Problems of Social Hygiene Public Health and History of Medicine

The methodological approaches to evaluation of economical efficiency of application of HPV-testing and cytological examination under provision of medical care on “Obstetrics and Gynecology” profile

The article presents comprehensive methodology to assess economic efficiency of application of HPV-testing and cytological examination under provision of medical care on "Obstetrics and Gynecology" profile. The implementation of proposed methodological approaches permitted to calculate costs and value of result of study using HPV-screening and common cytology, i.e. their economic efficiency. The higher (up to 25%) economic efficiency of HPV-screening was established.

The experience of organization of combined screening of uterine neck cancer in the Republic of Bashkortostan

The article considers organizational issues of cervical cancer screening in the Russian Federation. In particular, experience of implementation of the Project "HPV testing within the framework of combined cervical cancer screening (HPV and cytologic screening) in the Republic of Bashkortostan is considered. The cervical cancer is a widespread disease that requires early diagnosis and timely medical care. The main aspects of organization of medical care of patients with gynecological diseases in relevant normative legal regulatory documents are described. The algorithm and scheme of routing patients with suspected cervical cancer and with this disease are presented. The study covered more than 60,000 women aged 30-39 years from 14 medical organizations of Ufa. Such methods as sociological, statistical, analytical, content-analysis and organizational experiment were applied. The study permitted to substantiate and to approve both the Project "HPV testing as part of combined screening for cervical cancer (HPV screening and cytologic screening) and the algorithm of combined screening of cervical cancer during preventive examinations of female adult population aged 30-39 years of the Republic of Bashkortostan. The scheme was developed for routing patients with suspected cervical cancer or diagnosed disease to medical organizations for timely medical care support. By implementing developed routing and screening scheme for patients at risk of developing cervical cancer, as well as those who already suffer this pathology, it is possible to improve quality of organization and delivery of medical care, to reduce morbidity, mortality and disability because of this pathology and to assure early diagnosis and prevention of cervical cancer.

The trends of dynamics and characteristics of structure of population ovary cancer disability in the Chechen Republic

The article presents the results of analysis of issue of disability because of ovarian cancer in female population of the Chechen Republic. The object of study was total number of women, for the first time and repeatedly recognized as disabled ones. The analysis was applied to three age groups (the young, the middle aged and the elderly) in 2014-2020. It is established that dynamics of disability was characterized by negative trends of increasing of number of the disabled. The clear-cut age differentiation was revealed:the elderly disabled predominated. The study established that the disabled suffer of persistent malfunction of blood circulation system and of immune system that resulted in such life activity limitations as moving, self-service and work functions. The characteristics of structure of ovarian cancer disability according its severity were established. The disabled with second group of disability prevailed in all age groups. At that, percentage of women with first group of disability was higher in the middle-aged disabled. The results of the study testify actuality of optimization of onco-gynecological screening of female population for the purpose of early detection of risk factors and diagnosis of malignant process at initial stages of development. This is rational way to organ-preserving treatment and medical and social prevention of primary ovarian cancer disability. The results of the study can consider as scientific practical base for both targeted routing of preventive and therapeutic and rehabilitation measures.

The morbidity and mortality of cervix cancer in The Russian Federation in 2007—2018

All around the world, about 570 000 of new cases of cervical cancer are diagnosed annually and more than 300 000 of women die of this pathology. In the Russian Federation, in 2018, more than 17 500 of new cases of cervical cancer were diagnosed and more than 6 000 of women died of this pathology. The purpose of the study was to analyze incidence and mortality of cervical cancer in 2007-2018. The analysis of incidence rates of cervical cancer in the Russian Federation in 2007-2018 established steady trend of increasing of incidence rate from 12.8 (2007) to 15.8 (2018). The incidence rate increased up to 26.6%. The increasing is most pronounced in the age groups of 35-39, 40-44 and 45-49 years. The analysis of dynamics of mortality rates established relative stability indices in 2007-2018 (5.11 and 5.07 in standardized rates per 100 000). The decrease of 2018 as compared to 2007 made up to 0.78%. In most age groups mortality rates are decreasing. However, significant increase of mortality rate in age group of 40-44 years was established amounted up to 25%.

