ОСОБЕННОСТИ ВЫЯВЛЕНИЯ ЗЛОКАЧЕСТВЕННЫХ НОВООБРАЗОВАНИЙ ОРГАНОВ РЕПРОДУКТИВНОЙ СФЕРЫ У ЖЕНЩИН ФЕРТИЛЬНОГО ВОЗРАСТА
Маркина А.Ю.1, Шеметова О.Ю.2, Шеметов Д.Ю.3, Хусаинова М.Э.4
1к.м.н., доцент кафедры общественного здоровья и здравоохранения, ГБОУ ВПО ЮУГМУ Минздрава России
ОСОБЕННОСТИ ВЫЯВЛЕНИЯ ЗЛОКАЧЕСТВЕННЫХ НОВООБРАЗОВАНИЙ ОРГАНОВ РЕПРОДУКТИВНОЙ СФЕРЫ У ЖЕНЩИН ФЕРТИЛЬНОГО ВОЗРАСТА
Аннотация
Установлены основные пути выявления злокачественных новообразований репродуктивной системы женщин фертильного возраста.
Ключевые слова: злокачественные новообразования, репродуктивная сфера, фертильность.
Markina А.Y.1, Shemetova О.Y.2, Shemetov D.Y.3, Husainova М.E.4
1MD, associate professor of the Department of Public Health and Health Care, SBEI HVE SUSMU of the Ministry of Health of Russia
PECULIARITIES OF IDENTIFYING MALIGNANT TUMOURS OF ORGANS OF THE REPRODUCTIVE SPHERE IN WOMEN OF FERTILE AGE
Abstract
The main ways of identifying malignant tumours of the reproductive system for women of fertile age have been determined.
Keywords: malignant tumours, reproductive sphere, fertility.
Introduction.
At present the problem, which is of social importance in the Russian Federation and which requires taking purposeful solutions and a cross-sectoral approach, is the high incidence of malignant tumours (MT). More than 517 thousand of newly discovered cases of diseases are registered in the country annually and more than a half are discovered in women. More than 2.7 million patients are registered in oncologic dispensaries, which is 1.6% of the whole population of the country. The annual increase of the absolute number of patients within the female population is 1.4% [2,4].
The index of incidence of the female population in Russia has achieved the result of 365.6 cases per 100 thousand women, for the previous 10 years the increase is 20.7%. During preventive examinations only one in ten cases of oncopathology is detected and the part of persons with the first proven diagnosis of late identification, i.e., in the 4th stage, amounts to 22.3%, therefore, one in five tumours is detected when there are distant metastases.[3, 4].
At the background of low rates of decreasing indices of total mortality in the Russian Federation it is one of the highest indices in comparison with Europe, therefore, malignant tumours, whose share in the structure of reasons of the population death is 16.0-18.0%, are of special importance.
In addition, the number of persons with the first proven diagnosis, who died within one year, also remains very high – 33.9%. One of major reasons of mortality of the female population of Russia for the previous ten years is MTs of organs of the reproductive system, which have increased their specific weight in the structure of the oncological incidence more than twice [1,2].
Goal of research. To determine the main ways of identifying malignant tumours of the reproductive system for women of fertile age.
Materials and methods of research. The study of ways of identifying malignant tumours of the reproductive system for women of fertile age has been carried out with the help of the questionnaire method when they applied to oncological dispensaries of the Chelyabinsk region. The statistical aggregate, which has been formed with the help of the sampling method (method of sampling – at random), is the following: share of 44.9% is represented by respondents with malignant tumours of breasts, 26,1% - of body of uterus, 19.0% - of the ovary and 10.0% - of the uterine cervix.
The mathematico-statistical method has been used when carrying out the research. The incidence of malignant tumours of the reproductive system has been studied on the basis of intensive («rough») and standartized indices for 100 000 women. The authenticity of difference of compared values has been measured with the help of the confidential criterion (the criterion of accuracy t). The calculation of the non-parametric Wilcoxon-White test for unconnected aggregates (T) has been used for determining the statistic importance of differences or similarity of indices of compared aggregates.
Results. The starting point of the forthcoming analysis of the efficiency of routing women of fertile age, who suffer from MTs of the reproductive system, should be the study of ways of identifying their malignant tumours. In most cases the suspicion for having a malignant tumour has been announced by healthcare professionals, 41.5% of women have suspected having an oncologic pathology themselves in case of MTs of breasts, 12.2% of women in case of MTs of the uterine cervix, 8,1% in case of MTs of the ovary and only 1.0% in case of MTs of the body of uterus. In order to confirm their suspicions these women applied directly to clinics of oncological dispensaries for consultative assistance, and only 3.6% of women, who suspected having MTs of breasts, applied to an oncologist of a private health clinic. MTs of breasts for 54.9% of women have been suspected when they applied to healthcare professionals who are not experts in the sphere of oncology – to primary care doctors of a territorial (28.4%) and plant (9.2%) clinics and even in 8.9% of cases – to an average healthcare personnel at the rural medical and obstetrical station (MOS).
