Krisztina Juhász

Cancer screening policy in Hungary: Letter to the Editor

Dear Editor, Basu et al. published an excellent overview on the status of implementation and organization of cancer screening in the European Union Member States. This paper provides a valuable description of current cancer screening policies of the European countries. We would like to give some detailed information on the Hungarian screening programs. Mammography-based breast cancer screening has a long tradition in Hungary. Mammography-based opportunistic breast cancer screening started in Hungary as early as the late 1960s in the city of Bonyh ad. Even the first scientific evidences for the effectiveness of mammography screening in reducing the breast cancer mortality came from large randomized controlled trial performed by a Hungarian radiologist, Prof. L aszl o Tab ar, in two Swedish counties, Kopparberg and € Osterg€otland. Later several mammography screening pilot programs were performed in Hungary. Following the evaluation of pilot programs for mammography screening, a nationwide, organized population based breast cancer screening program was announced in 2001 and started in January 2002. Unlike the ones (45–64 years) given in table 2 of the paper by Basu and coworkers, women aged between 45 and 65 years old were invited for participating in the breast cancer screening program. Opportunistic cervical cancer screening started in Hungary during the 1970s. One should bear in mind that at that time Hungary was a socialist country, behind the “iron curtain” with limited access to the achievements of the developed countries. After the socialist system collapsed in 1990, Hungary initiated new pilot program for the early detection of cervical cancer. This program was financed by the World Bank. After three decades of opportunistic cervical cancer screening activities, an organized, nationwide cervical cancer screening was introduced in Hungary in July 2003 for women aged between 25 and 65 years old. Although in figure 2 of the paper mentioned that the Hungarian cervical cancer screening program’s rollout ongoing, we would like to emphasize that rollout was completed. However, we have several problems with the low participation rate of invited women: “The Hungarian organized, nationwide cervical screening program managed to moderately increase (13.7%) the screening coverage of the target population in the first screening round; therefore, it failed to attract women with high risk outside of the scope of both the previous opportunistic and the newly introduced organized cervical cancer screening program.” Between 2013 and 2015, a new element was added to the organized cervical cancer screening program, in order to increase the participation rate. A pilot program was introduced in 2013 for the involvement of health visitors. It meant that in addition to gynecologists, health visitors, having a B.Sc. degree in health sciences, were allowed to take the smears. The involvement of health visitors resulted in 8.3% increase in the participation rate. In Hungary, we had several pilot programs for colorectal cancer screening. In 1997–1998, the first Hungarian colorectal cancer screening pilot program was done in a well-defined administrative area of the Capital, Budapest, with support from the World Bank Close the gap public health programme. The next colorectal cancer screening pilot program was organized in a small city of Ajka, and the surrounding area in 2003– 2004. Later some other small scale pilot programs were organized in different Hungarian cities (Balatonf€ ured, B ek escsaba, Kecskem et, Nagyat ad). In 2015, we had a new colorectal cancer screening pilot program in County Csongr ad, financed from European Union’s funding (“Social Renewal Operational Programme: SROP-6.1.3A-13/1–2013-0001 To support the extension of pilot screening programs—cervical cancer screening by health visitor and colorectal cancer screening programs”). These pilot programs used immunochemical fecal occult blood test (FOBT) for the early detection of fecal blood. Following the evaluation of this pilot program, Hungarian health policy leaders committed to the introduction of a nationwide colorectal cancer screening program. We hope this program will be launched as soon as possible. Hungary can be considered as a pioneer with the application of immunochemical testing for colorectal cancer. But in Hungary we still did not have a nationwide colorectal cancer program, as it was stated in figure 3. The legal regulation of colorectal cancer screening was a bit confusing in Hungary. Since 1997, a ministerial decree regulates both the opportunistic and nationwide organized screening programs in Hungary. This decree defines breast and cervical cancer screening as an organized, nationwide screening program. Colorectal cancer screening program was mentioned as an organized, nationwide screening program in Hungary on a single day, the December 31, 2005! Never before or after this day colorectal cancer screening was not an organized, nationwide screening program, only opportunistic and/or pilot programs were carried out. We emphasize that the current Hungarian legal regulation (law) also does not mention colorectal cancer screening among the nationwide, organized cancer screening programs. Regarding cancer screening programs, we should mention their cost-effectiveness. In a country, with limited resources for healthcare, financial issues are important. In 2001–2002, Le tt er to th e E di to r

Impact of microRNAs on molecular epidemiology

Cancer research concerning short non-coding RNA sequences and functionally linked to RNA interference (RNAi) have reached explosive breakthrough in the past decade. Molecular technology applies microRNA in extremely wide spectrum from molecular tumor prediction, diagnostics, progression monitoring and prevention. Functional analysis of tissue miRNA and cell-free serum miRNA in posttranscription and translation regulation innovated and restructured the knowledge on the field. This review focuses on molecular epidemiology and primary prevention aspects of the small non-coding RNA sequences.