The lost years of potential life under cancer of neck of uterus in the Kyrgyz Republic

One of modern methods of estimating health losses under malignant neoplasms in economic terms, characterizing number of deaths and age of death are lost years of potential life. The cumulative losses from premature cancer mortality made up to 29 217.5 man-years in 2013 and 39 710 man-years in 2021. The number of years lost over 9 years increased by 10 492.5 man-years despite decreasing of mortality across all ages. The rate of lost years of potential life during this period increased from 5.3 to 6.2 years. The maximal contribution to lost years of potential life was made by population groups 45–59 years old. Total losses from premature mortality from cervical cancer were 2682.5 man-years and 2411 man-years in 2013 in 2021. The number of years lost decreased by 271.5 man-years. The rate of lost years of potential life during this period increased from 0.5 to 3.7 years. The greatest contribution to lost years of potential life was made by population groups 60–64 and 40–49 years old. The calculation demonstrated that there are significant reserves for reducing population mortality from malignant neoplasms in most vulnerable age population groups that is important for organization of oncological care and planning of target prevention programs.

EPIDEMIOLOGICAL FEATURES OF PAPILLOMAVIRUS INFECTIONS AND CERVICAL CANCER IN THE REPUBLIC OF BASHKORTOSTAN AND THE KALININGRAD REGION

In the context of improving cancer prevention programs, it becomes relevant to justify the introduction of regional HPV cervical cancer screening programs based on a study of the prevalence of human papillomavirus infection and cervical cancer.Aim: to identify the main patterns of the prevalence of human papillomavirus infection and cervical cancer in Bashkortostan and the Kaliningrad region for the scientific substantiation of the criteria for the adoption of regional screening programs.A prospective analytical cohort single-stage observational examination of 3428 women of the Republic of Bashkortostan and 1246 women of the Kaliningrad region was carried out, as well as a retrospective observational analytical study of cervical cancer incidence in Bashkiria and the Kaliningrad region according to the official statistics from 2011 to 2020 compared to Russian indicators.In Bashkortostan and the Kaliningrad region, HPV DNA was detected in 48.7% and 54.2% of women of reproductive age, respectively, of which HPV of high oncogenic risk (HPV HR) was 51.7 ± 6.2%, and 23.4% were found to have PCM . In the Kaliningrad region, HPV DNA was detected in 47.2% of the women under study, HPV VR - 31.1%, in 25.5% accompanied by cervix uteri diseases. An increase in the incidence is noted in the Kaliningrad region by 38.6% over 10 years, with an annual increase of 3.8%. In Bashkortostan, the growth is demonstrated by 31.8% with an annual increase of 3%, which is significantly higher than in the Russian Federation (13.3%, р=0.001). For 10 years, the prevalence of cervical cancer has increased in the Kaliningrad region by 10.1%, with an average annual increase of 1.1%. In Bashkortostan, the prevalence of CSM increased by 4.7% with an annual increase of 0.3%.The high prevalence of HPV infection among women of reproductive age, the unfavorable dynamics of indicators of cervical HPV-associated oncopathology in remote regions of the Russian Federation (Bashkiria and the Kaliningrad region) is a scientifically based criterion for the reorganization of regional cervical screening programs. The implementation of Organized screening with primary HPV examination with mandatory separate genotyping of types 16 and 18 and the remaining 12 types of HPV HRC in a complex will enhance the effectiveness of ongoing preventive measures and meet international standards.

The condition and tendencies of cervical carcinoma diagnostic in the Russian Federation

The elimination of cervical cancer is one of the leading international public health problems that is associated with corresponding high morbidity and mortality among women of able-bodied and reproductive age. In the Russian Federation, in 2018, in more than 17.5 thousand women cervix malignant neoplasms were diagnosed and more than 6 thousand of them died. Cervical cancer is preventable disease that can be eliminated if the targets of the WHO Global Strategy to Eliminate Cervical Cancer as Public Health Issue will be achieved. The purpose of the study is to analyze indices of timely cervical cancer diagnostics in the Russian Federation and in its subjects in 2007-2018. Despite favorable trend of increasing of active detection of cervical cancer, this indicator (41.8%) continues to be low, both in the country in whole and in most of the subjects of the Russian Federation. The cervical cancer in situ stage is detected only in 25.3 cases per 100 cases of cervix cancer and stages I and II of disease are detected in 66.1% of cases. More than a third of all cases of cervical cancer (32.6%) are detected at III-IV stages of oncologic process. The percentage of patients died within the first year after cervical cancer was diagnosed decreased significantly from 19.0% in 2007 to 13.8% in 2018.