Annals of Agricultural and Environmental Medicine 2012, Vol 19, No 4, 680-685 www.aaem.pl ORIGINAL ARTICLE Morbidity and mortality due to cervical cancer in Poland after introduction of the Act – National Programme for Control of Cancerous Diseases Iwona Bojar1,2, Radunka Cvejić2, Maria Danuta Głowacka3, Anna Koprowicz2, Ewa Humeniuk4, Alfred Owoc2 1 Department for Health Problems of Ageing, Institute of Rural Health in Lublin, Poland 2 Higher School of Public Health, Zielona Góra, Poland 3 Chair of Health Sciences, Medical University, Poznań, Poland 4 Department of Pathology and Rehabilitation of Speech, Medical University, Lublin, Poland Bojar I, Cvejić R, Głowacka MD, Koprowicz A, Humeniuk E, Owoc A. Morbidity and mortality due to cervical cancer in Poland after introduction of the Act – National Programme for Control of Cancerous Diseases. Ann Agric Environ Med. 2012; 19(4): 680-685. Abstract In 2005 in Poland, referring to the recommendations by the National Health Programme and recommendations by the European Union, the National Programme for Control of Cancerous Diseases was implemented by virtue of the Act, one of its basic assumptions being an improvement of oncologic awareness among the Polish population. It is expected that the result of actions in this respect will be an increase in reporting rates for prophylactic examinations and a decrease in the number of deaths due to cancerous diseases. The objective of the study was presentation of the analysis of morbidity and mortality due to cervical cancer in Poland and in individual regions, after the implementation of the National Programme for Control of Cancerous Diseases. The data was obtained from the Oncology Centre and from the computer Information System for Prophylaxis Monitoring (SIMP). In the analysis of obtained results, qualitative variables distribution was dened by means of the following values: number of instances (n) and frequency (%) with which they occur in a given category. The frequencies with which these categories of variables occur were compared by means of the chi-squared test with Yates’ correction. The permissible error probability of the rst type (p-value) is assumed to equal 0.05. The statistical assessment of results was performed by means of STATISTICA PL statistical software, version 9.0. In Poland in 2010, as many as 3,078 female patients suered from with cervical cancer, compared with 3,263 in 2005, i.e. prior to implementation of The National Cancer Prevention Programme Act. Therefore, it can be concluded that there was a decline in cervical cancer incidence of 5.7%. As regards the mortality rate, there was a decline of 3.4%. A comparison of the cervical cancer morbidity and mortality rate for Poland and its provinces between 2005-2010 showed statistically signicant dierences only for morbidity rate – a decline in frequency in the entire Polish territory and in the following provinces: Lublin, Łódź, Lesser Poland, and Greater Poland, as well as an increase in the morbidity rate in Kuyavian-Pomeranian province. Key words cervical cancer, reporting rates, mortality, prophylaxis INTRODUCTION 1) inhibition of growth in morbidity due to cancer; 2) achievement of the mean European indicators in the area On 1 July 2005, referring to the recommendations by the for early cancer detection; National Health Programme and recommendations by the 3) achievement of the mean European indicators in the European Union, by virtue of the Act, Poland introduced eectiveness of treatment; the National Programme for Control of Cancerous Diseases 4) creation of conditions for the use in oncologic practice for [1]. Among the basic assumptions of the Programme is an the advancement of knowledge concerning the causes and improvement of oncologic awareness among the Polish mechanisms of the development of malicious cancer; nation. It is anticipated that these actions will result in an 5) creation of the system of a constant monitoring of the increase in reporting rates for prophylactic examinations. eectiveness of cancer control on a national scale, and in In the Act, where the resources come from the State budget, individual regions of Poland. the eectiveness of all the prophylactic actions proposed is Within the Programme, among other things, actions are scientically conrmed. undertaken concerning: development of primary prevention e objective of the programme is (Ocial Journal of 2003, of malicious cancer, with the consideration of inadequate No. 15, Clause 148, Art. 2): nutrition and tobacco smoking; implementation of the population programmes of early cancer detection: cervical, Address for correspondence: Iwona Bojar, Department for Health Problems of Ageing, Institute of Rural Health, Jaczewskiego 2, 20-090 Lublin, Poland. breast and colon