Zwalczamy Nowotwory – Program Profilaktyk Program – Nowotwory „Zwalczamy Projekt

ZWALCZAMY

POWIAT NOWOTWORY KOSZALIŃSKI program profilaktyki nowotworowej w powiecie koszalińskim

EPIDEMIOLOGICAL REPORT concerning cancer of the prostate, testis, and other male reproductive organs in the population of the Koszalin county

POWIAT KOSZALIŃSKI

Report developed within the framework of the project: ‘We fight cancer – cancer prevention programme in the Koszalin county’ with financial support from the EEA Grants and Norway Grants for 2009–2014 and from the state budget. Programme PL13: Reducing Social inequalities in Health – Programme Operator: Ministry of Health Contract No. 009/011/13/NMF/2015/00/2723/41

Koszalin County 2017

Epidemiological report concerning cancer of the prostate, testis, and other male reproductive organs in the population of the Koszalin county

Koszalin County 2017 Implementation – comprehensive preparation, editing, and printing: commissioned by the Koszalin County under agreement No. 47/WR.042.01.2015.AK dated 16/01/2017

Centrum Szkolenia i Promocji „PRESTIGE” 76-200 Słupsk, Karżcino 25B

Koszalin County, within implementation of the project: ‘We fight cancer – cancer prevention programme in the Koszalin county’

Revision: Agnieszka Kryczyńska – Project Manager

Pictures and information materials: Koszalin County

POWIAT KOSZALIŃSKI

The budget of the project is PLN 2 898 337.00, including: PLN 2 463 586.45 from the funds of the EEA and Norway Grants, which constitutes 85% of funding level, and PLN 434 750.55 in the form of cooperation by the Program Operator (Ministry of Health), which is 15% of expenses. TABLE OF CONTENTS

1. FOREWORD BY THE STAROST OF KOSZALIN...... 6 2. INTRODUCTION...... 7 3. INTERVIEW WITH A SPECIALIST PHYSICIAN ...... 8 4. METHODOLOGY...... 10 Aim of the report...... 10 Research methods...... 10 Studied population...... 11 5. PROFILE OF RESPONDENTS...... 12 Gender...... 12 Age...... 12 Place of residence...... 13 Education...... 14 Professional status...... 14 6. ANALYSIS OF THE OBTAINED RESULTS...... 16 History of diagnostic examinations...... 16 Risk of cancer in the family and family relationship...... 18 Smoking cigarettes...... 19 Health issues...... 21 Chronic diseases...... 22 Use of medicines...... 23 Alcohol abuse...... 24 Lifestyle...... 25 Sports activity...... 26 Obesity...... 27 Diet...... 28 Prophylactic examinations...... 29 7. CONCLUSIONS AND RECOMMENDATIONS...... 30 8. REFERENCES...... 33 9. LIST OF FIGURES TABLES, AND GRAPHS...... 34 10. ANNEXES...... 35 Annex 1. Template of questionnaire...... 35 1. FOREWORD BY THE STAROST OF KOSZALIN

The Koszalin Poviat applied for funding for the project, „We are fighting cancer - a cancer prevention program in the Poviat of Ko- szalin” in March 2014. The competition was limited and aimed at selecting 156 poviats.

In December, 2015 the final list of the projects recommended for funding was announced. The Committee made a recommendation to fund 24 projects. The Poviat of Koszalin, with the number of total 57 points, took the 10th place! This is a huge success and an enormous challenge. Especially, that the project aims at reducing and preventing malignant lungs and bronchus, colon and rectum, and prostate cancer incidence as well as improving public health and the reduction of social inequalities in health.

The received grant of PLN 2 898 337,00 consists of: the amount of PLN 2 463 586,45 from the Norwegian Financial Mechanism, which constitutes 85% of the financing, and PLN 434 750,55 in the form of cooperation, by the Program Operator (Ministry of Health), which represents 15% of the expenditure; it has been al- located mainly to free preventive testing and a wide range of information-promotional campaigns, so that we could reach out directly to you and invite you to participate in the study.

6 With this epidemiological report, we would like not only to implement the objectives of the project, but above all, promote healthy behavior and a healthy lifestyle on an even larger scale. Preventive health education, leading to generating positive attitudes of the residents of our poviat, determines reduction in the incidence of cancer, and this is the priority of our work!

The Epidemiological Report is based on the assessment of 15 000 surveys (among people in the age of 35- 70) regarding three types of cancer: lung and bronchus, colon and rectum and prostate. The report includes in particular: a description of the population and the scope of the research conducted; a description of the health situation of the population in the poviat, resulting from statistical and other existing data, and determines the situation in the poviat against the province and the country.

You will also find here the information on the state of health of the inhabitants of the poviat of Koszalin and the causes of the health situation of the population studied. The collected data was used to draw conclusions and give recommendations as well as suggestions of activities for institutions in the field of health protection.

Remember about prevention and regular tests among children and adults; this is the only way we are able to early detect any threat in our body, and thus increase the effectiveness of treatment, shorten its time and avoid serious risks.

It is extremely important that we all know that health prevention is of paramount significance, not only in terms of reducing the incidence, but also cancer prevention.

I would like to thank the Residents of the Poviat of Koszalin for a healthy approach to life, for their assistance in the implementation of the Epidemiological Report and for their time and willingness to provide information to the interviewers. I believe all the actions undertaken by us will help raise awareness of healthy and effective cancer prevention among the Residents of the Poviat of Koszalin.

Have a good read!

