CC BY
8MEDICAL SCIENCES
FACTORS OF THE HIGH DEATH RATE FROM BREAST
CANCER
Shopov D.G.
MD, PhD, Chief Assistant Prof. Department of Social Medicineand Public Health Medical University -
Plovdiv, Bulgaria
ABSTRACT
The malignant diseases are an essential problem of the contemporary society.
The present article analyses the sick rate, the course of the disease and the death rate of malignant neoplasms of the female breast in statistically differentiated administrative- geographic regions of the Republic of Bulgaria for a 5-year period from 2011 to 2015 inclusive. The following facts have been established:
❖ In the Republic of Bulgaria breast cancer in women is leading in terms of sick and death rate, among the rest of the organ localizations of the malignant neoplasms.
❖ The dynamics of the GP staffing is directly dependent on the early diagnostics of malignant neoplasms.
❖ The social and economical status of the population in the studied administrative- geographic regions has a significant influence on the early diagnostics of the malignant neoplasms;
❖ The optimization of the financial and medical resource is essential for the mass coverage of the target groups of the population, including both health insured and uninsured persons for the conduct of prophylactic medical examinations intended for early diagnostics of oncological diseases.
Keywords: malignant diseases, population, administrative-geographic regions, sick rate, death rate, mammary gland
Introduction:
Malignant diseases are a serious problem of our contemporary society. They are the second leading cause of death in the developed countries. There is an upward trend of cancer-caused deaths in the world.[6;10] The malignant diseases cause much suffering, loss of working capacity and are a serious economical burden for the society, the individual and the family.[7;8] They require increased need of medical services and often have a lethal outcome. Almost 80% of the malignant diseases are due to the factors of the environment, the way of life and behaviour of the individuals, as well as their habits and customs.[11;12]
Malignant diseases are an important and always topical socially significant problem, therefore the attention of the society has been directed towards activities related to their timely diagnosis and treatment. The contemporary methods of diagnostics and treatment have led to reduction of the death rate and increase in the survival rate.[14] The high sick rate, the reduced death rate and increased survival rate lead to considerable increase in the oncological sickness. According to data provided by the National Statistical Institute in Bulgaria at the end of 2015 there were 284 355 people with malignant diseases. Such a significant number of sick people among the population leads to many new social problems, one of which is the adequate occupational and social re-adaptation.[16;18] It turns to be a conclusive stage in the complex struggle with the oncological diseases. It is carried out by the bodies of the medicinal expertise and is an integral part of the diagnostic, treatment and prophylactic activity of the medical institutions, the specialists in the diagnostic and consulting centres and the general prac-titioners.[19] The physician's assessment of the working capacity of a patient suffering from an oncological
disease and the results thereof arise significant personal psychological, socio-economical and socio-political consequences. They affect not only the individual and his family, but also his colleagues at work and eventually the whole society.[20]
Objective: The objective of the present article is to study the sick and death rates from malignant neoplasms located in different organs, with an emphasis on the female mammary gland in the population of the Republic of Bulgaria, occupying statistically differentiated areas.
Material and methods:
Subject of observation are the women in Bulgaria, living in statistically differentiated areas. The study is retrospective for a 5-year period from 2011 to 2015 inclusive. Quantitative and qualitative indices have been used for the analysis. The primary information has been derived from the annual reports of the National Statistical Institute (NSI). The statistical processing of the collected primary information was carried out using variational, alternative and non-parametrical analyses. The computer processing of the collected database was carried out using the statistical pack SPSS version 19 and Microsoft Excel.
Results and discussion:
The malignant diseases are among the main causes of death in Europe and in Bulgaria. At the end of the previous millenium the oncological diseases have caused the death of every fourth European citizen. The sick rate in terms of malignant neoplasms in Bulgaria has a variable tendency of increase (Chart 1). In the period 2011-2015 the sick rate (3602.7 in 2011) increased and reached 3961.5 per 100 000 p.e. The sick rate (new cases) is relatively permanent - from 448.7 in 2011 to 447.2 per 100 000 p.e. in 2015.
Chart 1
Registered cases of malignant neoplasms per 100 000 p.e.
4000 3500 3000 2500 2000 1500 1000 500
newly
I total
JIJJJ
2011 Year 2012 Year 2013 Year 2014 Year 2015 Year 448,7 432,4 461,9 442 447,2
3602,7 3703 3819 3867,7 3961,5
Information about the sick rate per 100 000 p.e. from malignant diseases by organ location is provided in Table 1. It becomes clear that:
The highest sick rate per 100 000 p.e. belongs to breast cancer in women (1385.6), followed by cancer
of the female reproductive system (1159.9), melanoma and other malignant skin neoplasms (836.8), digestive organs with most frequent localization in the colon, rectosigmoid area (581.2), male genitals with most frequent localization in the prostate gland (563.4).
