[European Code against Cancer: 12 ways to reduce your cancer risk]. / Európai Rákellenes Kódex: 12 lehetoség, hogy csökkentse a rák kialakulásának kockázatát.

Recently, the Word Health Organization/International Agency for Research on Cancer published the 4th edition of European Code against Cancer with 12 personal advices on how to diminish the risk of development of cancer. A proportion of advices refers to risk factors which are connected to our everyday lifestyle; another admonishes to comply with the services offered by the health care system. In Hungary, the European Code has not received adequate publicity so far. As common risk factors play a major role in the development of chronic non-communicable diseases, the advice may contribute to the prevention of both cardiovascular diseases and cancer.

[Implementation status of cervical screening in Europe]. / A rákellenes méhnyakszurés helyzete Európában.

Following the recommendation of the Council of the European Union, almost all governments made a policy statement on the introduction of cytology-based cervical screening for the health care system. However, the status of implementation is uneven. In the majority of the developed countries an organised model of screening recommended by the relevant international professional organisations are in use, while occasional screening is applied in some other countries. Screening strategies (i.e. age range, screening intervals), coverage of the target population, and compliance rates vary significantly. The screening activities are in a planning phase is some less developed Central-Eastern and South European countries. In Hungary, the transition from the traditional "gynaecological cancer screening" into the recommended organised cervical screening is in progress; the active involvement of the district health visitors in the cervical screening would provide further improvement.

[Factors influencing the participation in colorectal screening]. / Vastagbélszurés: a lakossági részvételt befolyásoló tényezok.

Participation of the target population in coloretal screening is generally low. In addition to demographic and socio-economic factors, the health care system and- in particular - family doctors play an important role. Further, the rate of participation is influenced by psychological, cognitive and behavioural factors, too. The paper analyses factors related to colorectal screening behaviour and potential interventions designed to screening uptake.

[Gynecological screening or cervical screening? Conflicts between clinical and public health viewpoints]. / Nogyógyászati rákszurés vagy méhnyakszurés? Klinikai és népegészségügyi nézopontok ütközése.

The "gynecological screening" that is composed of complex gynecological examination including colposcopy and cytological examinations has traditionally been incorporated into the gynecological protocol and practice. Over the past few decades, unfortunately, this screening practice has entrenched in the mind both of the gynecological community and the general public. As a result, the government-supported, organized cervical screening program of the population has come to a standstill. In order to adjust the cervical screening practice to the international public health recommendations in which cytology is the only screening test applied, the authors decided to involve primary care nurses and health visitors in smear taking, and to refer those with abnormal findings to a gynecologist for further clinical examination.

[Controversial issues in colorectal screening in Hungary: conflict of clinical and public health viewpoints]. / A vastag- és végbéldaganatok szurésének vitatott kérdései: klinikai és népegészségügyi nézopontok ütközése.

In Hungary, mortality rates from colorectal cancer are dramatically high, therefore the reduction by population screening as a public health measure is considered as one of the priorities of National Public Health Program. In the beginning, a human-specific immunological test was applied in the "model programs", as a screening tool, to detect the occult blood in the stool; compliance was 32% in average. However, the objectives of the model programs have not been achieved, because, among other reasons, a debate on the method of choice and the strategy to follow have divided the professional public opinion. In this study the debated issues are critically discussed, being convinced that, at present, population screening seems to be the most promising way to alleviate the burden of colorectal cancer.

[The state of the colorectal screening in Hungary: lessons of the pilot programs]. / A népegészségügyi vastag- és végbélszurés helyzete Magyarorszagon: a mintaprogramok tanulsagai.

