Years of life lost due to malignant neoplasms characterized by the highest mortality rate

A Prospective Pilot Study on Use of Liquid Crystal Thermography to Detect Early Breast Cancer

Background: Breast cancer is the most common cancer in women. While mammography is the standard for early detection in women older than 50 years of age, there is no standard for younger women. The aim of this prospective pilot study was to assess liquid crystal contact thermography, using the Braster device, as a means for the early detection of breast cancer. The device is intended to be used as a complementary tool to standard of care (sonography, mammography, etc). Patients and Methods: A total of 274 consecutive women presenting at Polish breast centers for prophylactic breast examination were enrolled to receive thermography; 19 were excluded for errors in thermographic image acquisition. The women were divided according to age (n = 135, <50 years; n = 120, ≥50 years). A control population was included (n = 40, <50 years; n = 23, ≥50 years). The primary endpoint, stratified by age group, was the C-statistic for discrimination between breast cancer and noncancer. Results: In women with abnormal breast ultrasound (n = 95, <50 years; n = 87, ≥50 years), the C-statistic was 0.85 and 0.75, respectively (P = .20), for discrimination between breast cancer and noncancer. Sensitivity did not differ (P = .79) between the younger (82%) and older women (78%), while specificity was lower in the older women (60% vs 87%, P = .025). The false-positive rate was similar in women with normal and abnormal breast ultrasound. Positive thermographic result in women with Breast Imaging Reporting and Data System (BIRADS) 4A on ultrasound increased the probability of breast cancer by over 2-fold. Conversely, a negative thermographic result decreased the probability of cancer more than 3-fold. Breast size and structure did not affect the thermography performance. No adverse events were observed. Conclusions: Thermography performed well in women <50 years of age, while its specificity in women ≥50 years was inadequate. These promising findings suggest that the Braster device deserves further investigation as a supporting tool for the early detection of breast cancer in women younger than 50 years of age.

Years of life lost due to malignant neoplasms of the digestive system in Poland during 10 years of socioeconomic transformation

The aim of the study was to analyse years of life lost due to selected malignant neoplasms of the digestive system (colorectum, stomach, and pancreas) in Poland, a post-communist country in Central Europe, according to socioeconomic variables: sex, age, level of education, marital status, working status, and place of residence. The study included a dataset comprising death certificates of Polish citizens from 2002 (N = 359 486) and 2011 (N = 375 501). The data on deaths caused by malignant neoplasms of the digestive system, that is, coded as C15-C26 according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision, was analyzed. The standard expected years of life lost meter was used to calculate years of life lost. In 2002, malignant neoplasms of the digestive system caused 25 024 deaths among Polish citizens (7.0% of all deaths), which translated into a premature loss of 494 442.1 years of life (129.4 years per 10 000 people). In 2011, the number of deaths increased to 26 537 (7.1% of all deaths) and the number of years of life lost rose to 499 804.0 (129.7 years per 10 000). The most important causes of mortality and years of life lost were colorectal, stomach, and pancreatic cancers. In both studied years, the socioeconomic features with an adverse effect on years of life lost due to each considered malignant neoplasm of the digestive system included male gender, lower than secondary education, widowed marital status, economic inactivity, living in urban areas. Years of life lost analysis constitutes a valuable part of epidemiological assessment of health inequalities in society. It appears that the observed inequalities may have many causes; however, further research is needed to better understand their full extent.

Standard Expected Years of Life Lost Due to Malignant Neoplasms in Poland, 2000-2014

The aim of the study was an analysis of mortality trends due to malignant neoplasms in Poland. The study material was a database, consisting of 1,367,364 death certificates of inhabitants of Poland who died during the period 2000-2014 due to malignant cancer. To calculate years of life lost, the SEYLLp index (Standard Expected Years of Life Lost per living person) was applied. We also calculated AAPC (Average Annual Percentage Change). The SEYLLp index (per 10,000 population) due to malignant neoplasms in Poland in males decreased from 586.3 in 2000 to 575.5 in 2014, whereas in females it increased from 398.6 in 2000 to 418.3 in 2014. The greatest number of lost years of life in 2014 was attributed to lung cancer (174.7 per 10,000 males and 77.3 per 10,000 females), breast cancer in females (64.5) and colorectal cancer in males (39.0). The most negative trends were observed for lung cancer in females (AAPC = 3.5%) and for colorectal cancer (AAPC = 1.8%) and prostate cancer (AAPC = 1.6%) in males. Many lost years could have been prevented by including a greater number of Polish inhabitants in screening examinations, mostly targeted at malignant neoplasm, whose incidence is closely connected with modifiable risk factors.