Az ellenoldali csípőtáji törésig eltelt időt befolyásoló prognosztikai tényezők vizsgálata

INTRODUCTION Although several national studies reported on the risk factors for contralateral hip fracture, there are no data about the prognostic factors of the time until contralateral hip fractures. AIM The aim of the study was to analyse the impact of different prognostic factors on the time until the development of contralateral fracture and to determine the incidence of contralateral hip fractures after femoral neck fractures. METHOD Patients aged 60 years and over with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their femoral neck fracture in Hungary in 2000. Risk factors as age, sex, comorbidities, type of fracture and surgery, place of living and hospitals providing treatment for primary fracture were analysed by one way ANOVA focusing on the time until the development of contralateral hip fracture. RESULTS 312 patients met the inclusion criteria. The incidence of contralateral hip fracture after femoral neck fracture ranged between 1.5% and 2.1%, the cumulative incidence was 8.24%. The mean time until the development of contralateral hip fracture was 1159.8 days. The incidence of contralateral hip fracture showed no significant deviation. Significantly shorter time (p = 0.010) was detected until the contralateral hip fracture in older patients with femoral neck fracture. CONCLUSIONS The yearly incidence of contralateral hip fracture showed no significant difference by patients with femoral neck fracture over 60 years. The shorter time until the contralateral hip fracture by the older age groups highlights the need of elaboration of prevention strategies. Orv Hetil. 2018; 159(38): 1543-1547.

Clinical and health policy experiences with HPV prevalence within the Hungarian organized cervical cancer screening program

Distribution of HPV genotypes is a keen issue in the identification of high risk genotypes. In the international scientific literature, there are several reports describing HPV genotype distributions [2]. The findings of Ouh and colleagues [1] are consistent with the results of other studies. However, limited information is available on the occurrence frequency or prevalence of HPV infection within the general population.

Ellenoldali csípőtáji törésekkel összefüggő halálozás és kockázati tényezőinek vizsgálata

INTRODUCTION There is a high mortality with not well understood risk factors after the second hip fracture. AIM Analysis of the 30- and 365-day mortality and its risk factors in patients with contralateral hip fracture. METHOD Patients with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their primary hip fracture in Hungary in 2000. Risk factors as age, sex, concomitant and chronic diseases, type of fracture and surgery, surgical complications, day of admission were analyzed by logistic and Cox regression as well as Kaplan-Meier analysis. RESULTS There were 312 eligible patients identified with 8.3 % mortality rate at 30 and with 38,4% at 365 days respectively. Significant risk factors for the 30 day mortality were intertrochanteric type of fracture (OR: 4.722; HR: 4.129) and non operative management (OR: 7.357; HR: 6.317) while for the 365 day mortality those were older age (OR:1.070; HR:1.050) and type of surgery (OR: 0.450). CONCLUSION Age, type of fracture and type of surgery proved to be risk factors. There is a need to identify further risk factors in order to develop an efficacious prevention strategy for the reduction of the mortality after the second hip fractures. Orv Hetil. 2017; 158(20): 783-790.Absztrakt: Bevezetes: Az ellenoldali csipőtaji toreseket kovető halalozas magas, kockazati tenyezőikről keves adat ismert. Celkitűzes: Ellenoldali csipőtaji toresek 30 napon, es 365 napon beluli halalozasanak es kockazati tenyezőinek vizsgalata. Modszer: Retrospektiv tanulmanyunk alapjat a 2000-ben combnyaktores miatt operalt időskoru betegek kepeztek, akik 2008. december 31-ig ellenoldali csipőtaji torest szenvedtek. A vizsgalt kockazati tenyezők az eletkor, nem, kiserő betegseg, tores lokalizacioja, műtet tipusa, lokalis szovődmenyek, intezmenyi felvetel napja, amelyet logisztikus, Cox-regresszios es Kaplan–Meyer-analizissel ertekeltunk. Eredmenyek: A kriteriumoknak 312 beteg felelt meg, 8,3%-os 30, illetve 38,4%-os 365 napon beluli halalozassal. A 30 napon beluli halalozas szignifikans kockazati tenyezői a pertrochantaer torestipus (EHpertrochantaer/combnyak = 4,722, VHpertrochantaer/combnyak = 4,129) es a műtet hianya (EHnincs műtet/osteosynthesis = 7,357, VHnincs műtet/osteosynthesis = 6,317), a 365 ...

Csípőtáji törések multidiszciplináris aspektusai magyarországi adatok alapján

Hip fractures are described by increased mortality, loss of quality of life, functional decline and burden of diseases. They show a growing number worldwide. The aim of the present study is to summarise the existing data on the incidence, mortality, complications and rehabilitation of hip fractures, which relevance is reported only by few studies. To reduce mortality and complications of hip fractures the authors emphasize the importance of primary treatment within 12 hours, appropriate selection of surgical methods corresponding to the fracture type after the assessment of femoral head viability, vitamin D supplementation, same conditions for primary treatment during everyday of the week, and an adequate acute treatment and rehabilitation for patients general health status. In the future integrated processing of multidisciplinary results of hip fractures based on Hungarian data can support the development of efficient treatment and prevention strategies, which can be advantageous for the patient, families, health care system, and the society, too, by the reduction of costly complications of hip fracture healing and mortality. Orv. Hetil., 2016, 157(37), 1469-1475.