Table 1
Sick rate per 100 000 p.e. from malignant diseases by organ localization
Organ localization of malignant neoplasms 2011 Year 2012 Year 2013 Year 2014 Year 2015 Year
Mammary gland 1246,4 1286,9 1326,8 1344,1 1385,6
Female reproductive system 1063,3 1092,3 1121,9 1131,5 1159,9
Melanoma and other malignant skin diseases 775 801 818,7 820,2 836,8
Digestive organs 542,4 548,3 562,6 573,1 581,2
Male genitals 419,1 460,3 504,4 529,4 563,4
According to data provided by the National Statistical Institute, in 2015 the sick rate per 100 000 p.e. was the highest from breast cancer in women (103.5), followed by cancer of the digestive organs (100.7), female reproductive system cancer (84.1), male genitals cancer (74.8).
In our survey we shall consider the breast cancer in women as leading in the sick and death rate among
the rest of the organ localizations of the malignant neoplasms. Table 2 presents data for people who have died from breast cancer by age groups over a 5-year period per 100 000 women in Bulgaria. It becomes clear that their number has increased in the analyzed period of time (2011-2015 inclusive), with significant difference in an upward direction after the age of 50.
Table 2
Women who have died from breast cancer by age groups per 100 000 women in Bulgaria
Year 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
2011 - 4,7 8,7 18,7 23,6 38,7 52,8 56,1 69,1 76,4 89,5 129,9 139,9
2012 - 2,4 10,8 12,5 25,4 48,4 54,0 60,5 75,9 77,7 96,9 129,9 159,3
2013 0,8 2,1 6,3 10,5 22,5 35,5 44,7 59,5 72,0 76,9 101,4 128,7 147,3
2014 0,8 2,5 10,9 19,8 26,7 38,8 49,6 62,1 69,8 79,2 97,8 116,4 159,5
2015 0,4 1,7 5,8 14,6 24,6 34,9 48,6 54,5 68,2 81,1 100,2 125,4 179,3
Statistically Bulgaria is divided into six administra- indicated in Table 3. tive-geographical regions. They comprise the areas
Table 3
Northwestern Central North North-East South-East South-West Central Southern
Vidin Veliko Tarnovo Varna Burgas Blagoevgrad Kardzhali
Vratsa Gabrovo Dobrich Sliven Kyustendil Pazardzhik
Lovech Razgrad Targovishte Stara Zagora Pernik Plovdiv
Montana Ruse Shumen Yambol Sofia Smolyan
Pleven Silistra Sofia (capital) Haskovo
For the purpose of better clarity we have numbered the administrative-geographical regions in the charts below:
Region №
North-Western 1
Central North 2
North-East 3
South-East 4
South-West 5
Central Southern 6
In the course of studying the breast cancer death region (46.6), followed by the North-Western region rate per 100 000 women in the statistically differenti- (41.9) and North-Eastern region. In the studied time ated regions (Chart 2), we found out that the highest frame (2011-2015 inclusive) the data marks an upward rate in 2015 was observed in the Central Northern trend.
Chart 2
According to data from Table 2 the number of of 50 has drastically increased. This imposed the study women who have died from breast cancer after the age of the per cent of women over 50 in the administra-
tive-geographical regions. Chart 3 visualizes in 2015 (50.22%), followed by the Central North region the highest per cent in North-Western region (47.84%).
Chart 3
Women over 50
/-
/ fTI
/ / / / y - — 1
1 2 3 4 5 6
■ 2011 Year 49,36% 46,52% 41,22% 42,97% 41% 43,75%
■ 2012 Year 49,48% 46,82% 41,57% 43,23% 41,10% 44,10%
■ 2014 Year 49,80% 41,43% 41,91% 43,52% 41,22% 44,52%
■ 2014 Year 50,00% 47,56% 42,29% 43,77% 41,26% 44,95%
■ 2015 Year 50,22% 47,84% 42,54% 43,93% 37,91% 41,78%
According to the strategies of the Ministry of Health and the main obligations of the General Practitioners (GPs), imposed by the Ministry of Health, the National Health Insurance Fund and the Bulgarian Medical Association, the general practitioners are the first, main unit responsible for the prophylactic programs and in charge of the primary and secondary prophylactics. The annual prophylactic medical checks announced mandatory for any health insured individual, among others, aim at early diagnostics of oncological diseases and partially covering the gap of mandatory annual medical checks and screenings from the time before the transitional period. Benefits for the population and public health from screening programs may only be achieved if there is a financial and human
resource for mass coverage of the target groups of the program and if the screening program is appropriately promoted and assumed by the target groups. This makes people especially vulnerable. A certain per cent of them are not health-insured due to unemployment.
