How to read a paper about inequality in respiratory disease: Basic epidemiological principles and how inequalities are measured

Health inequalities in respiratory disease are widespread, and monitoring them is important for advocacy, the design and delivery of health services, and informing wider health policy. In this chapter, we introduce the different ways in which health inequalities can be quantified, including measures that quantify absolute and relative inequalities, and those that measure gaps between groups or differences across the entire social gradient. We consider the strengths and limitations of these different approaches and highlight things to look out for when reading a paper on health inequalities in respiratory health. These include how common the outcome is and whether other factors have been adjusted for, as both can have a crucial impact on interpretation and can lead to misleading conclusions.Copyright © ERS 2023.

Interpreting Cancer Incidence Trends: Challenges due to the COVID-19 Pandemic.

The significant deficit in cancer diagnoses in 2020 due to COVID-19 pandemic disruptions in health care, can pose challenges in the estimation and interpretation of long-term cancer trends. Using SEER (2000-2020) data, we demonstrate that inclusion of the 2020 incidence rates in joinpoint models to estimate trends can result in a poorer fit to the data, less accurate, or less precise trend estimates, providing challenges in the interpretation of the estimates as a cancer control measure. To measure the decline in 2020 relative to 2019 cancer incidence rates, we use the percent change of rates in 2020 compared to 2019. Overall, SEER cancer incidence rates dropped approximately 10% in 2020, but for thyroid cancer the drop was as big as 18%, after adjusting for reporting delay. The 2020 SEER incidence data is available in all SEER released products, except for joinpoint estimates of trends and lifetime risk of developing cancer.

The prevalence of oncological diseases among the population of the Siberia region and the Far East

The purpose of the study was to analyze cancer incidence in Siberia and the Russian Far East in 2010–2021. Materials and methods. We used data from population-based cancer registries in 21 administrative territories of Siberia and the Russian Far East for 2010–2021. The calculations were carried out using the direct standardization method. Results. In 2021, the most common cancer sites in males were: lung (18.7%), prostate (14.1%) and colorectum (11.1%);in females: breast (21.0%), skin (12.6%) and colorectum (11.3%). From 2010 to 2019, the overall cancer incidence rate increased by 26.7%. Age-standardized incidence rates in males increased from 301.2 to 332.10/0000. For females, age-standardized incidence rates increased from 220.8 to 256.10/0000. In 2020, cancer incidence rates decreased, the overall decline was 12.9%. Age-standardized cancer incidence rates in males and females were 288.5 and 223.2 per 100 000 population, respectively. In 2021, the corresponding rates for males and females were 288.2 and 235.80/0000, respectively. Limitations. To assess the prevalence of oncological diseases in the territories of Siberia and the Russian Far East 1 233 759 new cases of malignant neoplasms were analyzed over 12 years, which is a sufficient reference sample. Conclusion. In Siberia and the Russian Far East, cancer incidence rates in 2020 were lower than in 2019 due to the COVID-19 pandemic, which led to the reduction in the number of cases diagnosed and referred for the first-line treatment. In 2021, an increase in the age-standardized cancer incidence rate was observed, with the age at diagnosis tended to be younger. In 2010, 80–84 years men and 75–79 years women exhibited the highest incidence rates (2536.5 and 1246.80/0000, respectively). In 2021, the highest cancer incidence rates for males and females were observed in the 70 to 74 years group (2717.1 and 1402.60/0000, respectively). © 2023 Izdatel'stvo Meditsina. All rights reserved.

The impact of the COVID-19 pandemic on the diagnosis of malignant neoplasms during preventive medical examinations.