The Koszalin Starost Marian Hermanowicz 2. 1. Specific aims of theproject included: mainaimof theprojectThe was to limittheincidence of diseases related to lifestyle inthecounty. Koszalin county. overallThe aimof theproject was to improve thepublichealth andlimitsocialinequalitiesinhealth inthe Programme PL13:Reducing SocialinequalitiesinHealth –Programme Operator: Ministry of Health. with financialsupportfrom theEEAGrants andNorway Grants for 2009–2014andfrom the state budget. prevention programme in the Koszalin carried out by county’ the Koszalin county in the years 2015–2017 the Koszalin county population was developed withintheframework of theproject ‘We fight cancer –cancer epidemiodologicalreportThe concerning cancer of theprostate, testis, andother malereproductive organs in 2. b. a. cancer of theprostate, testis, andother malereproductive organs, including: implementing aprophylaxis program for cancer bronchi, of large thelung, intestine, andrectum aswell as d. c. b. a. including: large intestine, and rectum as well as cancer of the prostate, testis, and other male reproductive organs, implementing ahealth promotion program aimedto reduce theincidence of cancer bronchi, of thelung, INTRODUCTION

as malignant neoplasmsof theprostate; prophylactic examinations dedicated for cancer bronchi, of large thelung, intestine, andrectum aswell further increasing theawareness of thesignificance of prophylactic examinations. promotion of physical activity; smoking; promotion of healthy behaviours, with particular regard for tobacco smoke and methods of quitting prophylactic examinations for diseases causingthelisted cancer groups. promotion of healthy nutritionhabitsandchangeof previous habits;

7 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS 3. INTERVIEW WITH A SPECIALIST PHYSICIAN

An interview with a specialist in the cancer of the prostate, testis, and other male reproductive organs, urol- ogist Marcin Chęciński.

Which types of examinations do you perform most often to detect cancer of the prostate, testis, and other male reproductive organs?

To detect prostate cancer, I determine the blood level of a neoplastic marker named PSA and perform rectal examination. If one of these tests gives an abnormal result, I perform prostate biopsy. If testicular cancer is suspected, I perform blood tests (tumour markers) and ultrasound of the testes. If penile cancer is suspected, biopsy specimens are sampled from the lesion and computed tomography of the abdomen is performed.

What are the most common symptoms of cancer of the prostate, testis, and other male reproductive organs?

The most common symptoms of prostate cancer are complaints related to urination: day- and night-time polyuria, weak stream of urine, urinary urgency, feeling of incomplete emptying of the bladder, in advanced stages even haematuria or urinary retention. In the initial period, the course of prostate cancer is very often asymptomatic. Testicular cancer presents with painless enlargement of the testis while penile cancer presents with nodular lesions and ulceration on organ surface.

In your opinion, what are the main causes of incidence in cancer of the prostate, testis, and other male reproductive organs in the Koszalin county and why? Please indicate.

The most common causes of prostate, testicular, and penile cancer are the same as elsewhere. In prostate 8 cancer development, risk factors are age above 50, genetic predisposition, and diet rich in read meat containing saturated fatty acids. Risk factors in penile cancer are age above 60, chronic hepatitis, chronic infections of the penis and foreskin, phimosis, smoking cigarettes, and large number of sexual partners. In the case of testicular cancer, the most common risk factor is cryptorchidism (undescended testis) as well as history of this cancer in patient’s father or brother, and Klinefelter syndrome (a genetic abnormality syndrome).

In what age, professional, and social groups in the Koszalin county does the risk of cancer of the prostate, testis, and other male reproductive organs occur most frequently and why? Please indicate.

Prostate and penile cancer occurs mainly in males aged over 50 and the risk increases with age, while testicular cancer is most common in young men aged 16–35. Penile cancer incidence is higher in lower social classes, which is related to poor hygiene and unsafe sexual behaviours. Occupation seems to have no effect on the incidence of these types of cancer.

Can you estimate the prevalence of cancer of the prostate, testis, and other male reproductive organs in the Koszalin county? How many cases do you diagnose a year? Do you observe an increase or a decrease over the years?

I know the exact number of genitourinary system cancer cases in the Koszalin county. In my practice (and in line with general epidemiology), prostate cancer is diagnosed most often – I diagnose about 100–130 cases a year – followed by testicular cancer (about 3–4 cases a year), while penile cancer is diagnosed most rarely (1–2 cases a year). The number of diagnosed cases of prostate cancer has increased (due to growing awareness of men, more common attendance at prophylactic examinations and longer life expectancy). My obser- vations indicate that the number of other cancer types remains constant. well aslimitingthenumberof sexual partners. cancer, important aspectsare goodhygiene, fighting reproductive organ infections and correcting phimosis as proved. Limitingtheconsumption of red meat andavoiding smokingare recommended. Inthecaseof penile Prostate andtesticular cancer incidence cannot bereduced, astheeffect of external factors hasnot been prostate examination. possible onesover numberof men,especially 50years old, andinforming themaboutannualprophylactic most important aspects regardingThe prophylactic measures are patient education, reaching the greatest dence of cancer of theprostate, testis, andother malereproductive organs belimited? Pleasegive examples. What prophylactic measures do you recommend and which do you think are most effective? How can inci symptoms have become very unpleasant. arestill patients whocome for theirfirst urological visitwithprostate cancer inmetastatic stage, onlywhen if they notice some slight lesions in the testes or feel even transient testicularslight, pain. Unfortunately, there tate cancer. Anincreasing numberof young menalsocome for prophylactic examinations of testes, especially More and more patients report for prophylactic examinations, which is mainly true for men over 50 and pros pathological lesions?Ifso, theninwhichstadium of disease dothey come most often? When dopatients contact you most often? Isitat thestageof prophylactic examination? Orat of thestage - -

9 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS 4. METHODOLOGY

The epidemiological report concerning cancer of the prostate, testis and other male reproductive organs in the population of Koszalin county is a summary of prophylactic examinations – medical interviews, respondents’ questionnaires concerning cancer of the prostate, testis, and other male organs combined with a lifestyle study carried out in the years 2015–2017.