Years of Life Lost Due to Cervical Cancer in Poland in 2000 to 2015

The aim of the study was an analysis of years of life lost due to cervical cancer in Poland in the period 2000 to 2015 with consideration given to differences related to education and place of residence. The study material was 28,274 death certificates of all female inhabitants of Poland, who died in 2000 to 2015 due to cervical cancer. In order to calculate years of life lost, the authors used indices: SEYLL_p (Standard Expected Years of Life Lost per living person), SEYLL_d (per deaths) and AAPC (Average Annual Percentage Change). The SEYLL_p index (per 100,000) due to cervical cancer in Poland decreased from 394.3 in 2000 to 220.9 years of life in 2015 (AAPC = −3.6%). Women with university education lost the smallest number of years of life (SEYLL_p = 139.0 in 2000 and 53.7 in 2015; AAPC = −5.4%), whereas those with elementary education had the greatest number of years of life lost (524.2 and 312.8; AAPC = −3.4%). Women living in rural areas lost on average 329.5 years in 2000 and 177.0 in 2015 (AAPC = −3.8%). In city areas, the values were 428.6 and 247.1 (AAPC = −3.4%). Many of the years of life lost could have been avoided by including more women, particularly those with elementary education, in screening examinations.

Years of life lost due to malignant neoplasms of the digestive system in Poland in the years 2000-2014

Background

Every fourth death that occurs in Poland is caused by a malignant neoplasm. A particularly negative epidemiological situation relates to colorectal cancers; in 2015 they constituted the fifth most important cause of years of life lost (YLL) in Poland.

Objective

We aimed to analyse YLL due to malignant neoplasms of the digestive system in Poland in between 2000 and 2014.

Methods

The study material included a database containing information gathered from 5,601,568 death certificates of Poles who died in 2000-2014. YLLs were calculated with the use of the standard expected years of life lost index (SEYLL).

Results

In the 15-year study period, malignant neoplasms of the digestive system contributed to 213,041 deaths in males and 177,644 deaths in females, which corresponded to a loss of 158.6 years per 10,000 men and 105.3 years per 10,000 women. Neoplasms of the large intestine (23.6%), stomach (22.0%) and pancreas (17.4%) contributed the most. A time trend analysis revealed (p < 0.05) a growing tendency of YLLs due to neoplasms of the large intestine and pancreas, and a decreasing trend due to neoplasms of the stomach.

Conclusion

Malignant neoplasms of the digestive system, especially of the large intestine, are becoming a more common cause of premature mortality in Poland.

Intensive rehabilitation as an independent determinant of better outcome in patients with lung tumors treated by thoracic surgery

INTRODUCTION

The frequency of postoperative complications after thoracic surgery remains high. Rehabilitation may become a procedure characterized by a high cost-effectiveness ratio. The aim of the study was to determine the independent importance of intensive rehabilitation in patients with lung tumors treated by thoracic surgery.

MATERIAL AND METHODS

The prospective observational study included two groups of patients: 187 patients treated according to the historical scheme including thoracic surgery without specific exercises improving cardio-pulmonary capacity, and 215 patients treated in agreement with the innovative algorithm of perioperative intensive physiotherapy until discharge from hospital. The evaluated clinical endpoints comprised bronchoscopy for pulmonary toilet and all other possible postoperative complications.

RESULTS

The use of intensive physiotherapy significantly shortened the duration of hospitalization through reducing the frequencies of different postoperative complications. The specific clinical benefit was associated with a significantly lower rate of bronchoscopy performance for pulmonary toilet (16% vs. 5.6%, p = 0.0006). Multivariate regression analyses revealed intensive physiotherapy as a significant independent predictor for all postoperative complications (OR = 0.57; 95% CI: 0.323-0.988; p = 0.045) and need to perform bronchoscopy for pulmonary toilet (OR = 0.24; 95% CI: 0.11-0.51; p = 0.0002).