The restrictive social distancing strategy during the COVID-19 pandemic in the healthcare system has led to a reduction in measures for the active detection of malignant neoplasms (MNs). Objective. To evaluate the impact of a temporary stop the measures for the secondary prevention of MNs on the frequency of detected cases of the disease during preventive medical examinations (PMEs). Materials and methods. The efficiency of active MN detectability in 2020 versus the pre-COVID-19 period (2018-2019) was com-paratively analyzed in 17 regions of the Central Federal District (CFD) of Russia. Information on the coverage of the population with PMEs and on the frequency of detected cancer cases when using fluorographic, mammographic, and cytological studies was obtained from the study of the data contained in the information project <<Passport of an Oncology Dispensary>> of the P.A. Herzen Moscow Oncology Research Institute, as well as those available in the public domain on the Internet and on the official websites of regional health authorities. Results. The comparative analysis of the results of PMEs did not reveal significant differences in their efficiency in the studied regions of the Central Federal District of Russia in 2018 and 2019. Compared to the pre-COVID-19 period in 2020, there was a sta-tistically significant decline in the population coverage with primary care, which was 33.2+/-2.3% among both sexes (p<0.01), 25.8+/-2.3 for males (p<0.05) and 39.7+/-3.0% females (p<0.01). The frequency of detected cancer cases was 1.0 in the general population, 0.6 for males and 1.2 for females. There was an increase in the number of detected cases during fluorographic (+27.1%) and mammographic (+22.9%) studies and a decrease in the proportion of cytologically detected MNs (-33.2%). At the same time, due to a decline in the number of the surveyed population in 2020, there was a decrease in the number of detected cancer cases of the lung (-34.8%), breast (-37.1%), as well as tumors diagnosed cytologically (-65.9%). Conclusion. This investigation may suggest that at least 1.065 lung cancer cases and 1.875 breast ones were not diagnosed due to the temporary reduction in PMEs in the regions studied.Copyright © 2021, Media Sphera Publishing Group. All rights reserved.

Vaccines for the prevention of infections in adults with haematological malignancies

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the benefits and adverse effects of vaccines for the prevention of infections in adults with haematological malignancies.Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Epidemiology, risk factors, and prevention of colorectal cancer.

Background: Colorectal cancer remains the fourth most common malignancy in Korea, and has been ranked as the third leading cause of cancer deaths in 2020. This study aims to describe the epidemiologic status of colorectal cancer in Korea, and provide basic data for effective primary and secondary prevention methods by summarizing risk factors and screening tools. Current Concepts: Although colorectal cancer incidence and mortality have decreased in recent years in Korea, it still poses a significant public health burden. From the early 1990s until the mid-2000s, the 5-year relative survival of patients with colorectal cancer in Korea continuously increased. This can be attributed to the successful introduction of the government-led screening program;development of improved surgical techniques, anticancer drugs, and adjuvant treatment;and advances medical resources and infrastructure along with economic growth. However, since the late 2000s, the improvement in survival has stagnated. The coronavirus disease 2019 outbreak has reduced hospital visits and screenings, which is assumed to cause delays in diagnosis, leading to a worse prognosis in the patients. To overcome these obstacles, it is essential to explore modifiable environmental risk factors and appropriate screening test methods in Korea. Discussion and Conclusion(s): Primary prevention through risk factor modification and secondary prevention using suitable screening programs can reduce the incidence and mortality rates of colorectal cancer.Copyright © Korean Medical Association.

The effect of the SARS-CoV-2 pandemic on suspected cancer referrals at a regional head and neck unit

The novel coronavirus SARS-CoV-2, initially identified in late 2019 as a small case cluster, has rapidly become a global pandemic. Government restrictions, closure of primary care services, interruption of cancer screening programmes, and fear of contracting the virus have demonstrably led to a reduction in referrals for suspected cancer and delays to treatment across the United Kingdom. A retrospective analysis was carried out on suspected cancer referrals to the maxillofacial service at Aberdeen Royal Infirmary during the 12 months from March 2020, and compared with the 12 months prior. Suspected cancer referrals reduced by 38.6% (p < 0.001) during this period, with a reduction in the percentage referred by General Dental Practitioners. Further analysis shows a proportionate reduction in squamous cell carcinoma diagnoses, with other diagnoses remaining stable. Time from referral to first appointment, biopsy, and treatment showed no change. Stage at diagnosis and treatment modality was also unaffected. Assuming no change to the incidence of head and neck malignancies, over a third of new malignancies may have been undiagnosed during the 12 months from March 2020. Evidence for the impact of the pandemic is likely to become apparent as services return to pre-pandemic levels and these patients begin to present.Copyright © 2021 The Authors

Impact of the COVID-19 pandemic on breast cancer incidence and tumor stage in the Netherlands and Norway