By outlining the important role of the general practitioners for the early discovery of malignant neoplasms, we analyzed the dynamics of their staffing within the period 2011-2015 inclusive. Chart 4 reflects the actual situation. The smallest number of GPs work in the Central North region, followed by those in the North-Western region. Generally the tendency of the number of general practitioners in Bulgaria is regressive.
Chart 4
The general practitioners experience a number of objective problems which are a precondition for insufficient motivation of the physicians to work at the primary medical aid. Here are some of them:
> The occupational organization of the general practitioners, including working schedule, schedule of home visits, leads to isufficient daily weekly and annual rest;
> The insufficient funds for the primary medical aid and the poor payment scheme of NHIF;
> Limitations for the number of medical referrals for examination of the patients by a specialist, sometimes leading to conflicts between GP and the patient and even to deterioration of the patient s condition, due to the inability to visit a specialist.
> A large number of Gps are not satisfied with the application of the capitation principle of payment of their labour, whereby the money follows the patient.
> GPs as managers according to their registration under the Commercial Act are facing the
dilemma: humanism and good quality of performance or good balance of the practice.
> The specialization in General medicine which is a precondition for practicing the profession now and in the future, also arises problems.
The health insurance system of healthcare guarantees free medical checks, tests and treatment in the medical institutions to health insured persons. The unemployed are not health insured and have low income. This further impedes the early diagnostics of the oncological diseases. We have reviewed the unemployment rate of women in the relevant regions (Chart 5). It has the highest rate in the North-Western, North-Eastern and Central North regions. Chart 5
Conclusions:
1. The malignant diseases are an important and topical socially significant problem, therefore the attention of the society has been turned towards any activity related to their timely diagnosis and treatment.
2. In Bulgaria breast cancer in women occupies the leading place in terms of sick and death rate, compared with the other organ localizations of the malignant neoplasms.
3. The dynamics of staffing of GPs is directly dependent on the early discovery of the malignant neoplasms.
4. The socio-economical status of the population in the studied administrative and geographic regions influences the early discovery of malignant neoplasms.
5. There is a need of more detailed analysis and possible solution of the staffing problem by regions. This would inevitably increase the success rate in diagnosis of malignant neoplasms.
6. The optimization of the financial and medical resourse is essential for the mass coverage of target groups of the population, including both health insured and uninsured individuals for prophylactic medical checks intended for early diagnostics of oncological diseases.
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ЗАБОЛЕВАЕМОСТЬ МЕТАСТАТИЧЕСКИМИ ОПУХОЛЯМИ ЦЕНТРАЛЬНОЙ НЕРВНОЙ СИСТЕМЫ В КАБАРДИНО-БАЛКАРСКОЙ РЕСПУБЛИКЕ
Абушаш О.М.
Кабардино-Балкарский государственный университет им. Х.М. Бербекова. Врач нейрохирург, Аспирант.
THE INCIDENCE OF METASTATIC TUMORS OF THE CENTRAL NERVOUS SYSTEM IN THE KABARDINO-BALKAR
REPUBLIC
Abushash O.M
Kabardino-Balkarian State University. HMBerbekova. Doctor of Neuroscience, researcher.
АННОТАЦИЯ
В статье рассматриваются региональные особенности заболеваемости метастатическими опухолями центральной нервной системы в Кабардино-Балкарской республике. За последние годы отмечается рост численности онкологическими заболеваниями, а также количество случаев метастарирования опухолей различных локализаций в центральную нервную систему. Проблема прогнозирования и ранней диагностики метастазов в мозг является актуальной в связи с широкой распространенностью и тяжелыми последствиями опухолевых заболеваний.
ABSTRACT
The article considers the peculiarities of regional incidence metastatic tumors of the central nervous system in the Kabardino-Balkar Republic. In recent years there has been an increased incidence of neoplastic diseases, as well as the number of cases metastasis tumors in different locations in the central nervous system. The problem of forecasting and early diagnosis of metastases to the brain is relevant due to the high prevalence and serious consequences of tumor diseases.
Ключевые слова: заболеваемость опухолями, метастазы в центральную нервную систему.
Keywords: incidence of tumors, metastases in the Central nervous system.
Рак является одной из основных причин логические заболевания занимают 13% в структу-смертности во всем мире. По данным ВОЗ, онко- ре общей смертности в мире. Каждый год от этого
