[All you should know about intraductal papillary mucinous neoplasm (IPMN)]

In an increasingly aging Western society, the treatment of the malignant diseases became the greatest challenge of medicine in the 21st century. Among these, pancreatic ductal adenocarcinoma (PDAC) is of particular interest which, in spite of modern oncology treatments, is a malignancy with an unfavorable prognosis. Underlying the poor survival rates, relatively late-stage recognition, limitations of surgical removal, and ineffective oncological treatments can be mentioned. Its importance is further enhanced by its growing incidence. As a consequence of these reasons, there is an increasing effort for the early detection of invasive tumors, the central part of which is the detection and clinical addressing of precancerous conditions in the pancreas. Of these, intraductal papillary mucinous neoplasia (IPMN) has a paramount importance. In this review, we present the latest evidence-based knowledge of the etiological factors, epidemiological features, pathomorphological manifestations, most up-to-date diagnosis and treatment of IPMN.

[Quality and performance indicators of colorectal cancer screening pilot program in Csongrád County, Hungary]

Colorectal cancer is a major social and economic burden for developed countries. Our analysis aimed to evaluate the quality and performance indicators of colorectal cancer screening pilot program. The colon cancer screening pilot program was carried out in 2015 involving an average-risk population aged 50-69 in Csongrád county, Hungary. The analysis involved data from the Communication module of the Office of the National Chief Medical Officer. We recorded 21.1% invitation rate (22,130 persons), 51.2% attendance and 47.3% participation rates, with a higher female participation rate (p<0.001). Participation rate was far lower than the expected 65%. The rate of non-negative results (13.1%) exceeds the international reference rate. Participation rate on the colonoscopy screening (90.1%) reached the expected value. Compared to the number of actual colonoscopies performed, adenomas were found in 2.5% and malignant lesions in 0.3% of the cases. Our results highlight the deficiencies regarding the follow-up and data recording of screening results in the IT system as well as the lack of communication between the GP and the diagnostic laboratories.

Mitochondrial function after associating liver partition and portal vein ligation for staged hepatectomy in an experimental model

BACKGROUND

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a two-stage strategy to induce rapid regeneration of the remnant liver. The technique has been associated with high mortality and morbidity rates. This study aimed to evaluate mitochondrial function, biogenesis and morphology during ALPPS-induced liver regeneration.

METHODS

Male Wistar rats (n = 100) underwent portal vein ligation (PVL) or ALPPS. The animals were killed at 0 h (without operation), and 24, 48, 72 or 168 h after intervention. Regeneration rate and proliferation index were assessed. Mitochondrial oxygen consumption and adenosine 5'-triphosphate (ATP) production were measured. Mitochondrial biogenesis was evaluated by protein level measurements of peroxisome proliferator-activated receptor γ co-activator (PGC) 1-α, nuclear respiratory factor (NRF) 1 and 2, and mitochondrial transcription factor α. Mitochondrial morphology was evaluated by electron microscopy.

RESULTS

Regeneration rate and Ki-67 index were significantly raised in the ALPPS group compared with the PVL group (regeneration rate at 168 h: mean(s.d.) 291·2(21·4) versus 245·1(13·8) per cent, P < 0·001; Ki-67 index at 24 h: 86·9(4·6) versus 66·2(4·9) per cent, P < 0·001). In the ALPPS group, mitochondrial function was impaired 48 h after the intervention compared with that in the PVL group (induced ATP production); (complex I: 361·9(72·3) versus 629·7(165·8) nmol per min per mg, P = 0·038; complex II: 517·5(48·8) versus 794·8(170·4) nmol per min per mg, P = 0·044). Markers of mitochondrial biogenesis were significantly lower 48 and 72 h after ALPPS compared with PVL (PGC1-α at 48 h: 0·61-fold decrease, P = 0·045; NRF1 at 48 h: 0·48-fold decrease, P = 0·028). Mitochondrial size decreased significantly after ALPPS (0·26(0·05) versus 0·40(0·07) μm² ; P = 0·034).