Introduction. The SARS-CoV-2 infection rate and the COVID-19 death rate were relatively high in the Netherlands during the first wave of the COVID-19 pandemic (2.7 and 7.2 times higher than in Norway, respectively). Moreover, social measures differed between the two countries. This study aimed to compare the effect of the pandemic on breast cancer incidence and stage between the Netherlands and Norway. Methods. Women diagnosed with DCIS or invasive breast cancer between January 2017 and December 2021 were selected from the Netherlands Cancer Registry and from the Cancer Registry of Norway. The COVID-19 period was divided in three approximately equal periods: March-September 2020 (first wave), October 2020-April 2021 (second wave), May-December 2021 (post-second wave). Breast cancer incidence during the COVID-19 periods was compared with averaged data of the corresponding reference period: March-September 2017, 2018, 2019 (first wave-ref), October-April 2017, 2018, 2019 (second wave-ref), May-December 2017, 2018, 2019 (post-second wave-ref). Incidences were compared by age group, clinical tumor stage, and method of detection. Results. The number of breast cancer diagnosis and the breast cancer incidence are shown in Table 1. Compared to the reference period, breast cancer incidence was lower during the first wave in the Netherlands and Norway (IRR: 0.72;95%CI: 0.70-0.75;IRR: 0.83, 95%CI 0.78-0.88, respectively), and was higher post-second wave in Norway (IRR: 1.10, 95%CI: 1.04-1.16) (Table 1). During the first wave, breast cancer incidence was lower in all age groups in the Netherlands (age < 50 IRR: 0.85, 95%CI: 0.79-0.91;50-69 IRR: 0.64, 95%CIL 0.61-0.67;70-74 IRR: 0.61, 95%CI: 0.56-0.67;>74 IRR: 0.86, 95%CI: 0.80-0.93, respectively). During the first wave, incidence was lower in women aged 50- 69 in Norway (i.e., women eligible for screening;IRR: 0.68, 95%CI: 0.62-0.74). Post-second wave incidence was higher in women aged 50-69 and >74 in Norway (IRR: 1.09, 95%CI: 1.01-1.17;IRR: 1.13, 95%CI: 1.00-1.28, respectively). In the first wave the incidence of DCIS, stage I tumors, and screen-detected tumors was lower in the Netherlands (IRR: 0.55, 95%CI: 0.50-0.61;IRR: 0.62, 95%CI: 0.59-0.65, IRR: 0.36, 95%CI: 0.33-0.38, respectively) as well as Norway (IRR: 0.66, 95%CI: 0.54-0.79;IRR: 0.73, 95%CI: 0.66-0.81, IRR: 0.46;95%CI: 0.40-0.52, respectively). Conclusion. The current study showed that the incidence of early-stage tumors mainly decreased. Moreover, during the first wave of the pandemic breast cancer incidence decreased in all age groups in the Netherlands but only in women aged 50-69 in Norway. The relatively high infection and death rate in the Netherlands might have increased the fear of patients to visit the general practitioner (GP) and/or to overburden the healthcare system at the start-up of the pandemic. In addition, it might have reduced the capacity at the GP. As a result, appointments with the GP might have been postponed, resulting in a decrease in the number of breast cancer diagnoses in all age groups. A catch-up in breast cancer diagnoses was seen post-second wave in Norway, but not in the Netherlands. Incidence rates should therefore be monitored in the coming period. (Table Presented).

The impact of the COVID-19 pandemic on cancer incidence and cancer care in patients with prostate cancer in the Siberian Federal District.

