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  • The parallel increases in cervical cancer incidence and mort

    2019-08-11

    The parallel increases in cervical cancer incidence and mortality is indicative of a lack of population-based screening and subsequent improvements in treatment. Additional information provided by the cohort analysis are comparable to results of studies from a number of other countries indicating the post-war increase of HPV prevalence [43]. Despite the major impact of HPV-related disease burden in post-war cohorts in most countries, the magnitude of increase is considerably lower in countries with effective cervical cancer control programs [5]. The rising number of cervical cancer cases and deaths predicted in Russia in the near future underscores the urgency of the implementation of control policies – population-based, quality-assured screening and vaccination programs [6]. The possible impact of both cytology-based and HPV detection methods as well as the effect of primary prevention - HPV vaccination - has been evaluated in models that incorporate cost-effectiveness. The results of these studies have indicated that both HPV and Norfloxacin screening can be a highly effective intervention in high-risk populations, with vaccination combined with screening the potential to reduce incidence from 7.0 to 0.2 cases per 100,000 women [44]. On the other hand, field studies are equally essential in implementing population-based programs to ensure quality assurance. The awareness among public and health care providers is reported to be limited in Russia [39]; integrating health promotion activities into cervical cancer prevention is essential as part of national cancer control policy. Despite the recently declining rates, breast cancer remains one the major causes of death in Russian women. Further development of evidence-based early detection policies and the optimization of current treatment strategies is essential for reducing the death toll. Current trends could be an indicator of diagnostic and treatment successes, but individual-level studies are also needed to assess the impact. The transition from opportunistic to population-based quality-assured mammography screening could further decrease breast cancer deaths [45]. Meanwhile, quantification of the magnitude of breast cancer incidence increases and mortality decreases that are due to screening and the level of over-diagnosis still remains [46]. Currently, opportunistic breast and cervical cancer screening in Russia is embedded in the “dispensarization” programme, which was introduced with a MOH order fin 2012. The latest guidelines on intervals, target age groups and tests were issued in 2017, and are mostly in line with international recommendations (Pap-test every 3 years from age 30 to 60 years, mammography every 3 years ate ages 39–48 years, followed by biennial mammography for women aged 50 to 70 years) [47]. Although detailed information on quality, actual intervals and coverage is not currently available, implementation of population-based screening is possible based on resources allocated by the MOH to “dispensarization”. HPV vaccination is not in the national vaccination calendar, while local vaccination campaigns with limited coverage were reported in several regional starting from 2009 [39]. The lack of a formal assessment of the quality of the data is an important limitation of the study. The DCO proportions for cervical cancer are reported between 1 and 2% in 2007–2013, while the proportion of morphological verification was 97% for the same period [48]. Even though these estimates are published, a comprehensive assessment of cancer registry data quality has not been performed, neither at national or subnational level. The reasons behind the observed trends may include true changes in risk factor distribution and cancer control activities, but can be also biased by changes in coding or registration practices [49]. However, the regional cancer registries did not report any changes that might influence breast, cervical, uterus NOS and female genital organs NOS cancer registration during the study period. In addition, we did not observe any sudden deviations in trends of age-specific or overall rates. On the other hand, the mortality from Uterus and Uterus NOS cancer (C54, C55) showed a decline in the last few years, which could suggest increased specificity of cervical cancer deaths. A few studies have explored cancer registry data quality in Russia, one assessing the heterogeneity in the registration of causes of death between the regions of Russia, and showing that the proportion of cancers and motor vehicle accidents deaths in the mortality structure are reported consistently across the country, in contrast to cardiovascular and infectious diseases [50]. The fact that cancer management demands morphological verification and in some instances expensive chemotherapy agents, often provided and financed by the state, makes high quality registration an aspect that is more likely to be established within oncology than in other fields of health care. However, further formal quality assessments are needed. Only few cancer registers are members of the International Association of Cancer Registries (IACR) and the European Network of Cancer Registries (ENCR). Therefore, the cancer statistics reported by international organizations are based on the limited data. Further initiatives should be focused on making Russian cancer registries data transparent and comparable. Without formal assessment of the quality of cancer registration, the interpretation of any future cancer registry-based research would be problematic in Russia.