CONCLUSIONS

The study showed the strong independent positive effect of intensive rehabilitation in patients with lung tumors treated by thoracic surgery.

Application of artificial neural networks for predicting presence of non-sentinel lymph node metastases in breast cancer patients with positive sentinel lymph node biopsies

INTRODUCTION

The aim of this study was to present a new predictive tool for non-sentinel lymph node (nSLN) metastases.

MATERIAL AND METHODS

One thousand five hundred eighty-three patients with early-stage breast cancer were subjected to sentinel lymph node biopsy (SLNB) between 2004 and 2012. Metastatic SLNs were found in 348 patients - the retrospective group. Selective axillary lymph node dissection (ALND) was performed in 94% of cases. Involvement of the nSLNs was identified in 32.1% of patients following ALND. The correlation between nSLN involvement and selected epidemiological data, primary tumor features and details of the diagnostic and therapeutic management was examined in metastatic SLN group. Multivariate analysis was performed using an artificial neural network to create a new nomogram. The new test was validated using the overall study population consisting of the prospective group (365 patients - SLNB between 01-07.2013).

RESULTS

Accuracy of the new test was calculated using area under the receiver operating characteristics curve (AUC). We obtained AUC coefficient equal to 0.87 (95% confidence interval: 0.81-0.92). Sensitivity amounted to 69%, specificity to 86%, accuracy - 80% (retrospective group) and 77%, 46%, 66% (validation group), respectively. The Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram the calculated AUC value was 0.71, for Stanford - 0.68, for Tenon - 0.67.

CONCLUSIONS

In the analyzed group only the MSKCC nomogram and the new model showed AUC values exceeding the expected level of 0.70. Our nomogram performs well in prospective validation on patient series. The overall assessment of clinical usefulness of this test will be possible after testing it on different patient populations.

Fifteen-year mortality trends in Poland analysed with the use of standard expected years of life lost, 2000-2014

The aim of the study is an evaluation of years of life lost by inhabitants of Poland according to the most important causes of mortality and identification of trends in the period 2000-2014. The study material included a database which contained information gathered from 5,601,568 death certificates of inhabitants of Poland. In order to calculate years of life lost, the SEYLL_p index (Standard Expected Years of Life Lost per living person) was applied. We also calculated AAPC (Average Annual Percentage Change). The SEYLL_p index (per 10,000 population) in Poland decreased from 2503.4 in 2000 to 2193.2 in 2014 among males (AAPC = -0.8%, p < 0.05) and from 1430.2 in 2000 to 1269.4 in 2014 among females (AAPC = -0.6%, p < 0.05). In 2014, the top 5 causes of years of life lost were: cardiovascular diseases (721.4 per 10,000 males and 475.6 per 10,000 females), malignant tumours (575.5 and 418.3), unintentional injuries (202.2 and 46.8), intentional injuries (114.6 and 16.3) and digestive diseases (120.2 and 58.3). Due to negative trends, there is a need to implement preventative measures, aimed at reducing mortality caused by respiratory infections in both males and females, malignant tumours in females and diabetes mellitus and intentional injuries in males.

Years of life lost due to infectious diseases in Poland

Purpose

An evaluation of mortality due to infectious diseases in Poland in 1999–2012 and an analysis of standard expected years of life lost due to the above diseases.

Methods

The study material included a database created on the basis of 5,219,205 death certificates of Polish inhabitants, gathered between 1999 and 2012 and provided by the Central Statistical Office. Crude Death Rates (CDR), Standardized Death Rates (SDR) and Standard Expected Years of Life Lost (SEYLL) due to infectious and parasitic diseases were also evaluated in the study period as well as Standard Expected Years of Life Lost per living person (SEYLL_p) and Standard Expected Years of Life Lost per dead person (SEYLL_d). Time trends were evaluated with the application of joinpoint models and an annual percentage change in their values.