Background. Prostate cancer incidence rates continue to increase every year, therefore, the study of the quality indicators for cancer care, especially during a pandemic, is of great importance. Aim. To analyze prostate cancer incidence rates and quality indicators of cancer care in the Siberian Federal District. Materials and methods. For the calculation of cancer incidence rates, population-bases cancer registry data were used. Quality indicators were calculated according to the methodological recommendations of P.A. Hertzen Moscow Oncology Research Institute - branch of the National Medical Research Radiological Center. Results. The implementation of restrictive measures and the suspension of cancer screening programs in 2020 negatively affected the cancer care. The prostate cancer incidence rate decreased from 52.8 per 100 000 population in 2019 to 43.1 per 100 000 population in 2020, especially in the territories of the Republic of Tyva and the Omsk Region. Morphological verification in 2020 decreased compared to 2019 (97.0 % versus 97.8 %), with the exception of the Krasnoyarsk Territory and the Republic of Altai. Early prostate cancer detection increased from 62.9 to 64.0 %, and cancer detection at late stages decreased from 36.3 to 35.0 %. One-year mortality in the region decreased from 8.0 % (2019) to 7,3 % (2020), however, it increased significantly in the Republic of Tyva (from 3.2 to 40.0 %) and the Altai Republic (from 3.7 to 10.7 %). The number of patients who have been followed-up for 5 years or more increased from 40.7 to 42.3 %, except for Republic of Altai (from 32.8 to 25.0 %). Conclusion. Delay in the diagnosis of prostate cancer is associated with advanced stage, poor survival and high cost treatment.Copyright © 2022 Authors. All rights reserved.

Epidemiology and survival of lung cancer patients, the impact of COVID-19. (clinical and population-based study).

Aim. The study is aimed at investigating the incidence of lung cancer (LC) at the population level with the analysis of key analytical indicators in the context of coronavirus. Materials and methods. We have used data from the IARC, statistical reference books of P.A. Herzen Moscow Research Oncological Institute, data from N.N. Petrov NMRC of Oncology, and the database of the Population Cancer Registry of St. Petersburg (DB PCR St. Petersburg) for the current study. Results. The study has established a steady decline in the incidence of LC among the male population in the worldwide, in Russia and in St. Petersburg. Among the female population, a significant increase in the incidence has been revealed. On the basis of the database PCR St. Petersburg, the patterns of age-sex indicators of the incidence of LC have been analyzed. It has been established that the largest number of cases is registered in the age group of patients over 70 years old, here the largest losses due to coronavirus have also been identified. An increase in the proportion of early stages of the disease has been noted. The accounting reliability index decreased from 2000 to 2019, with the exception of 2017. Comparison of yearly lethality in the DB PCR St. Petersburg showed a significant difference in the data. The detailed localization structure of LC has been studied, where it has been found out that the first place is occupied by cancer of the upper lobe, bronchi or lung, although over 19 years of observation, a decrease in the proportion of this localization in the total volume of C34 has been noted. The proportion of patients with LC without histological verification has decreased. The influence of the smoking factor on the increased risk of LC has been studied.Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

IMPACT OF THE COVID-19 PANDEMIC ON CANCER INCIDENCE IN PATIENTS UNDERGOING CANCER SCREENING DURING ANNUAL HEALTH CHECKUP (POPULATION-BASED STUDY).

Background. During the COVID-19 pandemic, annual adult check-ups have been postponed, resulting in cancer screening disruption. The aim of the study was to evaluate changes in the incidence and stage distribution of malignancies included in the screening program during the COVID-19 pandemic using the Arkhangelsk Regional Cancer Registry (ARRC). Material and Methods. We assessed the changes of the incidence rates and stage distribution for the colon, rectum, lung, breast, cervix, uterine body, ovary, prostate and kidney cancers over the periods 2018-19 and 2020-21. Results. A total of 12354 cases with 9 cancers were selected: 6680 for the period 2018-19 and 5674 (-15.1 %) for the period 2020-21. The most significant decrease in crude and age-standardized incidence rates was registered in patients with lung (-18.0-18.1 %), rectum (-25.1-25.9 %) and cervix (-33.6-36.9 %) cancers, p<0.001. The decrease was not significant in patients with breast, uterine body, and kidney cancers. The proportion of patients with stage I decreased in lung cancer (-20.0 %, from 14.8 % to 11.8 %), rectum (-20.2 %, from 20.9 % to 16.7 %), and uterine cervix (-37.1 %, from 53.2 % to 33.5 %). In prostate and kidney cancers, the proportion of patients with stage I increased by 30 % (from 19.5 % to 25.4 %) and 17.6 % (from 45.9 % to 54.0 %), respectively. A significant reduction in the proportion of early stages during the COVID-19 pandemic was observed in lung and cervical cancer. Conclusion Postponed health checkups due to COVID-19 pandemic disruptions have led to substantial reductions in new cancers being diagnosed, mainly for cervical, lung, colon and rectal cancers. No significant changes were observed for other cancers. Further analysis of mortality and survival of cancer patients is required.Copyright © 2022, Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved.