CONCLUSION

Impaired mitochondrial function and biogenesis, along with the rapid energy-demanding cell proliferation, may cause hepatocyte dysfunction after ALPPS. Surgical relevance Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a well known surgical strategy that combines liver partition and portal vein ligation. This method induces immense regeneration in the future liver remnant. The rapid volume increase is of benefit for resectability, but the mortality and morbidity rates of ALPPS are strikingly high. Moreover, lagging functional recovery of the remnant liver has been reported recently. In this translational study, ALPPS caused an overwhelming inflammatory response that interfered with the peroxisome proliferator-activated receptor γ co-activator 1-α-coordinated, stress-induced, mitochondrial biogenesis pathway. This resulted in the accumulation of immature and malfunctioning mitochondria in hepatocytes during the early phase of liver regeneration (bioenergetic destabilization). These findings might explain some of the high morbidity if confirmed in patients.

[Quality and performance indicators of the pilot program for cervical cancer screening by health visitors]

The aim of our analysis was the assessment of the qualitative and performance indicators of a pilot program for health visitors' cervical cancer screening. The analysis involved the data from the Communication module of the Office of the National Chief Medical Officer. In the examined period (October, 2013 - September, 2015) the participation indicators of women aged 25-65, the prevalence rates of human papillomavirus and the cervical intraepithelial neoplasia were determined. In the screening period, the call-in rate was 32.45% nationally, with the compliance of 8.26%. The occurrence of a positive result was 1.85% nationally, with the highest rate in Hajdú-Bihar county (7.24%). HPV infection was detected in 113 cases (0.45%) nationally, HPV prevalence was 37.44/100,000 persons. The willingness for participation among women was low concerning the indicators. Their raising should be an emphasized task for public health in favor of reducing mortality from morbidities.

[Assessment of the pilot program for cervical cancer screening by health visitors]

INTRODUCTION

Within the tender (6.1.3.A-13/1-2013-0001) supported by the European Union, we wished to involve health visitors into the organized cervical cancer screening program.

AIM

The aim of our survey was to assess the satisfaction of health visitors, instructors, and that of the teaching aids. Furthermore, we wished to assess whether the teaching materials met the expectations.

METHOD

Satisfaction of the health visitors was assessed by a survey, in four groups of questions. These involved the assessment of the instructors, the teaching aids, evaluation of the further training day, and the compliance with the knowledge of training. Period for completion of the questionnaires lasted from October to December in 2014. We used descriptive statistics for data evaluation.

RESULTS

Data of 2148 health visitors was evaluated. They rated the performance of gynecologist-obstetricians 4.65, that of health visitors 4.61, that of public health professionals 4.56, and that of IT specialists 4.52. 98% of the teaching aids were useful for them and the acquired knowledge was appropriate with their expectations.

CONCLUSION

The health visitors were satisfied with the theoretical instruction within the pilot program. The professionally well prepared health visitors may contribute to the success of the cervical cancer screening program. Orv. Hetil, 2017, 158(12), 461-467.

[Attendance of the fourth (2008-2009) screening round of the Hungarian organized, nationwide breast cancer screening program]

INTRODUCTION

Organised, nationwide screening for breast cancer with mammography in the age group between 45 and 65 years with 2 years screening interval started in Hungary in January 2002.

AIM

The aim of this study is to analyze the attendance rate of nationwide breast screening programme for the 2008-2009 years.

METHOD

The data derive from the database of the National Health Insurance Fund Administration. The ratio of women in the age group 45-65 years was calculated having either a screening mammography or a diagnostic mammography in the 4th screening round of the programme.

RESULTS

In the years 2000-2001, 7.6% of the women had an opportunistic screening mammography while in 2008-2009 31.2% of the target population had screening mammography within the organized programme. During the same periods 20.2% (2000-2001) and 20.4% (2008-2009) of women had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.6% (2000-2001) to 50.1% (2008-2009). The attendance rate failed to change between 2002 and 2009.

CONCLUSIONS

In order to decrease the mortality due to breast cancer, the attendance rate of mammography screening programme should be increased. Orv. Hetil., 154(50), 1975-1983.

Liver regeneration after different degrees of portal vein ligation

BACKGROUND

Selective portal vein ligation (PVL) is followed by ipsilateral atrophy and contralateral hypertrophy of the liver lobes. Although the atrophy-hypertrophy complex induced by PVL is a well-documented phenomenon, the effect of different degrees of extended portal vein occlusion on liver regeneration is not known. The aim of this study was to assess the effects of different degrees of portal occlusion on portal pressure and liver regeneration.