Results

Death certificates report that 38,261 people died due to infectious diseases in Poland in the period 1999–2012, which made up 0.73% of the total number of deaths. SDR caused by these diseases decreased, particularly in the male group: Annual Percentage Change (APC = -1.05; 95% CI:-2.0 to -0.2; p<0.05). The most positive trends were observed in mortality caused by tuberculosis (A15-A19) (APC = -5.40; 95% CI:-6.3 to -4.5; p<0.05) and also meningitis, encephalitis, myelitis and encephalomyelitis (G03-G04) (APC = -3.42; 95% CI:-4.7 to -2.1; p<0.05). The most negative mortality trends were observed for intestinal infectious diseases (A00-A09) Annual Average Percentage Change (AAPC = 7.3; 95% CI:3.1 to 11.7; p<0.05). SDR substantially decreased in the first half of the study period, but then significantly increased in the second half. Infectious and parasitic diseases contributed to a loss of around 37,000 standard expected years of life in 1999 and more than 28,000 in 2012. During the study period, the SEYLL_p index decreased from 9.59 to 7.39 per 10,000 population and the SEYLL_d index decreased from 14.26 to 10.34 years (AAPC = 2.3; 95% CI:-2,9 to -1.7; p<0.05).

Conclusions

Despite smaller numbers of deaths reported from infectious causes these diseases still represent a serious problem for Poland compared to countries in Western Europe.

The impact of the Polish mass breast cancer screening program on prognosis in the Pomeranian Province

INTRODUCTION

Mammographic screening results in diagnosis of less advanced breast cancer (BC). A meta-analysis of randomized clinical trials confirmed that BC screening reduces mortality. In 2007, the National Breast Cancer Screening Program (NBCSP) was established in Poland with the crucial aim of reducing mortality from BC. The purpose of this study was to assess the impact of participation in the NBCSP on prognosis.

MATERIAL AND METHODS

A single institution, non-randomized retrospective study was undertaken. The study population comprised 643 patients with BC treated in the Department of Surgical Oncology (DSO) at the Medical University of Gdansk over a 4-year period, from 01.01.2007 until 31.12.2010. Patients were divided into two groups: group A - patients who participated in the NBCSP (n = 238, 37.0%); and group B - patients who did not participate in the NBCSP (n = 405, 63.0%).

RESULTS

Statistical analysis revealed that group A displayed a less advanced AJCC stage (more patients in AJCC stage I, p = 0.002), lower tumor diameter (more patients with pT1, p = 0.006, and pT < 15 mm, p = 0.008) and a lower incidence of metastases to axillary lymph nodes (more patients with pNO, p = 0.01). From 2009 to 2010 the NBCSP revealed a statistically significant benefit - significantly more patients in stage 0 + I (60.7% vs. 48.8%, p = 0.018) and with tumors pT < 15 mm (48.8% vs. 35.1%, p = 0.011) were observed in group A.

CONCLUSIONS

The study results revealed the beneficial impact of the NBCSP. Superior prognostic factors and favorable staging were observed in women who participated in the NBCSP.

Educational inequalities in premature mortality in Poland, 2002-2011: a population-based cross-sectional study

BACKGROUND

The aim of the study is to evaluate the differences in premature mortality between educational groups of Polish inhabitants in 2002 and 2011.

METHODS

The analysis included all deaths among inhabitants of Poland, aged 25-64 years, which occurred in 2002 (N=97 004) and 2011 (N=104 598). We calculated age-standardised death rates (SDRs) and summary measures on inequalities. The relative index of inequality (RII) was calculated with Poisson regression.

RESULTS

The SDR for Poland decreased from 285.7 per 100 000 in 2002 to 246.0 in 2011 among males with higher education and increased from 1141.0 in 2002 to 1183.0 in 2011 among males with lower secondary or less education (the rate ratio increased from 4.0 to 4.8). With regard to females with higher education, the SDR decreased from 127.2 per 100 000 in 2002 to 115.6 in 2011. Among females with lower secondary or less education, the SDR increased from 375.8 per 100 000 in 2002 to 423.1 in 2011 (the rate ratio increased from 3.0 to 3.7). The RII increased from 5.8 to 9.7 in the male group and from 4.4 to 8.3 in the female group. The greatest educational inequalities in 2011 were observed in females who died of cardiovascular diseases (RII=14.9) and lung cancer (RII=6.6) and in males who died of suicides (RII=19.3) and lung cancer (RII=11.9).