IMPACT OF THE COVID-19 PANDEMIC ON CANCER INCIDENCE IN PATIENTS UNDERGOING CANCER SCREENING DURING ANNUAL HEALTH CHECKUP (POPULATION-BASED STUDY)

Background. During the COVID-19 pandemic, annual adult check-ups have been postponed, resulting in cancer screening disruption. The aim of the study was to evaluate changes in the incidence and stage distribution of malignancies included in the screening program during the COVID-19 pandemic using the Arkhangelsk Regional Cancer Registry (ARRC). Material and Methods. We assessed the changes of the incidence rates and stage distribution for the colon, rectum, lung, breast, cervix, uterine body, ovary, prostate and kidney cancers over the periods 2018–19 and 2020–21. Results. A total of 12354 cases with 9 cancers were selected: 6680 for the period 2018–19 and 5674 (-15.1 %) for the period 2020-21. The most significant decrease in crude and age-standardized incidence rates was registered in patients with lung (-18.0–18.1 %), rectum (-25.1–25.9 %) and cervix (-33.6–36.9 %) cancers, p<0.001. The decrease was not significant in patients with breast, uterine body, and kidney cancers. The proportion of patients with stage I decreased in lung cancer (-20.0 %, from 14.8 % to 11.8 %), rectum (-20.2 %, from 20.9 % to 16.7 %), and uterine cervix (-37.1 %, from 53.2 % to 33.5 %). In prostate and kidney cancers, the proportion of patients with stage I increased by 30 % (from 19.5 % to 25.4 %) and 17.6 % (from 45.9 % to 54.0 %), respectively. A significant reduction in the proportion of early stages during the COVID-19 pandemic was observed in lung and cervical cancer. Conclusion Postponed health checkups due to COVID-19 pandemic disruptions have led to substantial reductions in new cancers being diagnosed, mainly for cervical, lung, colon and rectal cancers. No significant changes were observed for other cancers. Further analysis of mortality and survival of cancer patients is required.

Epidemiology, risk factors, and prevention of colorectal cancer

Background: Colorectal cancer remains the fourth most common malignancy in Korea, and has been ranked as the third leading cause of cancer deaths in 2020. This study aims to describe the epidemiologic status of colorectal cancer in Korea, and provide basic data for effective primary and secondary prevention methods by summarizing risk factors and screening tools. Current Concepts: Although colorectal cancer incidence and mortality have decreased in recent years in Korea, it still poses a significant public health burden. From the early 1990s until the mid-2000s, the 5-year relative survival of patients with colorectal cancer in Korea continuously increased. This can be attributed to the successful introduction of the government-led screening program;development of improved surgical techniques, anticancer drugs, and adjuvant treatment;and advances medical resources and infrastructure along with economic growth. However, since the late 2000s, the improvement in survival has stagnated. The coronavirus disease 2019 outbreak has reduced hospital visits and screenings, which is assumed to cause delays in diagnosis, leading to a worse prognosis in the patients. To overcome these obstacles, it is essential to explore modifiable environmental risk factors and appropriate screening test methods in Korea. Discussion and Conclusion: Primary prevention through risk factor modification and secondary prevention using suitable screening programs can reduce the incidence and mortality rates of colorectal cancer.

The impact of the COVID-19 pandemic on cancer incidence and cancer care in patients with prostate cancer in the Siberian Federal District