MATERIALS AND METHODS

Male Wistar rats (n = 96; 220-250 g) were randomized into three groups and underwent 70%, 80%, or 90% portal vein ligation, respectively. The portal pressure was measured immediately and 24, 48, 72, 120, and 168 h after PVL (n = 6/group/time point). The hepatic lobes and the spleen were weighed, and liver regeneration ratio was calculated. Changes in liver histology and the mitotic activity were assessed on hematoxylin-eosin stained slides.

RESULTS

Higher degree of portal occlusion triggered a stronger regenerative response (regeneration ratio of PVL 70%168h = 2.23 ± 0.13, PVL 80%168h = 3.11 ± 0.37, PVL 90%168h = 4.68 ± 0.48) PVL led to an immediate increase in portal pressure, the value of which changed proportionally to the mass of liver tissue deprived of portal perfusion (PVL 70%acute = 17 ± 2 mm Hg, PVL 80%acute = 19 ± 1 mm Hg, PVL 90%acute = 26 ± 4 mm Hg). Findings in histology showed necro-apoptotic lesions in the atrophic liver lobes and increased mitotic cell count in the hypertrophic lobes. The mitotic cell count of PVL 90% peaked earlier and at a significantly higher value than of PVL 70% and PVL 80% (PVL 9024h%: 96.0 ± 3.5 PVL 70%48h: 64.0 ± 2.1, PVL 80%48h: 56.3 ± 4.0). The mitotic index after 24 h showed a strong correlation with the acute portal hypertension.

CONCLUSIONS

A higher degree of portal vein occlusion leads to a greater regenerative response, presumably triggered by the proportional increase in portal pressure, which supports the role of the so-called "blood-flow" theory of PVL-triggered liver regeneration.

[Inequalities in cervical screening practices]

Theoretically, the cytology-based cervical screening is capable of early detection of precancerous epithelial lesions of cervix uteri and its cancer, and of early referral to treatment. In this way, screening can inmprove the quality of life of the patients and reduce mortality from the target disease. Unfortunately, this often remains unexploited, because there might be inequalities on both "supply" and "demand" side of screening. In addition to the geopolitical situation of a country, inequalities might result from differences in the health care systems, and heavy access to the screening services. On the other hand, the socioeconomic status, the health-conciousness of the target population, and their knowledge and information of the benefits and potential harms of screening examination might have a bearing on the acceptance or refusal of the offered screening. Efforts need to be made to increase the uptake of cervical screening programmes.

Alterations in hepatic lobar function in regenerating rat liver

BACKGROUND

Ligation of a branch of the portal vein redirects portal blood to nonligated lobes resulting in lobar hypertrophy. Although the effect of portal vein ligation on liver volume is well documented, the parallel alterations in liver function are still the subject of controversy. Our aim was to assess the time-dependent reactions of regional hepatic function to portal vein ligation by selective biliary drainage.

METHODS

Male Wistar rats (n = 44) underwent 80% portal vein ligation. Before the operation as well as 1, 2, 3, 5, and 7 d after circulation, morphology and function (laboratory blood test; hepatic bile flow; plasma disappearance rate of indocyanine green; and biliary indocyanine green excretion) of the liver were examined.

RESULTS

Although portal vein ligation affected liver circulation and morphology to a great extent, serum albumin levels, bilirubin levels, and total hepatic bile flow did not change significantly after the operation. Nevertheless, plasma disappearance rate and biliary indocyanine green excretion indicated a temporary impairment of total liver function with the lowest value on the second day and normalization by the fifth day. Bile production and biliary indocyanine green excretion of ligated lobes decreased rapidly after the operation and remained persistently suppressed, whereas the secretory function of nonligated lobes--after a temporary decline--showed a greater increase than the weight of the lobes.

CONCLUSIONS

Portal vein ligation induced temporary impairment of total liver function, followed by rapid recovery mainly by reason of increase in the function of nonligated lobes. Functional increase in nonligated lobes was more pronounced than suggested by the degree of volume gain.

Implementation status of cervical screening in Europe

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. Orv. Hetil., 2014, 155(50), 1975–1988.