AIM OF THE REPORT

Professional presentation of the free prophylactic examinations performed as part of the project, including primarily:

1. an analysis of cancer risk in the Koszalin county; 2. extent of risks in the Koszalin county based on data obtained from surveys and from the previous years prior to the analysis of the project, so that the gathered material provides a detailed picture of risk; 3. performing analyses and statistics by presenting information about: a. the number of persons who underwent examinations as well as persons who did not undergo examinations, but helped demonstrate the extent of risk by filling out report surveys, b. examinations performed to date, c. respondents’ place of residence (city/village) as well as region (commune) where a given person lives, d. age range in prostate cancer classification, from 35 to 70 y.o., e. employment status, f. education, g. risk of cancer in the family and family relationship, h. smoking tobacco, abuse of alcohol and prescription drugs, 10 i. symptoms present in respondents, j. diet, lifestyle, sports, etc.

RESEARCH METHODS

In preparation of the report, data from quantitative studies using direct conversation with a paper version of the questionnaire (PAPI – Paper and Pencil Interview).

A standardised survey questionnaire containing 8 closed-ended questions and 4 semi-open-ended questions with single-choice answers, giving a total of 12 questions, and a personal data section for providing demographic data of respondents were used in the study. Questions in the questionnaire were used to gather quantitative data that were next used in statistical analysis. The survey template is set out in Annex 1.

An electronic version of the questionnaire was available on the project web page at www.zdrowie.powiat.koszalin.pl to be downloaded, printed, and delivered to the office of the project or the institution performing the study. The survey was undertaken by residents during picnics, fairs, meetings in communes, and other information and promotion events.

The answers collected from respondents were coded and used in statistical analyses. Analysis was analysed first, so that collective statements of statistical answers could be presented in the form of diagrams. The next stage of analysis consisted in using contingency tables and compiling the studied variables in various configurations as well as defining possible relations between them. Statistical significance of relations between variables was de- fined with the use of parametric and non-parametric tests, depending on the type of variable that was analysed. 3. 2. 1. Selection criteria for thesample: statistical error not exceeding 3%. ly significant conclusions concerning thewholepopulation of the Koszalin county, with97%probability and study wasThe performed onarandom-stratified size sample sample allowsof 3814men.The for statistical- • • population ofThe malesaged35–70intheKoszalin county consisted of 10673men,including: Results of analyses were thebasisfor developing conclusions andrecommendations. 4. 3. 2. 1. during preparation available These of thereport. documents were, inter alia: Apart from statistical data, desk-research data, i.e. data from research of available documents, were alsoused STUDIED g. f. e. d. c. b. a. history of at least oneof thefollowing: age: 35–70,withoutsymptoms of cancer of theprostate, testis andother malereproductive organs, with residence intheKoszalin county andtheKoszalin city, male gender: rural areas: 8456persons. urban areas: 2217persons, Reports basedondata of theCancer Centre, epid.coi.waw.pl/krn/ Statistical data of theCounty Employment Office in Koszalin, www.pup.koszalin.pl ‘Deaths according to cause’ compilation, Central Statistical Office, stat.gov.pl b. a. Documents prepared andmadeavailable by theKoszalin County, suchas:

plastic diseases. men over 50years oldwhohave not undergone prophylactic examinations towards theabove neo men whoabusealcohol, men whosmoke tobacco, men whoare obese, men whocome from rural areas, associated cancer: of thetestis or other maleorgans, men whohave at least onefirst degree patrilineal relative withcancer of theprostate and/or other prophylaxis andhealth promotion program of theKoszalin County, men whohave problems witherection, assessment of theneedsof Koszalin county. POPULATION -

11 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS 5. PROFILE OF RESPONDENTS

An analysis of a survey study should begin with presenting the respondents’ profile. The respondents were adults living in the Koszalin county. The profile was based on basic socio-demographic variables, i.e. gender, age, education, place of residence and professional status.

GENDER

As the disease unit affects only men, women were not included in the study. Thereofre, 100% of the studied population were males.

AGE

Study participants were of various age. With age group analysis, age ranges were formed in accordance with BDL classification1. The largest group were persons aged 50–64 (48.3%), that is ones most often suffering from the problem; this group was followed by persons 40–49 years old (34.7%), while the smallest group were persons aged 35–39 (2.2%). The age structure of the studied males is presented in graph 1.

Graph 1. Age structure of the study subjects

Age structure of the study subjects N = 12 . %

.% - y.o.

- y.o. .% > y.o.

Source: Authors on the basis of study results

1. Local Data Bank, CSO Source: Authors on thebasisof study results of similarsize Sianów (24.9%) and Polanów (10.2%) communes. Groups of respondents from the remaining communes were est group of respondents were residents of Koszalin andsurrounding area (34%), followed by residents of the canbeobservedThis whenlookingat themapof county’s communes (Figure 1), whichindicates that thelarg of rural areas (41%). Regarding place of residence, slightly more respondents were residents of urbanareas (59%)thanresidents PLACE Graph 2.Place of residence of respondents according to breakdown into urbanandrural areas OF RESIDENCE Source: Authors onthebasisof study results . Figure 1.Residence structure of respondents by commune of theKoszalin county gm. Będzino N = Urban /Rural , % gm. Biesiekierz , % gm. Mielno ,% gm. Świeszyno % ,% KOSZALIN ,% gm. Sianów ,% gm. Manowo % ,% gm. Bobolice ,% gm. Polanów ,% Rural Urban -

13 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS EDUCATION

The education status of the study participants varied. In a division into elementary, vocational, secondary, and higher education, the largest group had vocational education (44.3%) and secondary education (35.25%). One in 10 participants (11.5%) declared higher education. The same number of persons had elementary education (9%).