Background. Prostate cancer incidence rates continue to increase every year, therefore, the study of the quality indicators for cancer care, especially during a pandemic, is of great importance. Aim. To analyze prostate cancer incidence rates and quality indicators of cancer care in the Siberian Federal District. Materials and methods. For the calculation of cancer incidence rates, population-bases cancer registry data were used. Quality indicators were calculated according to the methodological recommendations of P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center. Results. The implementation of restrictive measures and the suspension of cancer screening programs in 2020 negatively affected the cancer care. The prostate cancer incidence rate decreased from 52.8 per 100 000 population in 2019 to 43.1 per 100 000 population in 2020, especially in the territories of the Republic of Tyva and the Omsk Region. Morphological verification in 2020 decreased compared to 2019 (97.0 % versus 97.8 %), with the exception of the Krasnoyarsk Territory and the Republic of Altai. Early prostate cancer detection increased from 62.9 to 64.0 %, and cancer detection at late stages decreased from 36.3 to 35.0 %. One-year mortality in the region decreased from 8.0 % (2019) to 7,3 % (2020), however, it increased significantly in the Republic of Tyva (from 3.2 to 40.0 %) and the Altai Republic (from 3.7 to 10.7 %). The number of patients who have been followed-up for 5 years or more increased from 40.7 to 42.3 %, except for Republic of Altai (from 32.8 to 25.0 %). Conclusion. Delay in the diagnosis of prostate cancer is associated with advanced stage, poor survival and high cost treatment. © 2022 Authors. All rights reserved.

Insight into cervical cancer prevention awareness, experiences, and attitudes among Southern Vietnamese women

Background At least 80% of new cervical cancer cases and deaths occur in low- and middleincome countries. Vietnam is a middle-income country where cervical cancer is the second most common and the deadliest gynecologic cancer. Cervical cancer incidence in Southern Vietnam has been shown to be 1.5-4 times higher than that in Northern Vietnam. However, less than 10% of Southern Vietnamese women have received the Human papillomavirus (HPV) vaccine and only 50% have ever been screened for cervical cancer. No study has examined the perceptions toward cervical cancer prevention and screening in Southern Vietnamese women. Hence, this study aimed to explore cervical cancer awareness, barriers to screening, and acceptability of HPV self-sampling for cervical cancer screening among rural and urban women in Southern Vietnam. Methods In October-November 2021, three focus groups were conducted in the rural district of Can Gio (n=21 participants) and three were conducted in the urban District Four (n=23 participants) in Ho Chi Minh City, Southern Vietnam. All participants were cervical cancer-free women aged 30-65 years. Awareness of, attitudes toward, and experience with cervical cancer prevention and screening were explored using audio-recorded, semi-structured discussions in Vietnamese. During the focus groups, participants also watched four short videos with Vietnamese subtitles and voiceover about cervical cancer screening methods and discussed their views on each. The recordings were transcribed, translated into English, and coded and analyzed using Dedoose 9.0.46. Results Four main themes emerged. First, women showed low awareness, but high acceptance of cervical cancer screening and HPV vaccination. Second, screening barriers were related to logistics (e.g., cost, time, travel distance), psychology (e.g., fear of pain, embarrassment, fear of the test revealing they had cancer), and healthcare providers (e.g., doctors' impolite manners, male doctors). Third, women were concerned about self-sampling incorrectly and pain, but believed HPV self-sampling to be a feasible screening tool in some circumstances (e.g., during the COVID-19 pandemic, those living in remote areas). Fourth, women related cervical cancer prevention to COVID-19 prevention;they believed strategies that have been successful for COVID-19 control in Vietnam could be applied to cervical cancer. No differences in themes emerged by rural/urban areas. Conclusions Southern Vietnamese women showed low awareness but high acceptance of cervical cancer screening despite barriers. Strategies for successful COVID-19 control in Vietnam, including campaigns to increase public awareness, advocacy from the government and doctors, and efforts to increase access to screening and vaccination, should be applied to cervical cancer control. Health education programs to address HPV self-sampling concerns and promote it as a cervical cancer screening tool are warranted given its potential to improve screening uptake in this low-resource setting.