Factors influencing participation in colorectal screening

Participation of the target population in coloretal screening is generally low. In addition to demographic and socio-economic factors, the health care system and- in particular – family doctors play an important role. Further, the rate of participation is influenced by psychological, cognitive and behavioural factors, too. The paper analyses factors related to colorectal screening behaviour and potential interventions designed to screening uptake. Orv. Hetil., 2014, 155(27), 1051–1056.

Demonstration of metabolic and cellular effects of portal vein ligation using multi-modal PET/MRI measurements in healthy rat liver

Objectives

In the early recognition of portal vein ligation (PVL) induced tumor progression, positron emission tomography and magnetic resonance imaging (PET/MRI) could improve diagnostic accuracy of conventionally used methods. It is unknown how PVL affects metabolic patterns of tumor free hepatic tissues. The aim of this preliminary study is to evaluate the effect of PVL on glucose metabolism, using PET/MRI imaging in healthy rat liver.

Materials and Methods

Male Wistar rats (n = 30) underwent PVL. 2-deoxy-2-(¹⁸F)fluoro-D-glucose (FDG) PET/MRI imaging (nanoScan PET/MRI) and morphological/histological examination were performed before (Day 0) and 1, 2, 3, and 7 days after PVL. Dynamic PET data were collected and the standardized uptake values (SUV) for ligated and non-ligated liver lobes were calculated in relation to cardiac left ventricle (SUV_VOI/SUV_CLV) and mean liver SUV (SUV_VOI/SUV_Liver).

Results

PVL induced atrophy of ligated lobes, while non-ligated liver tissue showed compensatory hypertrophy. Dynamic PET scan revealed altered FDG kinetics in both ligated and non-ligated liver lobes. SUV_VOI/SUV_CLV significantly increased in both groups of lobes, with a maximal value at the 2^nd postoperative day and returned near to the baseline 7 days after the ligation. After PVL, ligated liver lobes showed significantly higher tracer uptake compared to the non-ligated lobes (significantly higher SUV_VOI/SUV_Liver values were observed at postoperative day 1, 2 and 3). The homogenous tracer biodistribution observed before PVL reappeared by 7^th postoperative day.

Conclusion

The observed alterations in FDG uptake dynamics should be taken into account during the assessment of PET data until the PVL induced atrophic and regenerative processes are completed.

[Participation rates in the third round (2006-2007) of the breast cancer screening program in Hungary]

Organised, nationwide screening for breast cancer with mammography in the age group of 45-65 years with 2 years screening interval started in Hungary in January 2002. The aim of this study is to analyse the attendance rate of breast screening programme for the 2006/2007 years, including the analysis of the ratio of screening and diagnostic mammography examinations. The data derive from the financial database of the National Health Insurance Fund Administration (NHIFA) covering the 8 years period between 2000 and 2007. The ratio of women in the age group of 45-65 years was calculated having either a screening mammography or a diagnostic mammography. The analysis was carried out for the years 2000-2001 before and 2006-2007 after the implementation of nationwide organised programme. In the years 2000-2001 7.26% of the women aged 45-65 years had an opportunistic screening mammography while in 2006-2007 29.4% of the target population had screening mammography within the organised programme. During the same periods 19.8% (2000-2001) and 21.8% (2006-2007) of women aged 45-65 years had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.2% (2000-2001) to 49.7% (2006-2007). The attendance of the Hungarian organised breast cancer screening programme slightly declined in 2006-2007 compared to 2002-2003/2004-2005, and to achieve the expected results in mortality decrease a further improvement of the uptake is necessary.

[Gynecological screening or cervical screening? Conflicts between clinical and public health viewpoints]

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.

[Controversial issues in colorectal screening in Hungary: conflict of clinical and public health viewpoints]

In Hungary, mortality rates from colorectal cancer are dramatically high, therefore the reduction by population screening as a public health measure is considered as one of the priorities of National Public Health Program. In the beginning, a human-specific immunological test was applied in the "model programs", as a screening tool, to detect the occult blood in the stool; compliance was 32% in average. However, the objectives of the model programs have not been achieved, because, among other reasons, a debate on the method of choice and the strategy to follow have divided the professional public opinion. In this study the debated issues are critically discussed, being convinced that, at present, population screening seems to be the most promising way to alleviate the burden of colorectal cancer.