Graph 3. Education structure of the study subjects

Education N =

, % .% , % , % .% , % , % , % , % , % .% .% , % , % , % elementary vocational secondary higher

Source: Authors on the basis of study results

14 PROFESSIONAL STATUS

The largest part of study subjects were economically active (83.4%). Unemployed persons constituted 5.2% of respondents, with a similar number of pensioners (9.2%).

The proportion of unemployed persons in the study group is not representative of the unemployment level in the Koszalin county, which was 17% at the end of December 20162.

Graph 4. Education status of respondents

Professional status N = 90,0% 83.4% 80,0%

70,0%

60,0%

50,0%

40,0%

30,0%

20,0% 9.2% 10,0% 5.2% 2.2% 0,0% economically active unemployed pensioner no data

Source: Authors on the basis of study results

2. Data from the County Employment Office in Koszalin, status on 23.02.2017. http://www.pup.koszalin.pl/urzad_pracy/2015-2017.html tions of thereport discuss thegathered will andaggregated data. was amanagedfrom 56to 64,withvocational orsecondary education, economically active. furthersec- The Summing uptherespondents’ characteristic, itcanbeconcluded that thestatistical participant of thestudy cer amongrespondents. there are no significant correlations between unemployment andthe prophylaxis of reproductive organ can- obtainedresultsThe are compatible withthetendency of theentire Koszalin county. Inrespect of thisstudy, than 1year. Alarge partof survey respondents provided noinformation inthisrespect (23%). had not beenemployed for over 2years (36%). second The largest group were persons unemployed for less Among persons whodeclared most were unemployment, long-term unemployed persons, that isoneswho Source: Authors onthebasisof study results N = Duration ofunemployment , % , % , % , % , % , % , % , % , % under year .% Graph 5.Duration of unemployment up toyears .% over years .% no data .%

15 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS 6. ANALYSIS OF THE OBTAINED RESULTS

This report presents results of the study based on the questions included in the survey questionnaire. The report also presents correlations, but only statistically significant ones.

HISTORY OF DIAGNOSTIC EXAMINATIONS

First, respondents were asked whether they had undergone prostate cancer diagnostic examination, and if so, when and with what result (was cancer diagnosed)?

Graph 6. Have you undergone prostate cancer diagnostic examination?

Undergoing diagnostic examinations N =

.% .%

YES

.% no data 16

Source: Authors on the basis of study results In the studied group, only 9,5% (i.e. 363 persons) declared having undergone prostate cancer diagnostic examination, of whom only 4 persons were diagnosed with cancer (1% of participants). Unfortunately, as many as 18% of respondents provided no answer to this question, so the real number of detected cancer cases is not known.

Graph 7. Was cancer diagnosed?

Proportion of cancer cases diagnosed N =

cancer not diagnosed .% .%

cancer diagnosed

.% no data

Source: Authors on the basis of study results respect certainly increases theriskof developing disease. disease to be one of the four most common cancers in the Koszalin county. lack of examination The in this examination, since especially reports of theKoszalin County anddata from theCancer Centre confirm this It is, however, worrying proportion that suchasmall of men(9.5%)undergoes prostate cancer diagnostic Source: Authors onthebasisof study results Table 1.Whendidyou have prostate cancer diagnostic test done? able analysis of thestudied issue isnot possible. provided noanswer for this question (25.4%). Withthisproportion of missing data inthestudy group, areli - remaining results are not significant for the whole population, however a significant proportion of persons tutes 27.7%of persons whohaddiagnostic examinations done. In2015,theproportion dropped to 19%.The largest group of respondents hadexaminations performed in2014;thegroup was 86persons, whichconsti- In thenext years, theproportion of menwhounderwent examination increased. presented As 1,the intable between 2000and2016of whichnoneof theparticipants underwent examination inthe years 2000–2005. Information provided by therespondents indicated that any diagnostic examinations they hadtook place Year of examination No data 2014 2016 2015 2013 2012 2011 2010 2009 2008 2007 2005 2000 Number of persons 96 86 13 69 32 17 18 22 3 3 1 2 1 Proportion 26.4% 23.7% 3.6% 8.8% 4.7% 6.1% 0.8% 0.8% 0.3% 0.6% 0.3% 19% 5%

17 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS RISK OF CANCER IN THE FAMILY AND FAMILY RELATIONSHIP

Risk factors increasing incidence of prostate and related organs cancer include genetic factors occurring in the family. In this study, respondents were also asked to answer whether there is history of prostate cancer in their families. The data obtained confirmed such cases in over 10% of respondents. This means that prostate cancer or related diseases occurred in every tenth family.

Graph 8. Is there history of prostate cancer in your family?

History of prostate cancer in respondent's family N =

.% .%

YES

.% no data

Source: Authors on the basis of study results Graph 9 shows that cancer was most often diagnosed in fathers (33.2%), that is in the first line of kinship. This 18 relation was followed by brothers (26%). There was a total of 329 positive answers to this question. On the other hand, respondents did not inform about cancer incidence among nephews. This may be simply due to limited knowledge of the health status of more distant family.