cancer, and selected types of cancer in E-mail: [email protected] children; improvement of the availability of the methods for Received: 1 April 2012; accepted: 5 November 2012 early diagnosis, and the provision of the quality of cancer Annals of Agricultural and Environmental Medicine 2012, Vol 19, No 4 681 Iwona Bojar, Radunka Cvejić, Maria Danuta Głowacka, Anna Koprowicz, Ewa Humeniuk, Alfred Owoc. Morbidity and mortality due to cervical cancer in Poland… diagnostics and therapy; improvement of the functioning of In the analysis of obtained results, qualitative variables the system of collection of data pertaining to the degree of distribution is dened by means of the following values: cancer advancement; popularization in society of knowledge number of instances (n) and frequency (%) with which they concerning prophylaxis, early diagnosis and treatment of occur in a given category. e frequencies with which these cancer [1]. categories of variables occur were compared by means of the Among the priorities of the programme is the carrying out chi-squared test with Yates’ correction. e permissible error of prophylactic actions. Within the Act, the following tasks are probability of the rst type (p-value) is assumed to equal performed in the area of prophylaxis and health promotion: 0.05. e statistical assessment of results was performed by primary prevention of cancer, population programme of means of STATISTICA PL statistical soware, version 9.0. prophylaxis and early cervical cancer detection, population e results are presented in Tables. programme of early breast cancer detection, screening tests programme for early colon cancer detection, programme of care of families at high risk, hereditary cancer risk [1]. RESULTS e Programme is nanced from the State budget and out- of-budget resources. e planned outlay for the performance e National Cancer Prevention Program Act was signed of tasks related with early cancer detection is 3 milliard PLN, by the Polish President in July 2005 and implemented in and in the subsequent years, the following percentage of the 2006. In the initial stages of implementation of the Act annual outlay should be allocated for the Programme: 2006 there was a noticeable increase in cervical cancer morbidity and 2007 – 20%; 2008 and 2009 – 25%; 2010 and 2011 – 30%, and mortality, while starting in 2009 (morbidity) and in and 2012, 2013, 2014 and 2015 – 35% [1]. year 2008 (mortality) a decline of both rates was reported. Aer many years of reasonable and consistent functioning, Cervical cancer morbidity and mortality in individual Polish the National Programme for Control of Cancerous Diseases provinces in years 2005-2010 are presented in Table 1. may create for Polish patients the conditions of prophylaxis In Poland in 2000, as many as 3,777 women suered from and treatment consistent with the recommendations and cervical cancer. In 2010, cervical cancer morbidity declined standards by the World Health Organization (WHO) and by 699 cases, i.e. to 3,078. Prior to implementation of e the European Union (EU). is may bring Polish results National Cancer Prevention Programme Act, in 2005 as in this area closer to the level of the countries of Western many as 3,263 women fell ill with the disease, which means and Northern Europe, which would mean that the level of that in 2010 there was a decline in morbidity by 185 [4]. cured cases among males should be approximately 40%, and Table 2 presents the number of women, morbidity and among females – approximately 50% [1, 2]. ese actions mortality due to cervical cancer in Polish provinces in should also improve statistics concerning morbidity and years 2005 and 2010, along with evaluation of statistical mortality due to cervical cancer, which is a primary malicious signicance of frequency dierences. carcinoma of the cervix. Invasive cancer of this organ is A comparison of morbidity and mortality due to cervical preceded by cervical intraepithelial neoplasia (CIN), also cancer for Poland and provinces in 2005-2010 did not show known as cervical dysplasia or pre-invasive cancer. CIN any signicant dierence of mortality rates. However, it may progress to invasive cancer, therefore, an early detection showed statistically signicant dierences of morbidity of changes before the pre-invasive period is important [3]. in the entire Polish territory (decline, p = 0.008) and in Knowledge of this problem and knowledge of prevention the following provinces: Kuyavian-Pomeranian (increase, of other cancerous diseases may reduce the risk due to this p = 0.02), Lublin (decline, p = 0.03), Łódź (decline, p = 0.03), disease in Poland and worldwide. Lesser Poland (decline, p = 0.003), and Greater Poland (decline, p = 0.0003). Table 3 presents a standardized rate (per 100