The attendance of the second screening period (2004–2005) of the Hungarian organized breast cancer screening program

Célkitűzés: Az országos kiterjedésű, szervezett emlőszűrési program 2002 januárjában indult el Magyarországon a 45–65 év közötti nők számára 2 éves szűrési intervallummal. A dolgozat célja a szervezett emlőszűrési program részvételi mutatóinak meghatározása, beleértve a szűrési és diagnosztikus célú képalkotó emlőfelvételek gyakoriságának elemzését. Adatok és módszerek: Az elemzésben szereplő adatok az Országos Egészségbiztosítási Pénztár finanszírozási adatbázisából származnak, és a 2000–2005 közötti 6 évet ölelik fel. A 45–65 éves nők körében meghatározták azok arányát, akik a szervezett szűrést megelőző két évben (2000–2001), illetve a program első két ciklusában (2002–2003, 2004–2005) akár szűrési, akár diagnosztikai célú képalkotó emlővizsgálaton vettek részt. Eredmények: A szűrési célú képalkotó emlőfelvételen részt vettek aránya (átszűrtség) a 2000–2001-es 7,4%-ról a 2002–2003-as, illetve 2004–2005-ös szervezett emlőszűrési ciklusban 34,0, illetve 29,5%-ra emelkedett. A diagnosztikus célú képalkotó emlőfelvételen részt vettek aránya (átvizsgáltság) pedig ugyanezen időszakokban 19,8%-ról 22,1 (2002–2003), illetve 23,2%-ra (2004–2005) emelkedett. Az országos lefedettség (átszűrtség + átvizsgáltság) ennek megfelelően a szervezett szűrés hatására 26,2%-ról (2000–2001) 53,5%-ra (2002–2003), illetve 50,8%-ra (2004–2005) nőtt a vizsgált kétéves ciklusban a 45–65 év közötti nők esetében. Következtetés: A magyar emlőszűrési program kezdeti részvételi arányai 2004–2005-ben kissé csökkentek; az emlőrák miatti halálozás érdemi csökkentéséhez ennek emelése szükséges.

Cervical screening in Hungary: why does the "English model" work but the "Hungarian model" does not?

A comparison has been made between the English practice and the "Hungarian model" of cervical screening. In England, until 1986, extensive opportunistic screening was the practice, but--as it had no effect on cervical cancer mortality--afterwards, the screening policy was changed to be strictly in line with international recommendations. On the other hand, in Hungary, the "old practice" has been petrified: gynaecologists are the "gatekeepers", a "gynaecological examination completed with smear-taking for cytology" makes up the screening strategy. Although in the frame of a National Public Health Programme all the prerequisites for nationwide organised screening have been provided, and an up-to-date screening strategy declared, 20-times as many smears are taken and analysed outside as inside the programme, and the efforts have had no impact on cervical cancer mortality. This is because "old habits die hard". There is an urgent need to reconsider the screening strategy, and to reorganise the cervical screening practice in Hungary.

[The state of the colorectal screening in Hungary: lessons of the pilot programs]

In Hungary, colorectal cancer is the second most common malignant disease. Due to its natural history, colorectal cancer is particularly suitable for screening. At present, epidemiological evidences of the effectiveness of detection of the symptomless colorectal cancer and its precursors are only available for the demonstration of fecal occult blood, endoscopic methods are also in use. For mass screening, fecal occult blood tests are recommended. Guaiac-type chemical methods are widely criticized because of the lack of specificity. Out of the emerging technologies, immunochemical methods based on the antigenicity of blood proteins (hemoglobin) seem to be the most suitable. In the model programmes organized in the frame of the National Public Health Programme, an immunochemical method using two blood proteins (hemoglobin and albumin) have been used. The compliance was not more than 30-45%. About one-third of those with positive blood test refused colonoscopy. The programmes revealed a great number of adenomatous polyps and early cancers, and in the way, the effectiveness of the method has been proved. The model programmes are still continued. Before the continuous and gradual extension of colorectal screening, the validity of the specific method needs to be tested and proved in order to be recognized as a routine procedure for screening. There is a need to test the feasibility of total colonoscopy, however, to this effect the colonoscopic capacity in the country has to be further developed.

