TEMPORAL TRENDS OF CERVICAL CANCER MORTALITY IN GEORGIA, 2011-2018.

Cervical cancer is the fifth most common cancer diagnosed in Georgia, after breast, thyroid, colorectal, and uteri cancers. During 2015-2018 cervical cancer incidence composed 17.9, 19.6, 15.0 and 14.3 per 100000 female population accordingly. The study aims to describe cervical cancer (CC) mortality in Georgia during the period of 2011 and 2018. Descriptive analysis was conducted using mortality data during the period of 2011-2018 from the National Statistics Office of Georgia. To estimate time trends of CC mortality study period was divided into two groups - 2011-2014 and 2015-2018 years. For data analysis, descriptive statistics was performed, in which the mortality rates, age-specific mortality rates per 100,000 female population and other statistical measurements - median, the first quartile (Q1), the third quartile (Q3), and interquartile range (IQR) of age at death from Cervical cancer were estimated. Statistical analysis was completed by using the programs of EpiInfo version 7 and Statistical Package of the Social Science (SPSS) version 23 for Windows. The statistical significance tests - p value, and 95% of Confidence Interval (95% CI) were used in order to estimate statistical reliability of the results. The number of annual deaths varied between 121 and 185 cases that composed variation of mortality rates from 6.1 to 9.5 per 100,000 women. According to the 95% of CI the difference between mortality rates according to calendar years is not statistically significant. Mean mortality rates for the periods 2011-2014 and 2015-2018 were 7.1(SD=0.7) and 8.7 (SD=0.5) accordingly and presented a slight increase. Taking into consideration that during 2005-2010 annual number of registered deaths from cervical cancer in Georgia was quite low and varied between 50 and 60, it is likely that this increase is related to the improvement in registration and is not a true increase. Therefore, the second period (2015-2018) of the study represents more real data, then the first (2011-2014). Cervical cancer mortality increases with age, which indicates that advanced age is a predictor factor. The age effects for almost all calendar years included in analysis (2011-2018) presented an increasing trend with age from 25 to 59, while a moderate decrease was shown within the age group from 60-64 to 65-69 and over 80 years of old. The median age of deaths from CC fluctuated inconsistently between 57 and 62 years; Interquartile range in different calendar years composed: 47-67, 52-72, and 52-67 years. Comparatively stable median age of deaths, indicates that, there is no tendency of cervical cancer early mortality reduction. The study revealed a slight increase in CC mortality, which could be related to the improvement of death registration.

EFFECT OF SELECTED PROGNOSTIC AND RISK FACTORS ON SURVIVAL OF WOMEN WITH BREAST CANCER IN GEORGIA.

According to the population-based cancer registry data in Georgia, the incidence rate of breast cancer per 100000 women was 90.6 in 2016. The aim of this study is to explore the effects of risk and prognosis factors on survival of female invasive breast cancer patients in Georgia. Cancer survival analysis was conducted, it is based on retrospective study of Georgian cancer registry data. Almost all breast cancer cases who were diagnosed and histologically confirmed during the period of 2006-2015 and are recorded in the cancer registry system, were included in the study. From factors, associated with prognosis of disease and are considered as risk and prognosis factors, demographic (age at diagnosis, place of residence) and histopathology factors (stage at diagnosis and tumor cell differentiation grade) were included in the study. Survival status (alive, dead or censored) was used as the dependent (response) variable. As the starting point of time for estimating survival of patients was defined the date of diagnosis. Patients' observation period included the time from the date of diagnosis to the last follow-up (31ST December 2016) for those who was alive by the end of the study, and the date of death (end-point) for those who died during the study period. Any cause of death of cancer patients was considered as the end point. That means the overall (and not breast cancer specific) survival rate response to predictor factors was estimated in the study. Cox proportional hazard regression model was constructed to analyze the effect of all risk and prognosis factors and calculate the hazard ratio (HR) for mortality and 95% Confidence Interval (95% CI). A p value < 0.05 was considered as statistically significant. Total number of breast cancer cases enrolled in the study is 3852, age range from 21 to 80 years. We have found that cancer diagnosed between 41-59 years of age had a lower death hazard (HR=1.45, p=0.04) compared to cancer detected over 60 years of age (HR=2.40, p<0.01). There were significant differences (p<0.01) in terms of survival between patients, detected at different stages: the hazard ratio of death for cancer patients diagnosed at the second, third and fourth stages was 2.25, 4.04, and 10.43 accordingly. The study results showed that the moderately differentiated tumor had better survival chance (HR=1.35, p=0.44), than those with poorly differentiated (HR=2.37, p=0.03), and undifferentiated cancers (HR=5.19, p=0.01). Patients living in regions of Imereti (HR=1.40, p=0.02), Adjara (HR=1.37, p=0.07), and Guria (HR=1.30, p=31), had higher risk of mortality than residents of Tbilisi, while living in Shida Kartli (HR=0.59, p=0.01) region had statistically significant effect on better survival. Breast cancer survival dissimilarities among the regions of Georgia could be explained by detection of cancer at different stages and non-standard approaches to cancer management. Some risk and prognosis factors, such as the demographic (age and place of residence) and histopathology (stage at diagnosis and tumor cell differentiation grade) factors have impact on survival of the female invasive breast cancer patients, moreover, this effect mainly is statistically significant.