CONCLUSIONS

Educational inequalities in premature mortality in Poland are growing. There is a need to implement health education programmes targeted at groups of the most poorly educated Polish inhabitants, especially for diseases resulting from smoking and excessive alcohol consumption.

Years of Life Lost due to Premature Mortality in a Province with the Shortest Life Expectancy in Poland

AIM

The aim of the study was to evaluate years of life lost for citizens of the Lodz Province, which is characterized by the lowest life expectancy in Poland, and to identify current trends in this area according to the most common causes of death.

METHODS

The study material included a database containing information gathered from 470,000 death certificates of Lodz Province inhabitants, who died between 1999 and 2011. In order to calculate years of life lost, the authors applied the SEYLLp (Standard Expected Years of Life Lost per living person) and SEYLLd (per death) indices. The analysis of time trends was carried out with the application of joinpoint models.

RESULTS

The SEYLLp measure was 2,300 years per 10,000 males and 1,500 years per 10,000 females in 2011. Cardiovascular diseases contributed to the highest number of years of life lost (SEYLLp=682 years per 10,000 males and 559 years per 10,000 females). Next were malignant neoplasms (SEYLLp=505 years per 10,000 males and 437 years per 10,000 females), external causes of death (SEYLLp=361 years per 10,000 males and 83 years per 10,000 females). The number of years of life lost due to acute myocardial infarction decreased most rapidly, the Annual Percent Change (APC) was -10.1% in males and -3.7% in females. However, heart failure contributed to the highest increase in the number of years of life lost (APC=10.8% in males and 10.9% in females).

CONCLUSIONS

A further decrease in the mortality rate due to cardiovascular diseases might contribute to the highest reduction of years of life lost. The most effective preventive activities are those aimed at reducing productive years of life lost due to a particular cause of death, i.e. road traffic accidents, suicides, cirrhosis of the liver, alcoholic liver disease, and malignant neoplasms of the trachea, bronchi and lungs.

The role of micronutrients in the risk of urinary tract cancer

Prostate, bladder and kidney cancers remain the most common urological malignancies worldwide, and the prevention and treatment of these diseases pose a challenge to clinicians. In recent decades, many studies have been conducted to assess the association between supplementation with selected vitamins and elements and urinary tract tumour initiation and development. Here, we review the relationship between vitamins A, B, D, and E, in addition to calcium, selenium, and zinc, and the risk of developing prostate, kidney and bladder cancer. A relatively consistent body of evidence suggests that large daily doses of calcium (> 2,000 mg/day) increase the risk of prostate cancer. Similarly, supplementation with 400 IU/day of vitamin E carries a significant risk of prostate cancer. However, there have been many conflicting results regarding the effect of these nutrients on kidney and bladder neoplasms. Moreover, the role of other compounds in urinary tract carcinogenesis needs further clarification.

The burden of premature mortality in Poland analysed with the use of standard expected years of life lost

Background

Despite positive changes in the health of the population of Poland, compared to the EU average, the average life expectancy in 2011 was 5 years shorter for males and 2.2 years shorter for females. The immediate cause is the great number of premature deaths, which results in years of life lost in the population. The aim of the study was to identify the major causes of years of life lost in Poland.

Methods

The analysis was based on a database of the Central Statistical Office of Poland, containing information gathered from 375,501 death certificates of inhabitants of Poland who died in 2011. The SEYLL_p (Standard Expected Years of Life Lost per living person) and the SEYLL_d (SEYLL per death) measures were calculated to determine years of life lost.

Results

In 2011, the total number of years of life lost by in Polish residents due to premature mortality was 2,249,213 (1,415,672 for males and 833,541 for females). The greatest number of years of life lost in males were due to ischemic heart disease (7.8 per 1,000), lung cancer (6.0), suicides (6.6), cerebrovascular disease (4.6) and road traffic accidents (5.4). In females, the factors contributing to the greatest number of deaths were cerebrovascular disease (3.8 per 1,000), ischemic heart disease (3.7), heart failure (2.7), lung cancer (2.5) and breast cancer (2.3). Regarding the individual scores per person in both males and females, the greatest death factors were road traffic accidents (20.2 years in males and 17.1 in females), suicides (17.4 years in males and 15.4 in females) and liver cirrhosis (12.1 years in males and 11.3 in females).