The coverage of cervical screening in Hungary

A dolgozat célja annak meghatározása, hogy Magyarországon a nők hány százaléka vesz részt nőgyógyászati citológiai vizsgálaton (lefedettség), akár a szervezett szűrővizsgálat keretében, akár az egyéb nőgyógyászati vizsgálatok során. Adatok és módszerek: Az elemzés az Országos Egészségbiztosítási Pénztár (OEP) rutinszerűen gyűjtött finanszírozási adatokat tartalmazó adatbázisára épül. A vizsgálatban a 2000 és 2002 közötti 3 éves periódus volt az opportunisztikus szűrés referencia-időszaka, míg a 2003 és 2005 közötti 3 év a szervezett szűrés első szűrési ciklusa. Eredmények: Míg a 2000 és 2002 közötti 3 évben 1 667 618 nőnél végeztek citológiai vizsgálatot, addig ez a szám 2003 és 2005 között 1 749 498 főre emelkedett. A 25–64 év közötti női korosztályban 2000 és 2002 között az 1 éves lefedettség 22,0–23,3% között változott, ami 2003 és 2005 között 23,4–24,3%-ra emelkedett. A 2000 és 2002 közötti 3 éves lefedettség pedig 48,9%-ról 2003 és 2005 között 52,6%-ra emelkedett a szervezett szűréssel érintett célpopulációban (+3,7%). Következtetés: A szervezett szűrés kismértékben növelte a citológiai vizsgálaton részt vevő nők számát. Ahhoz azonban, hogy érdemi mortalitáscsökkenést eredményezzen a program, a részvételi mutatókat növelni szükséges.

The undesirable psychological adverse effects of screening

A szűrővizsgálat elutasításának okai között szerepelnek a szűrés nemkívánatos lélektani mellékhatásai. Ennek lehetséges okai három csoportba sorolhatók: 1. Általános okok, mint például az egészségügyi szolgáltatások igénybevételét meghatározó emberi magatartás. Különösen azoknak a szolgáltatásoknak az elutasítása gyakori, amelyek nem a jelenben is kínzó tünetek és panaszok orvoslását célozzák, hanem a jövőben majd esetleg fellépő betegségek megelőzését szolgálják; ilyen „jövőre irányuló” szolgáltatás a szűrővizsgálat is. 2. A rákbetegségnek a közfelfogásban rögzült negatív képe és a gyógyíthatóságát illető kételyek. Szóba jönnek továbbá 3. a szűrővizsgálat szubjektív megtapasztalásával közvetlenül összefüggő okok. A szolgáltatóknak törekedniük kell az okok kiküszöbölésére: a) a különböző korú, társadalmi helyzetű és műveltségi szintű rétegekhez szóló egészségnevelés feladata, hogy kialakítsa a betegségmegelőzés szükségességét elfogadó magatartást, és változtasson az embereknek a rákkal szemben eltúlzottan negatív, a vereséget előre elkönyvelő szemléletén; b) a szűrővizsgálatot szolgáltató szakemberek kötelessége, hogy minden tőlük telhetőt megtegyenek a szűrővizsgálattól visszatartó tényezők mérséklése érdekében. Ennek módja a jó munkaszervezés és a szakmai munka minőségének optimalizálása, valamint a jó kommunikáció: a szűrővizsgálat előtti, alatti és utáni felvilágosítás, információszolgáltatás és tanácsadás.

[Screening for early detection of lung cancer: conflict between clinical and public health viewpoints]

In Hungary, lung cancer, gradually increasing among women, is the leading cause of cancer mortality. The screening, using chest x-ray and sputum cytology as screening tool, does not reduce the mortality from lung cancer, therefore, screening for lung cancer is not recommended. The low-dose spiral CT is a sensitive and promising method, however, its specificity is far from being ideal. The results of the on-going RCTs are expected in a few years time, and so far it is not applicable for routine screening. In this country, the one-third of lung cancer cases are detected by the routine chest x-ray for tuberculosis, obligatory by law, and most of the detected cases are still resectable, but this does not have any influence on the mortality. According to our view, the detection of the lung cancer, particularly in those at high risk, is a by-product of periodic chest x-ray aiming at early detection of tuberculosis, however, mass screening for lung cancer as public health measure is not recommended. For the time being, the implementation of tobacco control measures is the only way to reduce the risk of lung cancer in the long run.

