of RC stage I and II up to 82.3%. This, in its turn, improved survival of RC patients.
982 case records of the patients with cancer of the stomach (CS) were analyzed for the period from 1980 to 1997. Among them tumor of stage IV made up 21.1% (autopsy data were not taken into account). The main cause of late CS diagnosis was defective system of screening for CS. The survival rate of the patients with CS stage IV did not exceed 2 years. Chemotherapy in inoperable patients allowed a reliable increase of 7% to 26% in corrected survival rate during one year. Palliative operations increase the values of 1 year survival rate of patients with CS from 5% to 60%.
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Results of diagnosis and treatment of gastric cancer according to the program of screening in permanently followed-up population group during 1980-1995 years, developed and introduced into practice of Medical Center of the President of Russia Administration, are analysed. According to the Cancer Register data through this period, total number of cases of this disease comprised 896 patients. Active revealing of cancer of the stomach made up 61%. The causes of advanced disease in patients with stage IV cancer have been thoroughly analysed, their share being high enough--23.5%. Due to achieved level of early diagnosis (I stage) the possibility of only radical surgical treatment rises up to 83.5%, allowing to receive a high percent of corrected 5-year (92-93%) and 10-year (83-88%) survival. Every third patient with cancer of the stomach succumbs due to causes unconnected with the progression of the disease.
In 1980-1995 the authors observed 739 cases of lung cancer. A special screening program on early diagnosis of lung cancer has been developed. The centralized system of the information collection, storage and processing of all the cancer cases, follow-up of all the registered cases provided observed and corrected 5- and 10-year survival. Efficacy of screening and early treatment is shown.
Gastric cancer is one of the most common diseases in patients over 70 years of age. It makes 14.4% of all malignant tumours, 15.7%--if oncohaematological cases are not included, and 19.8%--if oncohaematological cases and skin basaliomas are not considered. Most frequently the 1st stage of cancer was found in patients over 70 years of age (41.8%). The 4th stage of cancer is most commonly detected in patients of the oldest age group (34.5%). The program for early detection makes it possible to increase significantly timely diagnosis of gastric cancer (up to 80% in stages I and II). The screening program provides the detection of early stages of gastric cancer in 40.6% of the patients with the 1st stage of gastric cancer. 5-year survival is 30.2%, the corrected rate--40.3%. The rates of 5-year survival (both--observed and corrected) are the highest in patients with the 1st stage of the disease. The 5-year survival rate in patients aged 50-59 years is 65.5%; whereas in patients over 70--16.0% and 27.7% (observed and corrected, respectively).
The authors have conducted an epidemiological study for multiple myeloma morbidity and mortality among 80,000 patients of the Medical Center examined in 1988-1995. Myeloma was diagnosed in 65 cases. Standard incidence rate was 4.09, 3.18 and 3.5 per 100,000 for myeloma in males, females and both sexes, respectively. Standard mortality was 2.76 and 1.73 per 100,000 for males and females, respectively. The above rates do not differ much from those of other countries. In terminal myeloma renal insufficiency occurred in 39 of 41 cases. In 8 cases chronic pyelonephritis was an independent course of renal failure thus indicating the importance of its persistent treatment.
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A special program aimed at detecting skin cancer at early stages was worked out and launched into use in 1989. It provides for a series of measures for primary examination and subsequent follow-up of population. Dermatologists conducted examinations of persons at high risk 2-4 times a year depending on the disease. They were joined by oncologists, whenever required, and morphological examinations were sometimes carried out. The group at high risk for skin cancer included patients older than 50, with the following pathologies: (I) Obligate precancerous dermatites: Bowen's syndrome, erythroplasia of Queyrat, Paget's disease (extramammary localization), intraepidermal epithelioma of Jadassohn, late-onset radiation dermatitis, early childhood-Kaposi's disease, Manganotti's chilitis and verrucous precancer of the lip; Optional precancerous dermatosis: childhood-onset epidermodysplasia veruciformis, actinic keratosis, cutaneous horn, keratoacanthoma, carcinoid papillomatosis of Gottron, giant condyloma of Buschke-Lowenstein, leukoplakia and limited precancerous hyperkeratosis of the lip's red edge; (2) Dermatoses involving pathological regeneration: eruthematosis, lupus tuberculosis, psoriasis (more than 15 years old), trophic ulcers, extensive scars (particularly, those caused by burns), chronic ulcerative pyoderma and pyoderma vegetans; (3) Hemorrhagic diathesis on the surface or fundus of neoplasm; (4) Consolidation at neoplasm base; (5) Absence of complaints; (6) Resistance to therapy.
Information on kidney carcinoma case rate among a contingent kept under continuous observation and subjected to regular medical examination is discussed. The authors had 390 cases under observation which allowed them to estimate the case rate according to the patients' sex and age group. A 5.8-fold increase of the case rate in a period of 15 years was found. In males it increased from 0.31:1000 to 1.8:1000, and was highest in the 50-59-year age group. Among females the kidney carcinoma case rate increased 2.5-fold in 15 years; it was highest among females aged over 70 (3.20:1000) and was 2.6 times higher than the case rate in the 50-59-year age group and 4.5 times higher than that in the 40-49-year age group (0.32:1000 and 1.44:1000, respectively). Kidney carcinoma takes a steady 6th place in the morbidity structure. Ultrasonic diagnosis of kidney carcinoma is the most effective method. The authors point out that study of the case rate of malignant kidney tumors is very important for elaborating the volumes of examination.
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