Colorectal cancer screen-up-to-date: 10-year prevalence in a regional safety-net health system

Introduction: Colorectal cancer (CRC) screening is an effective secondary prevention method with an increased probability of diagnosing CRC at an earlier stage, and a consequent improvement in survival post-treatment. This is especially true for individuals who undergo guideline recommended screening at appropriate intervals. Studies have reported a consistent rise in long-term trends of guideline-adherent screen-up-to-date (SUTD) rates among predominantly White and insured individuals. Here we use longitudinal data from 2011-2020 and report 10-year prevalence and correlates of CRC SUTD among patients in a safety-net health system. Method(s): All patients aged 50-74 years who had a primary care encounter in any of the 12 community clinics in a large county safety-net health system were included. An individual was considered to be SUTD if he/she had a stool test during the calendar year, flexible sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years. To obtain a population health estimate (and not only examine frequencies), we included in the denominator patients with a primary care visit in the past 3 years. Multivariable generalized estimating equations (GEE) model was used to examine the association of SUTD status with time-varying demographic and clinical characteristics over the 10-year period. Result(s): Our analytical cohort had 50,647 patients in 2011, of which 40.9% (20,708) patients were SUTD. Annual rates of SUTD were largely unchanged until 2019, when the prevalence increased to 46.8% after initiation of a population health outreach mailed FIT program. The SUTD rate fell to the baseline level of 40.8% in 2020 after the pandemic-induced suspension of the mailed FIT program. Multivariable GEE model demonstrated that older patients, females, and Hispanics had higher odds of being SUTD compared to younger patients, males, and non-Hispanics, respectively. Additionally, patients who had prior interaction with the healthcare system (had prior stool tests or prior primary care encounters) had higher odds of being SUTD than those with no prior experience with the healthcare system (no prior stool tests or no prior primary care encounters). Conclusion(s): This study establishes contemporary evidence about the 10-year prevalence and correlates of CRC SUTD status among patients in a safety-net health system. Prevalence remained constant for most of the decade, except in 2019, when a population-based mailed FIT outreach program was implemented to complement usual visit-based screening. Despite the disruptions caused by the COVID-19 pandemic, screening rates in 2020 did not drop below pre-2019 levels (~40%), though the prior increases due to the mailed FIT program were lost. We believe that effective implementation of broad population-based, screening outreach efforts are instrumental in improving and sustaining CRC SUTD rates in safety-net health systems, and can consequently help to decrease CRC incidence and related mortality.

Covid and cancer in Russia

Coronaviruses (lat. Coronaviridae) is a family of RNA-containing viruses, including 43 species as of May 2020 (it is constantly being updated), of which 7 coronaviruses affect humans (the first of them HCoV-229E is an alphacoronavirus, first identified in 1965). Transmission mechanisms: airborne, airborne-dust, fecal-oral, contact. In December 2019, an outbreak of pneumonia began in China caused by the seventh newly discovered SARS-CoV-2 virus, betacoronavirus. Coronaviruses suppress the immune system, the body ceases to recognize the infection and fight it. Very quickly, the coronavirus pandemic swept across all continents. New strains of this virus are being registered in various countries, the third, fourth, fifth and even sixth waves of its prevalence are noted. At the first stage of the pandemic, panic was certainly observed, outpatient clinics and even specialized hospitals were closed. All were aimed at fighting the new virus, The purpose of our study is to determine the impact of the newly emerged virus on the organizational problems of the oncological service in connection with the generalization of statistical data on morbidity and mortality from malignant neoplasms for the first year of the pandemic in Russia, the Northwestern Federal District of the Russian Federation and St. Petersburg. Materials and methods. The research material was the official data of the state reporting of the activities of the oncological service (f. No 7), the data of the State Statistics Committee on the deceased, the database of the cancer registry of St. Petersburg and the Northwestern Federal District of the Russian Federation. Results. The study made it possible to determine the impact of the spread of the SARS-CoV-2 coronavirus in Russia on the activities of the oncological service, primarily on the possibility of screening programs and early diagnosis programs for cancer. The tasks set to determine the maximum damage from the coronavirus to patients with cancer have been completed by us. It was found that in Russia as a whole, the under-registration of patients with cancer amounted to about 100,000 people, the quality of primary registration of patients decreased by 13%. The structure of cancer incidence in men and women has not changed much, but it turned out to be at lower absolute values. The maximum damage in the accounting of primary patients with cancer was inflicted on elderly and senile citizens, especially in localities with a low mortality rate. The incidence (detectability) of cancer decreased by almost a quarter in Moscow (this is 12,000 patients), in St. Petersburg - 3.5 thousand, in the Northwestern Federal District of the Russian Federation by 8.4 thousand. Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.