Is the organised screening of prostate cancer reasonable?

A prosztatarák Magyarországon is jelentős népegészségügyi probléma, ezért a halálozás mérséklése céljából szűrővizsgálata indokolt lenne. Szűrővizsgálati módszerek, úgymint a prosztataspecifikus antigén (PSA) kimutatása és a rectalis digitális vizsgálat rendelkezésre állnak, ám érzékenységük, fajlagosságuk, pozitív jósló értékük kívánnivalókat hagy maguk után. Nem randomizált vizsgálatokból származó bizonyítékok a szűrés lehetséges haszna mellett szólnak, azonban randomizált, ellenőrzött vizsgálatok még nem szolgáltattak meggyőző bizonyítékot. A szűrővizsgálat – a fajlagosság korlátozott volta miatt – túldiagnosztizálás és túlkezelés révén jelentős kárt is okozhat. A szerzők népegészségügyi szempontból megalapozott álláspontja szerint a szűrővizsgálati módszerek alkalomszerű felhasználása a szakorvosi diagnosztika keretében nem ütközik akadályba, azonban népegészségügyi lakosságszűrés nem kezdhető el mindaddig, amíg a folyamatban lévő randomizált, ellenőrzött vizsgálatok meg nem hozzák a várt bizonyítékokat.

Oral cancer screening: how to develop a country-wide opportunistic system in Hungary

Magyarországon a szájüreg rosszindulatú daganatai súlyos népegészségügyi problémát jelentenek. Jóllehet korai felismerésükre irányuló szervezett szűrővizsgálatok hatásosságára epidemiológiai bizonyítékkal nem rendelkezünk, tekintettel e betegség népegészségügyi súlyára, a Nemzeti Népegészségügyi Program lakosságszűrési komponense keretében folytatni kell a szájüregi rák előtti állapotok és korai daganatok felismerésére tett erőfeszítéseket. Az egészségügyi kormányzat döntését követően az érintett szakmák képviselőiből munkacsoport jött létre, amely javaslatokat dolgozott ki egy, az országot lefedő, a veszélyeztetett személyeket rendszeresen vizsgáló alkalomszerű szűrővizsgálati rendszer létrehozására. A fogorvosok mellett a háziorvosi és foglalkozás-egészségügyi szolgálat jelentősen hozzájárulhat a szájüregi rák okozta halálozás kívánt mérsékléséhez.

The state of the organised mammography screening in Hungary in 2006

Magyarországon az emlőrák jelentős népegészségügyi probléma. A halálozás mérséklésére a tünetmentes asszonyok szervezett, azaz személyes behíváson, visszahíváson és utánkövetésen alapuló szűrővizsgálata a legígéretesebb módszer. A tapintásos emlővizsgálattal kiegészített mammográfiás szűrés az 50–65 éves korcsoportban bizonyítottan hatásos; praemenopausalis asszonyok esetében a hatásosság még nem bizonyított, ennek ellenére a közvélemény és a szakmai döntéshozókra nehezedő nyomás miatt a perimenopausalis korban levő (45 év feletti) asszonyokat nem rekesztik ki a szűrőprogramból. Magyarországon a Nemzeti Népegészségügyi Program megteremtette a szervezett emlőszűrés szervezeti, adminisztratív, jogszabályi és pénzügyi feltételeit, így a szűrőprogram 2002 óta működik. A két szűrési ciklus adatai szerint a szervezett szűrésen a meghívottak mintegy 40%-a vesz részt. Az Országos Egészségbiztosítási Pénztár észrevételei szerint a meghívásos szűrés hatására jelentősen megemelkedett a diagnosztikus mammográfiás vizsgálatok száma; ez arra utal, hogy számosan a szervezett szűrés keretein kívül keresik a szűrés lehetőségét. A szűrővizsgálattal felfedezett emlőrákok száma, ezen belül a kis rákok aránya a nemzetközi standard értékeknek megfelelő. Az ún. intervallumrákok gyakoriságának megállapítására a szűrési nyilvántartással együttműködő patológiai adatbank létesítése folyamatban van. A szervezett emlőszűrés egészség-gazdaságtani elemzés szerint elfogadható a finanszírozó számára.