EFFECT OF AGE AT DIAGNOSIS ON THE PROGNOSES IN FEMALE BREAST CANCER PATIENTS IN GEORGIA.

The aim of the study was to describe prognostic factors of Breast Cancer (BC) survival in relation to patient's age at diagnosis. Cox proportional hazard regression model was constructed. All women aged ≤80 years, diagnosed from 2006 to 2015 with invasive breast cancer, and included in the national cancer registry database, were eligible for inclusion in the analysis. We estimated hazard (mortality) ratio (HR) and 95% of confidence interval (95%CI). The patients under 41 years were selected as a reference group. High risk of death was defined as a mortality of BC patients within 5 years after diagnosis. Total number of BC cases enrolled in the study is 3852, about 10% of patients was under 41 years (a young group), 50% - 41-59 years (a middle age group), and 40% - 60 years and over (an elderly group). There were some age-specific differences in almost all the variables of interest: for example, 53.3% of patients aged under 41 years were detected at early stages (the first and second) compared with 46% in patients aged 41-59 years, and 45% in patients aged ≥60 years old. Younger women were more likely to have histologically poorly differentiated tumor; it was 42%, 35%, and 31% in young, middle, and elderly age group of patients accordingly. Utilization of radio and chemotherapy decreased with age. Application of radio and chemotherapy among young group of patients in comparison with older counterparts were about twice and 1.2 times higher accordingly. The HR for cancer cases detected at any stage, except of the first stage, was increasing with age and it was the highest and statistically significant for older patients, diagnosed at the second (HR=2.84; 95%CI=1.02-7.95) and fourth stages (HR=2.71; 95%CI=1.64-4.49). Poorly differentiated cancer has the worst outcome among elderly - aged ≥60 years old (HR=2.78; 95%CI=1.61-4.80), while moderately differentiated cancer survival is not related with patients' age during detection of cancer. In addition, absence of a radio or chemotherapy treatment is associated with increased hazard of mortality. In conclusion, the relatively low risk of mortality among young women diagnosed with BC in Georgia can be explained by the higher proportion of cases in the early stages and the high level of use of chemotherapy and radiotherapy.

FACTORS AFFECTING SURVIVAL OF WOMEN DIAGNOSED WITH BREAST CANCER IN GEORGIA.

Breast cancer is the most frequently diagnosed cancer in women worldwide with nearly 2.4 million new cases diagnosed in 2015, In Georgia survival from breast cancer is lower than in many developing countries. The goal of the study was to identify predictors for low survival of disease in the country. Data from population-based cancer registry was used in order to estimate 1-year and 5-years relative survival rates for breast cancer. To identify predictors for low survival time, was performed bivariate analysis. Statistical analyses looked at correlations between possible predictors and survival period. From the cancer registry database 190 breast cancer cases, whose diagnosis were conformed histologically and died in 2015 were included in a statistical analysis. All analyses were performed using Epi Info version 7. According to population-based cancer registry, breast cancer is the most common form of  cancer among women in Georgia. In 2015 1838 breast cancer new cases were detected in the country, incidence rate composed 94.7 per 100000 population. Based on 190 breast cancer patients' data, that died during 2015, one-year and 5-year survival rate composed 69% and 26% in accordance. The results of bivariate analysis, show that late stage at diagnosis (OR=1.89, 95%CI=0.74-4.68), a young age of patients at diagnosis (OR=1.89, 95%CI=0.50-7.17), highly differentiated histological grade (OR=1.21, 95%CI= 0.44 - 3.54), is positively correlated with low survival period (less than 5 years), while having mastectomy (OR=0.52, 95%CI=0.27-0.89), adjuvant chemotherapy (OR=0.38, 95%CI=0.20-0.74), and a radiotherapy (OR=0.62, 95%CI=0.31-1.25), have statistically significant positive association with high (more than 5 years), survival period. A young age of patients at diagnosis, highly differentiated histological grade and late stage at diagnosis were possible predictors for low survival time (less than 5 years) in Georgia. Breast cancer survival can be extended by using complex methods of treatment and implementation of standardized approaches to management of diseases throughout the country.