Conclusions

It would be most beneficial to further reduce the number of deaths due to cardiovascular diseases, because they contribute to the greatest number of years of life lost. Moreover, from the economic point of view, the most effective preventative activities are those which target causes which result in a large number of years of life lost at productive age for each death due to a particular reason, i.e. road traffic accidents, suicides and liver cirrhosis.

Years of life lost due to external causes of death in the lodz province, poland

BACKGROUND

The aim of the study is the analysis of years of life lost due to external causes of death, particularly due to traffic accidents and suicides.

MATERIALS AND METHODS

The study material includes a database containing information gathered from 376,281 death certificates of inhabitants of the Lodz province who died between 1999 and 2010. The Lodz province is characterized by the highest mortality rates in Poland. The SEYLLp (Standard Expected Years of Life Lost per living person) and the SEYLLd (per death) indices were used to determine years of life lost. Joinpoint models were used to analyze time trends.

RESULTS

In 2010, deaths due to external causes constituted 6.0% of the total number of deaths. The standardized death rate (SDR) due to external causes was 110.0 per 100,000 males and was five times higher than for females (22.0 per 100,000 females). In 2010, the SEYLLp due to external causes was 3746 per 100,000 males and 721 per 100,000 females. Among males, suicides and traffic accidents were the most common causes of death (the values of the SEYLLp were: 1098 years and 887 years per 100,000 people, respectively). Among females, the SEYLLp values were 183 years due to traffic accidents and 143 years due to suicides (per 100,000 people).

CONCLUSIONS

A decrease in the number of years of life lost due to external causes is much higher among females. The authors observe that a growing number of suicides contribute to an increase in the value of the SEYLLp index. This directly contributes to over-mortality of males due to external causes. The analysis of the years of life lost focuses on the social and economic aspects of premature mortality due to external causes.

Self-rated quality of life of city-dwelling elderly people benefitting from social help: results of a cross-sectional study

Background

The percentage of people aged 65 or older living in Poland is 13.6%, but 17.2% in Łódź. The aim of the study was to identify factors correlating with the self-rated quality of life of elderly inhabitants of cities applying for social help, on the basis of a cross-sectional study.

Methods

The study was conducted in Łódź, a large Polish city, between September 2011 and February 2012 in a group of people applying for help in the Municipal Social Welfare Centre. Four hundred and sixty-six respondents aged 65 or older were included in the study. The tool used in the study was an interview questionnaire. The respondents answered questions on their demographic situation, living conditions, financial, health and social situation. The authors also applied the WHOQOL-BREF Questionnaire, the Activities of Daily Living Scale (ADL) and the Geriatric Depression Scale (GSOD). For statistical purposes, the authors used single- and multiple-factor regression and the Statistica 9.0 Program. The results were presented as an odds ratio (OR) with a 95% confidence interval (CI); the adopted significance level was p < 0.05. The authors applied the Pearson’s x² test in order to evaluate the structure of the studied group and the subpopulation, who were aged 65 or older and using social help, throughout the city.

Results

Logistic regression confirmed that a high quality of life depends on the following variables: university education (OR = 2.31; p < 0.05), an income which is sufficient to live (OR = 1.63; p < 0.05), no heart palpitations (OR = 2.32; p < 0.05), stable blood pressure (OR = 2.32; p < 0.05), no headaches (OR = 1.55; p < 0.05), no pain in the chest (OR = 1.51; p < 0.01), no shortness of breath (OR = 1.51; p < 0.01), no tiredness (OR = 2.08; p < 0.05), a score on the Geriatric Depression Scale pointing to a lack of suspected depression (OR = 9.88; p < 0.001 if the person does not suffer from depression and OR = 6.33; p < 0.001 if there is uncertain depression) as well as not using nursing services, a score on the ADL Scale confirming the person’s fitness and participation in family gatherings.

Conclusions

A subjective evaluation of the quality of life of the elderly depends on many factors. An identification of these factors might be helpful in implementing steps aimed at improving the quality of life of elderly people who, as a consequence, will need less social help: particularly nursing services.