For the majority of women with MTs of genital organs (from 42.8% in case of MTs of the body of uterus to 81.3% in case of MTs of the ovary) the suspicion of having MTs has been announced by an obstetrician-gynecologist or during a visit to a maternity welfare clinic or during a planned preventive examination. Significantly less number of women applied directly to an oncological dispensary, e.g., in case of suspicion of MTs of the uterine cervix the number is approximately one in five, in case of MTs of the body of uterus – 14.2% and only one in twenty in case of MTs of the ovary. Healthcare professionals, who are not experts in oncology or gynecology, namely, primare care doctors and surgeons of territorial or plant clinics, and average healthcare professionals of MOSs have been applied to by 13.6% of women at suspicion on MTs of the ovary, 29.3% - in case of MTs of the uterine cervix and 43.0% - in case of MTs of the body of uterus.
The efficiency of treating oncological diseases depends mainly on the timeliness of starting a specialized treatment in an oncological dispensary or an oncological (radiologic) department of a municipal health care institution. During the study of this issue it has been established that the average time from the moment of the first application to a medical institution in connection with the present disease till the moment of admission for a specialized treatment is rather long, i.e., from 6.9 months in case of MTs of breasts till 15.6 months in case of MTs of the ovary.
Here, this period for women with MTs of genital organs, despite the differences in periods, can be considered the same, as there are no statistical differences (t<2), and at the same time it is significantly shorter (t>2 when р<0,05) than in case of MTs of the ovary.
In order to explain such a long period of time since the moment of the first application in connection with the present disease till the moment of admission for a specialized treatment we have studied the structure of duration of this period for each of these four localizations of MTs.
Practically every second woman (47,5%), who has been detected as having MTs of breasts, is admitted to an oncological dispensary for a treatment within the first month since the moment of verifying the diagnosis; within the first year a specialized treatment is provided to 87,3% of women of fertile age with MTs of breasts. In case of MTs of genital organs one can note another dynamics: e.g., in case of MTs of the ovary and of the body of uterus only one in ten female patients is admitted to an oncological dispensary within the first month of the disease. The major part of patients starts to have a specialized treatment only by the end of the first year since the moment of verifying the diagnosis, and for 39.7% of women of fertile age with MTs of the ovary and 25.3% with MTs of the body of uterus this process lasts for many years. In case of MTs of the uterine cervix the major part of women of fertile age receives a specialized treatment within the first year (87,3%), but their admission to a hospital is more uniform by months of a year than for women with MTs of breasts.
Thus, too long average duration of the period since the first application till the start of a specialized treatment for women of fertile age is explained with the fact that too many patients are admitted for a specialized treatment too late. Partly this fact can be explained by the ‘self-treatment’ of female patients. On the whole, every fifth woman of fertile age with MTs of breasts (21.3%) and every fourth one with MTs of the uterine cervix (24.4%) and also 5.6% of patients with MTs of the body of uterus were trying to relieve their suffering themselves or with the help of non-professionals.
The main part of female patients with all three types of localization of MTs were carrying out self-treatment within the first year of the disease, and this fact led to the prolongation of terms of receiving a specialized treatment in the oncological service of the region.
Conclusion.
On the whole, the detectability of early stages of malignant tumours of organs of the reproductive system in women of fertile age is not high, i.e., only one in two tumours is detected (58.6%). Moreover, for all female reproductive organs this index had a negative tendency for decreasing within a five-year period. The 4th stage of the tumour process has been registered in 13.6% of malignant tumours of organs of the female reproductive system, and what is more this index did not have a tendency for decreasing and even vice versa one could note the increase of detectability for the body of uterus and breasts at the 4th stage. All these facts have negatively influenced the level and the dynamics of mortality because of MTs.
References
- Маркина, А.Ю. Пути выявления злокачественных новообразований репродуктивной системы у женщин фертильного возраста на примере Челябинской области/ Маркина А.Ю,, Тюков Ю.А.//Журн. Медицинская наука и образование Урала. – 2013. – Т. 14, № 1. – C. 130-132.
- Пухов, А.Г. Совершенствование технологии лимфодиссекции в онкологии/ А.Г. Пухов, О.С. Леонтьева, А.А. Медведев//Журн. Вестник Челябинской областной клинической больницы.-2009.-№4.-С.70-71.
- Фролова, О.А медико-демографические показатели как индикаторы репродуктивного здоровья/ О.А. Фролова, Р.И. Уткельбаев, З.Ф. Сафиуллина// Общественное здоровье и здравоохранение.- 2012.- №1.-С.5-8.
- Чисов, В.И. Злокачественные новообразования в России в 2010 году (заболеваемость и смертность) / В.И. Чисов, В.В. Старинский, Г.В. Петров.-М. 2012.-260с.