The state of the organized screening in Hungary in 2006

A rosszindulatú daganatos megbetegedések súlyos népegészségügyi problémát jelentenek Magyarországon. A daganatos halálozás mérséklésére a tünet- és panaszmentes személyek szervezett szűrővizsgálata a legígéretesebb stratégia. A szakterület mai állása szerint a népegészségügyi szűrővizsgálat kritériumait a mammográfiás emlőszűrés, a citológiai vizsgálatot alkalmazó méhnyakszűrés és a székletbeli rejtett vér immunkémiai kimutatásán alapuló vastagbélszűrés elégíti ki. A szájüregi daganatok és a prosztatarák korai felismerésére szolgáló epidemiológiai módszerek hatásossága máig nem bizonyított, ezért csak az orvosi gyakorlat részeként, alkalomszerűen alkalmazhatók. A korai tüdőrák felismerésére még nem rendelkezünk hatásos módszerrel, ezért nem szerepel a népegészségügy napirendjén. – A szervezett, azaz személyes meghívást, visszahívást és követést alkalmazó szűrővizsgálatok helyt kaptak a Nemzeti Népegészségügyi Programban. A népegészségügyi szűrés koncepciója összhangban van az Európai Unió irányelveivel. A szűrővizsgálati programok megszervezése, koordinálása és értékelése az Országos Tisztifőorvosi Hivatal feladata. Az elmúlt években kiépült a feladat ellátására alkalmas adminisztratív és információs rendszer, beleértve az országos szűrési nyilvántartást, az ÁNTSZ intézeteire alapozott szűrési koordinációs rendszer, valamint az országos igényeket kielégíteni képes mammográfiás és citológiai hálózat. A vastagbélszűrés feltételeinek megteremtése folyamatban van. A közlemény összefoglalja a megoldásra váró feladatokat és a szervezett szűrés várható eredményeit.

The organisation and results of first screening round of the Hungarian nationwide organised breast cancer screening programme

BACKGROUND

The aim of this paper is to give an overview of organisational issues of the Hungarian nationwide organised breast cancer screening programme and to provide the results of the first screening round of the programme for the years 2002-2003.

PATIENTS AND METHODS

Data were derived from the financial database of the National Health Insurance Fund Administration covering the period 2000-2003. Women who underwent mammography screening were included into the study.

RESULTS

Uptake of the organised screening programme in 2002-2003 was 45.09%, while the recall rate was 7.23%. Malignant cases represented 65.38% of total surgeries and 0.36% of total number of screened women yielding a cancer detection rate 3.6 per 1000 screened women. Malignant cases of 10.78% were identified as ductal carcinoma in situ, while 89.22% was invasive cancer. Benign to malignant ratio was 0.54 : 1.

CONCLUSION

There is therefore an urgent need to closely monitor performance and to review programme policies and procedures with the aim of increasing both the participation rate and the proportion of women eligible to attend screening.

[The attendance of the first screening round (2002-2003) of the Hungarian organized breast cancer screening program and its effect on the number of diagnostic and screening mammography]

AIM

Organised, nationwide screening for breast cancer with mammography in the age group 45-65 years with 2 years screening interval started in Hungary in January 2002. The aim of this study is to analyze the attendance rate of breast screening programme, including the analysis of the ratio of screening and diagnostic mammography examinations.

DATA AND METHODS

The data derive from the financial database of the National Health Insurance Fund Administration (NHIFA) covering the period 2000-2003. The ratio of women was calculated in the age group 45-65 years having either a screening mammography or a diagnostic mammography. The analysis was carried out for the years 2000-2001 (mainly opportunistic screening) before and 2002-2003 after the implementation of nationwide organized programme.

RESULTS

In the years 2000-2001 7,26% of the women aged 45-65 had an opportunistic screening mammography while in 2002-2003 33,95% of the target population had screening mammography within the organized programme. During the same periods 19,67% (2000-2001) and 22,05% (2002-2003) of women aged 45-65 had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 25,85% (2000-2001) to 53,46% (2002-2003).

CONCLUSIONS

The attendance of the Hungarian organized breast cancer screening programme - compared to the previous period before the implementation of the organized screening programme - is promising, although to achieve the expected results in mortality decrease a further improvement of the uptake is necessary.