Graph 9. Degree of relatedness with an ill person

Degree of relatedness N =

father 15.4% 33.2% grandfather 12.1% brother

uncle 26.0% 13.4% no data

Source: Authors on the basis of study results 54 years. Therefore, theaverage duration of smokinginthestudied population was 23years. smoking was 1year, the largest proportion hadsmoked for 20years, whilethelongest periodof smokingwas Respondents’ answers about theduration of smokingwere very diverse. shortest The declared periodof survey respondents (25%)admitted that they smoked cigarettes. Another condition increasing theriskof developing cancer issmokingcigarettes. Inthisstudy, aquarter of all SMOKING CIGARETTES Source: Authors onthebasisof study results Source: Authors onthebasisof study results N = Duration ofsmokinginyears N = Smoking cigarettes maximum minimum average Graph 11.How longhave you smoked cigarettes? .% Graph 10.Doyou smoke cigarettes? . % .% no data NO YES

19 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS Studying the issue of smoking tobacco, investigators also asked respondents how many packs or cigarettes they smoked in a day. Again, answers were diverse, from the minimum of 1 cigarette a day to the maximum number of 66 cigarettes a day. The largest group of smokers, i.e. over 49%, smoked 20 cigarettes a day. The average number of cigarettes in the general studied group was 18 a day.

Graph 12. How many cigarettes a day?

Number of cigarettes a day N =

maximum

average

minimum

Source: Authors on the basis of study results

20 Source: Authors onthebasisof study results – total PSA). Persons whoreported complaints were referred for further, specialist tests (tumour –bloodsampling markers erection (17.2%)andfeeling of incomplete emptying of thebladderafter passing urine(16.9%). passing of duringthenight urine, occurring especially most frequently. Othersymptoms were problems with none of the symptoms listed in the questionnaire. Only in few cases, specific issues occurred, with frequent reproductive organs occur intheircase. According to respondents’ answers, thevast (over majority 80%)had of cancer. Therefore, study participants were asked whether any health problems related to theprostate or Scientific research indicates that there isagroup of cancer ordiseases precedingco-morbidities theonset HEALTH feeling ofincompleteemptyingthebladderafterpassingurine N = Health issues ISSUES frequent passingofurine,especiallyduringthenight Graph 13.Doany of thefollowing occur inyour case? intermittent streamofurine thinned streamofurine blood inspermorurine problems witherection difﬁculty inurination haematuria prostatitis obesity .% . % . % .% . % .% .% .% .% .% .% .% .% .% .% .% .% .% . % . %

21 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS CHRONIC DISEASES

Next, respondents were asked whether they had any chronic diseases. Nearly 14% confirmed that they did have chronic diseases. However, a clear majority of respondents (over 86%) declared that they had no health problems requiring treatment.

Graph 14. Do you have any chronic diseases?

Chronic diseases N =

. %

.% YES

no data . %

Source: Authors on the basis of study results

22 suffered from circulatory diseases anddiabetes. diseases, diabetes, andhighcholesterol levels. above The indicates that thestudied group of menmost often of medications (20%) were drugs used in disorders of internal secretion and metabolism, including thyroid which they listed: cardiac diseases, circulatory diseases, and arterial hypertension. second The largest group manently, thegreatest that is59%,took medications usedinthetreatment part, of thecirculatory system, of Respondents answered very variously about the types of medications drugs used. per Of 390 persons taking spondents might possibly not identify permanent useof medicineswithchronic diseases. higher thantheproportion of respondents whowere asked whether they hadchronic diseases. Somere demonstrated that over 15% of respondents use medications permanently. Interestingly, this proportion is Chronic diseases are directly related to permanent treatment, pharmaceuticals. includingtaking study The USE OF MEDICINES Source: Authors onthebasisof study results Source: Authors onthebasisof study results % N = Use ofmedicines N = Type ofmedicationsusedbydiseasetype % % % % Graph 15.Doyou take medicinespermanently? % .% % Graph 16.What medications? % . % % .% don’t remember other digestive diseases osteo-articular diseases Respiratory diseases neurological diseases Genitourinanry diseases circulatory diseases internal secretiondisorders no data NO YES - -

23 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS ALCOHOL ABUSE

A cause of many cases of disease, alcohol was abused by over 8% of respondents in this study. A vast majority of respondents denied to abuse alcohol (over 90%). It is not known, what respondents understood as ‘abusing’ alcohol. It can be, therefore, concluded that the problem of alcohol abuse did not occur in the studied population.

Graph 17. Do you abuse alcohol?

Alcohol abuse N =

.% .%

YES

no data . %

Source: Authors on the basis of study results

24 causes increasing theriskof developing cancer of theprostate, testes, andother malereproductive organs. persons (26,7%)live asedentary lifestyle. Inaccordance to theresults of scientific studies, itisone of the Most respondents declared they didnot live asedentary lifestyle (73.2%). Ontheother hand, oneinfour LIFESTYLE Source: Authors onthebasisof study results N = Sedentary lifestyle Graph 18.Doyou live asedentary lifestyle? . % .% .% no data NO YES

25 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS SPORTS ACTIVITY

The studies carried out indicate that a much smaller number of respondents (12.3%) practiced active sports. Most respondents (87.7%) admitted that they did not participate regularly in sporting activities. Lack of physical activity also contributes to the development of diseases, especially if it is combined with negative behaviour, like sedentary lifestyle.

Graph 19. Do you practice sports regularly, at least 2 times a week?

Practicing sports regularly N =

YES

NO .%

Source: Authors on the basis of study results

26 that over 86%of respondents declared they were not obese. about symptoms. Inthat case, obesitywas reported by 14.7%of respondents. studies performed The indicate Among respondents, 13%were obese. Interestingly, thisproportion wasthaninthecaseof answers smaller OBESITY Source: Authors onthebasisof study results N = Obesity .% Graph 20.Are you obese? . % .% no data NO YES

27 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS DIET

Respondents were also asked whether they follow high carbohydrate diet. Almost 100% of respondents admitted they did not follow such diet. It can be assumed, however, that this high proportion of negative answers resulted from lack of knowledge about what high carbohydrate diet is.