DIETARY HABITS OF SCHOOL-AGE CHILDREN IN TBILISI.

Study Goal was to determine dietary habits in school-aged children. Sampling of children was conducted in two stages. In the first stage, five schools in Nadzaladevi district of city Tbilisi were randomly selected. On the second stage the study groups from the appropriate school-aged students (10-14 years old children) were also randomly selected. All student participants filled out standardized and adopted questionnaires suggested by the American Academy of family physicians. Data were analyzed by using EpiInfo 7th version. Statistical analyses looked at correlations between criteria of unhealthy diet (such as morning without breakfast, frequent consumption of non-alcoholic beverages and fast food products) and overweight/obesity. A Body Mass Index (BMI) was calculated by using CDC tool. 175 children with ages of 10-14 years (47% boys) were included and interviewed. Half of the children noted that they love or like fast food products. 10% - visits fast food places 2-3 times a week together with a family. 11% - visits fast food places 5 times a week and even more. 34% - do not start morning with breakfast; 15% - eat only twice a day; 26% - add salt to their dishes; 58% - drink non-alcoholic beverages every day or many times during a week; 24% - are overweight; 29% suffer from obesity; 25% noted that fast food places are located near schools. Very weak correlation was found between unhealthy diet (morning without breakfast, frequent consumption of non-alcoholic beverages and fast food products) and overweight/obesity. According to study results, dietary habits of school-age children in Tbilisi is unhealthy; to improve nutritional habits is essential: (1) promote consumer (students, parents and teachers) awareness on a healthy diet, (2) educate children, adolescents and adults about nutrition and healthy dietary practices, (3) encourage to raise awareness about the salt consumption in recommended doses in children.

Unexpected non-seasonal increase of bacterial meningitis cases in Georgia in 2009.

In summer of 2009, During the period of 20-June - 31-August in total 32 patients with the clinical diagnosis of bacterial meningitis were hospitalized in two hospitals of Tbilisi (Center for Infectious Pathologies and Iashvili Child Clinic). Within a week's time (13 July-19 July) 9 persons with suspected cases of bacterial meningitis were hospitalized in both clinic. Our attention was attracted by the increased number of hospitalized patients within non-seasonal period. Goal of investigation was to establish the extent of the outbreak, to detect possible exposures, and to establish recommendations for prevention activities of disease. For laboratory confirmation cerebral spinal fluid biochemical and bacteriological (culturing) testing was used, but no single causative agent was isolated. To detect risk factors patients' were interviewed. 78.5% (25) of the hospitalized persons were under 14 years of age, and among them--70% (22) preschool children. The most common exposure identified through the interviews with patients included active or passive exposure to tobacco smoking (38%), an existence of the recent upper respiratory infection (31%), and attending crowded places (23%). Since causative agents were not isolated, we were not able to establish whether the increasing number of disease was caused from different etiologic pathogens or from single agent. We were not able to establish the presence of an outbreak since no single causative agent was isolated. Previous use of antibiotics remains the only likely reason for low detection of the pathogen. Detected risk-factors for distribution of disease were smoking, existence of the recent upper respiratory infection, and attending crowded places. In order to control increasing number of bacterial meningitis, improving basic laboratory diagnosis by implementing advanced methods that are not affected by the prior use of antibiotics, such as serological testing might be crucial, as well as increasing awareness of population about risk factors of bacterial meningitis and importance of early seeking medical care.