Graph 21. Do you follow a high carbohydrate diet?

Following high carbohydrate diet N =

.% . %

YES

no data .%

Source: Authors on the basis of study results

28 High carbohydrate diet is based on the assumption that every person can easily facilitate burning of calories, since there are products that accelerate metabolism. It involves eliminating high glycaemic index foods. Apart from sugar, the group includes white bread, corn flakes, cookies, potatoes, white rice, honey, and cooked car- rots. On the other hand, recommended products are, for example:

• wholegrain bread, • most fruits, • brown rice, rolled oats, sugar-free muesli, • leguminous vegetables, • pasta, • skimmed and semi-skimmed milk, plain yoghurt, • decaffeinated coffee, • freshly pressed juices, • skimmed or semi-skimmed curd and cheese, • fresh and smoked meat, fish. among themeninstudy. in prophylaxis, which significantly increases the risk of cancer of the prostate and other male organs, is clear doctors whoclaimthat patients report for avisitinadvances stagesof disease progression. of Lack interest peared. Fewer persons undergo examinations aimedat cancer prevention. isalsoconfirmed This by specialist means thatThis respondents undergo examinations onlywhenalarmingsymptoms orcomplaints have ap 9.5% hadprostate cancer diagnostic examinations done, only1.2%underwent prophylactic examinations. also worrying that almost 100%of respondents have not undergone suchexaminations; moreover, while Finally, respondents were asked whether they hadundergone diagnostic examinations towards cancer. Itis PROPHYLACTIC Source: Authors onthebasisof study results Graph 22.Have you undergone prophylactic examinations for cancer detection? N = Undergoing phophylacticexaminations EXAMINATIONS .% .% .% no data NO YES -

29 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS 7. CONCLUSIONS AND RECOMMENDATIONS

Based on the performed studies as well as the gathered and analysed data, the following conclusions and recommendations regarding further procedure can be formed.

Table 2. List of conclusions and recommendations No. Conclusion Recommendation 1. Future studies should also include residents of rural areas and smaller communes of the Koszalin county. It would also help popularise Most study participants were residents of urban ar- prophylactic programs and health promotion in eas, mostly of the Koszalin city. Place of residence rural areas. 1. matters in the context of access to diagnostic and 2. Access to prophylactic examinations and on- prophylactic examinations. cologists should be improved. 3. To reach residents of villages, study authors should engage rural organizations, village lead- ers, shop owners, and parishes. Nearly half of respondents had vocational education. Low education does not correlate with low 1. Prophylactic programs and health promotion level of participation in prophylactic and diagnostic 2. should be implemented irrespective of the lev- examinations. This suggests that low level of edu- el of education. cation does not affect respondents’ participation in prophylactic programs or living a healthy lifestyle. 1. The organised social campaigns as well as health promotion and cancer prevention programs should be highly adapted to employed The performed studies indicate that over 80% of 30 persons and their needs, mainly time con- persons are economically active. Hence, pro-health straints. 3. behaviour of respondents does not depend on pro- 2. Initiatives should be coordinated and employ- fessional status. Unemployment level is too low to ers should be engaged, e.g. through free ex- affect other results. aminations at work, promoting information by companies/businessmen among their male employees. 1. Knowledge about the significance of health prophylaxis and regular examinations of the prostate and other male organs should be pop- ularised. The vast majority of study participants do not un- 2. The medical sector (primary healthcare cen- dergo prophylactic or diagnostic tests. Over 90% 4. tres, non-public healthcare centres) should be of men are at risk of having cancer diagnosed too engaged in informing patients about principles late. of prevention, e.g. using posters and leaflets or communicating with patients during primary care visits. 3. Campaigns in local media should be organised. The performed studies prove that the Koszalin county is characterised by a low proportion of di- 1. Cancer detection in early stages should be in- agnosed cancer of the prostate or related organs creased by intensifying social programs in the occurrences. This may be due to the fact that very county: prophylaxis and health promotion, in- few men undergo examinations. The subject is cer- cluding extensive social campaigns. 5. tainly embarrassing, so maybe not all respondents 2. Appropriate conditions should be created that answered honestly. The proportion of detected would ensure conversation and examination in cancer cases is directly proportional to the propor- health centres is comfortable for men. tion of men undergoing prophylactic examinations, 3. Family support is needed. while it is reversely proportional to the number of deaths in the county due to this disease. No. 10. 6. 7. 9. 8. organs. developing cancer of the prostate and other male netic factors are important indefiningtherisk of Polish andinternational studies indicating that ge Family history of cancer casesstatistics confirmed majority of respondentsmajority donot abusealcohol. Studies indicate,or didnot admitit. however, that the Residents of theKoszalin county didnot abusealcohol ly stages of cancer. 20% of respondents had symptoms typical for ear appeared inpersons younger than40.Slightly over were related to the respondents’ age. rarely They Moreover, symptoms indicated inthequestionnaire teristics didnot affect smoking. among persons agedfrom 50to 64.Other charac- largestents. The proportion of smokers was noted Smoking was determined by theageof respond- nificantly increases therisk of developing cancer. cigarettes. Intensive smokingfor many years sig- this behaviour for over 20years, smokingabout20 cigarettes. Almost ahalfof smokers hadcontinued One infour residents of theKoszalin county smoked chronic disease andusesmedications chronically. study indicates that onein7mensuffers from a cardiac diseases, hypertension, anddiabetes. The however, respondents usedmedications to treat erection typicalfor thedisease occurred. Mostly, cancer (4), urological issues andproblems with In persons whowere diagnosedwithprostate disease ortheuseddrugs. tween thereported health issues andthetypeof However, there was no significant correlation be itively correlated. Chronic diseases andusingmedications were pos ing nature of suchproblems. male organs. could This bedueto theembarrass issues typicalfor cancer of theprostate orother of respondents majority The didnot report health Conclusion - - - - - 1. 3. 2. 1. 3. 1. 2. 1. 3. 2. 1. School psychologists shouldbeengagedineducat ing boys asearly aspossible proved, for especially malesover 40years old. and prophylactic examinations shouldbeim- ease andavailability of specialist physicians should beimplemented to avoid casesof dis Prophylactic programs andhealth promotion tients duringprimarycare visits posters andleaflets or communicating withpa- ative effects of smokingon health, e.g. using engaged ininforming patients abouttheneg- tres, non-publichealthcare centres) shouldbe healthcare cen medicalsector (primary The - man body ing thenegative effects of smokingonthehu- There should beeducation at schoolsconcern- paigns, are needed. Further alcohol-related actions, e.g. socialcam- cancer, withemphasisonthemaleline Families should be educated about the risk of cancer shouldbeimplemented. DNA testing programs aimedat thisparticular Anti-smoking campaignsshouldbeorganisedAnti-smoking . Specialised trainings for physicians are needed. tients duringprimarycare visits posters andleaflets or communicating withpa- creased riskof contracting cancer, e.g. using engaged in informing patients about the in- tres, non-publichealthcare centres) shouldbe healthcare cen medicalsector (primary The - nations are needed. Social campaignsencouraging regular exami- . Recommendation . . . . - -

31 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS No. Conclusion Recommendation 1. Physical activity should be promoted among residents, who should be encouraged to spend time actively. 2. The implementation of elements like: a. Inexpensive club cards for all sport venues in the county, i.e. sports halls, swimming pools, gyms. b. Voicing and promoting county sports associ- Most respondents did not live a sedentary lifestyle ations, hobby clubs, or other units related to (over 73% of respondents), but they also did not 11. physical activity. practice sports regularly. Only one in 8 residents of c. Organising free sporting events for county the county did active sports. residents, such as runs and sports compe- titions, during which residents could also talk with a dietician or physician or try using sporting equipment. d. Increasing the number of equipment rental units available to county residents such as bicycle rental, outdoor gyms in parks and green squares. Residents of the Koszalin county had no problems with obesity, generally. This was correlated with the fact that most respondents did not live a sed- 1. Health promotion and active leisure programs entary lifestyle. On the other hand, obesity was including campaigns promoting healthy nutri- related to the reported health problems, especially tion and the advantages of carbohydrate diet 12. cardiac diseases, hypertension, etc. should be implemented. 2. Healthy nutrition education is needed. Studies indicate, however, that knowledge of high 3. Workshops and free dietetic consultations are carbohydrate diet was limited. This can be deduced needed. from the proportion of persons who admitted they 32 did not follow such diet (nearly 100% percent).

In summary, the most important issue for the Koszalin county should be increasing the proportion of men undergoing regular diagnostic and prophylactic examinations to prevent incidence of cancer of the prostate, testes, and other male organs. 5. 4. 3. 2. 1. 8. Reports basedondata of theCancer Centre, epid.coi.waw.pl/krn/ Statistical data of theCounty Employment Office in Koszalin, www.pup.koszalin.pl/ ‘Deaths according to cause’ compilation, Central Statistical Office, stat.gov.pl Assessment of theneedsof Koszalin county Prophylaxis andhealth promotion program of theKoszalin County REFERENCES

33 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS 9. LIST OF FIGURES TABLES, AND GRAPHS

Figure 1. Residence structure of respondents by commune of the Koszalin county...... 13

Table 1. When did you have prostate cancer diagnostic test done?...... 17

Table 2. List of conclusions and recommendations...... 30

Graph 1. Age structure of the study subjects...... 12

Graph 2. Place of residence of respondents according to breakdown into urban and rural areas...... 13

Graph 3. Education structure of the study subjects...... 14

Graph 4. Education status of respondents...... 14

Graph 5. Duration of unemployment...... 15

Graph 6. Have you undergone prostate cancer diagnostic examination?...... 16

Graph 7. Was cancer diagnosed?...... 16

Graph 8. Is there history of prostate cancer in your family?...... 18 34 Graph 9. Degree of relatedness with an ill person...... 18

Graph 10. Do you smoke cigarettes?...... 19

Graph 11. How long have you smoked cigarettes?...... 19

Graph 12. How many packs a day/cigarettes a day?...... 20

Graph 13. Do any of the following occur in your case?...... 21

Graph 14. Do you have any chronic diseases?...... 22

Graph 15. Do you take medicines permanently?...... 23

Graph 16. What medications?...... 23

Graph 17. Do you abuse alcohol?...... 24

Graph 18. Do you live a sedentary lifestyle?...... 25

Graph 19. Do you practice sports regularly, at least 2 times a week?...... 26

Graph 20. Are you obese?...... 27

Graph 21. Do you follow a high carbohydrate diet?...... 28

Graph 22. Have you undergone prophylactic examinations for cancer detection?...... 29 testis, andother malereproductive 1). organs (page Annex 1.Template of questionnaire regarding prophylactic examinations detecting thecancer of the prostate, 10. ANNEXES wykorzystania mojego wizerunku. wizerunku. mojego wykorzystania yozsai mjg wzrnu e sytih publik wszystkich we wizerunku mojego wykorzystanie ze zdrowiu, w nierówności społecznych Ograniczanie izęnm o elzci rjku o nzą „Zwalcz nazwą pod projektu realizacji do niezbędnym 4. Czy występują Pana: u NIE TAK, ………………lat, od ……………………… pac 3. Czy pali Pan/Pani papierosy? NIE TAK, stopień pokrewieństwa zo narządów skojarzonych (jądra i męskich innych narz zacho przypadki występowały rodzinie Pana w Czy 2. NIE TAK, kiedy i czy znaleziono no 1. Czy wykonywano badanie Panu diagnostyczne raka prostaty? w kier unku 1. Statusna rynku pracy: aktywny zawodowo Wykształcenie: podstawowe zawodowe średnie wy Miasto Wieś Nr telefonu ………………… Ulica…………………….………………………………..………… Nr domu.…………………….… Adres zamieszkania: Kod pocztowy……………………………..……… PESEL………………………………………………………………………………………….… Wiek ………… Nazwisko ……………………………………………………………………………………… Imię………… dan ochronie o r. 29.08.1997 dn. z ustawą z Zgodnie .CycouePnn hrb relke 5. Czy choruje choroby na Pan przewlekłe? .Cyndżw a loou 7. Czy alkoholu? Pan nadużywa .CypzjuePnn tł ei □ □ NIE 6. Czy przyjmuje stałe na Pan leki? .Cypoaz a idąyty yi? 8. Czy prowadzi siedzący Pan życia? tryb jeśliTAK, jakie…………………………………………………………… 9. Czy uprawia sport Pan regularnie min. 2 w razy t arsewkyai oowrw □ □ NIE TA w zakresie wykrywania nowotworów? 12. udział Czy Pan brał w badaniach profilaktycznyc 11. Czy stosuje Pan 10. Czy cierpi otyłość? na Pan Finansowego 2009-2014 oraz budżetu Państwa. Program Państwa. budżetu oraz 2009-2014 Finansowego Projekt: „Zwalczamy nowotwory – program profilaktyk program – nowotwory „Zwalczamy Projekt:

INFORMACJE: INFORMACJE: a) b) e) d) c) g) f) j) i) h) DEKLARUJĘ CHĘĆ WZIĘCIA UDZIAŁU W BEZPŁATNYCH BADANI BEZPŁATNYCH W UDZIAŁU WZIĘCIA CHĘĆ DEKLARUJĘ

uczucie niecałkowitego opróżnienia pęcherza odda po zseodwnemcu zzgli oy częste oddawanie moczu, szczególniew nocy rbeyzeecą przerywany strumieńmoczu erekcją z problemy trudności w oddawaniu moczu wżn tuińmcu zwężony strumień moczu aaei trz zapalenie stercza tłś □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK otyłość krwiomocz krewspermie w moczu lub ANKIETA W ZAKRESIE BADAŃ PROFILKATYCZNYCH WYKRYWANI GRUCZOŁU KROKOWEGO, JĄDRA I INNYCH MĘSKICH NARZĄDÓW it yooęlwdnw? □ □ NIE TAK dietę wysokowęglowodanową?

ych osobowych (Dz. U. z 2002r. nr 101 poz. 926 ze środków Norweskiego Mechanizmu Finansowego 2009-201 Finansowego Mechanizmu Norweskiego środków m nwtoy porm rflkyi oowrwj w nowotworowej profilaktyki program – nowotwory amy cah a orey elzci rjku jk również jak projektu, realizacji potrzeby na acjach PL13 - Ograniczanie społecznych nierównościw zdro i nowotworowej w powiecie koszalińskim”. powiecie w nowotworowej i Data……………………….……………… Czytelny podpis…………………………………… Czytelny Data……………………….……………… wotwór ?...... wotwór ……………………………………………………………………….……………… bezrobotny, jak długo ………………………………………… sobą chorą ……………………………………………………… gdi? ygodniu? h h ądów płciowych)? rowania na raka gruczołu krokowego lub inne nowotwo inne lub krokowego gruczołu raka na rowania zek dziennie/szt. dziennie ……. Miejscowość …………………………………………………… niu moczuniu zm.), wyrażam zgodę na przetwarzanie moich danych o danych moich przetwarzanie na zgodę wyrażam zm.), rea sę rw wąayh knrl i zatwierdz i kontrolą z związanych praw się zrzekam ………… Nr lokalu………………..…………………. ACH 4 oraz budżetu państwa. Jednocześnie wyrażam zgodę zgodę wyrażam Jednocześnie państwa. budżetu oraz 4 oice ozlńkm, elzwng w aah pro ramach w realizowanego koszalińskim”, powiecie .…………………………………..………………… …………………… Dofinansowany ze środków Norweskiego Mechanizmu Mechanizmu Norweskiego środków ze Dofinansowany

ższe

wiu – Operator Programu Ministerstwo Zdrowia. Zdrowia. Ministerstwo Programu Operator – wiu □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK □ □ NIE TAK . . A NOWOTWORÓW NOWOTWORÓW A PŁCIOWYCH PŁCIOWYCH TAK TAK K

sobowych w zakresie w sobowych aniem każdorazowo każdorazowo aniem ……………………… na nieodpłatne nieodpłatne na

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35 EPIDEMIOLOGICAL REPORT CONCERNING CANCER EOG GRANTS OF THE PROSTATE, TESTIS, AND OTHER MALE REPRODUCTIVE ORGANS Annex 1. Template of questionnaire regarding prophylactic examinations detecting the cancer of the prostate, testis, and other male reproductive organs (page 2).

POWIAT KOSZALIŃSKI

PROJECT OFFICE Starostwo Powiatowe w Koszalinie (County Governor’s Office) ul. Racławicka 13 75-620 Koszalin phone 94 714 01 75 e-mail: [email protected] www.zdrowie.powiat.koszalin.pl