In Hungary, colorectal cancer is the second most common malignant disease. Due to its natural history, colorectal cancer is particularly suitable for screening. At present, epidemiological evidences of the effectiveness of detection of the symptomless colorectal cancer and its precursors are only available for the demonstration of fecal occult blood, endoscopic methods are also in use. For mass screening, fecal occult blood tests are recommended. Guaiac-type chemical methods are widely criticized because of the lack of specificity. Out of the emerging technologies, immunochemical methods based on the antigenicity of blood proteins (hemoglobin) seem to be the most suitable. In the model programmes organized in the frame of the National Public Health Programme, an immunochemical method using two blood proteins (hemoglobin and albumin) have been used. The compliance was not more than 30-45%. About one-third of those with positive blood test refused colonoscopy. The programmes revealed a great number of adenomatous polyps and early cancers, and in the way, the effectiveness of the method has been proved. The model programmes are still continued. Before the continuous and gradual extension of colorectal screening, the validity of the specific method needs to be tested and proved in order to be recognized as a routine procedure for screening. There is a need to test the feasibility of total colonoscopy, however, to this effect the colonoscopic capacity in the country has to be further developed.

[The undesirable, psychologically adverse effects of screening]. / A szûrés nemkívánatos lélektani mellékhatásai.

The psychological adverse effects might play an important role in the non-compliance with the offered screening examination. The possible sources of them are three-fold: 1. The general human attitude, such as the rejection of health interventions, particularly those aiming at the prevention of eventual future health problems instead of handling existing complaints and symptoms at present; the screening can be seen as a "future-oriented" intervention. 2. The cultural image of cancer and the disbelief of its curability. 3. The subjective experiences in relation to the screening process. The providers have to do their best to eliminate these causes: by means of a) health education addressing people of various ages, social classes and cultural levels, promoting the understanding of the importance of disease prevention, and, changing their negative, defeatist attitude towards cancer; b) minimizing the psychological adverse effects of all kinds. This can be done by proper organisation of the screening process; optimizing the quality of work, and, provision of good quality of information and advice to the screenees before, during and after the screening.

[Screening for early detection of lung cancer: conflict between clinical and public health viewpoints]. / Szurovizsgálatok a tüdorák korai felismerésére: a klinikai és népegészségügyi nézopontok ütközése.

In Hungary, lung cancer, gradually increasing among women, is the leading cause of cancer mortality. The screening, using chest x-ray and sputum cytology as screening tool, does not reduce the mortality from lung cancer, therefore, screening for lung cancer is not recommended. The low-dose spiral CT is a sensitive and promising method, however, its specificity is far from being ideal. The results of the on-going RCTs are expected in a few years time, and so far it is not applicable for routine screening. In this country, the one-third of lung cancer cases are detected by the routine chest x-ray for tuberculosis, obligatory by law, and most of the detected cases are still resectable, but this does not have any influence on the mortality. According to our view, the detection of the lung cancer, particularly in those at high risk, is a by-product of periodic chest x-ray aiming at early detection of tuberculosis, however, mass screening for lung cancer as public health measure is not recommended. For the time being, the implementation of tobacco control measures is the only way to reduce the risk of lung cancer in the long run.

[Oral cancer screening: how to develop a country-wide opportunistic system in Hungary]. / Szájüregi szurovizsgálatok: tervek az alkalomszeru szurés kiterjesztésére Magyarországon.

In Hungary, oral cancer represents a very heavy public health problem. Even epidemiological evidence in support of the effectiveness of organized screening for early detection does not exist, the efforts to detect the precancerous lesions and early cancers of oral cavity must be continued. The mass screening component of the National Public Health program provides a good opportunity for that. Following the Government decision, a multidisciplinary Working Group has been brought together, and a proposal made to develop a country-wide opportunistic system to regularly examine those at high risk for oral cancer. In addition to dentists, primary care personnel as well as the occupational health service have a lot to offer to the desired effect: reduction of mortality from oral cancer.

[Is the mass screening for prostate cancer justifiable?]. / Indokolt-e a népegészségügyi prosztataszurés?

In Hungary, prostate cancer is a major public health problem, therefore screening should be considered to reduce the number of deaths. Screening tests are available, i.e. prostate-specific antigen (PSA) and digital-rectal examination, nevertheless their sensitivity, specificity and positive predictive value are far from being perfect. Evidences from non-randomized screening trials suggest possible benefit but randomized controlled trials are still needed for conclusive evidence. The screening might cause more harm than good due to overdiagnosis and overtreatment as a result of limited specificity of the test. According to authors' point of view, opportunistic screening as part of diagnostics of patients having symptoms indicative of prostatic disorder is fully justified but mass screening of population of average risk should not be introduced until supportive evidence is available from the ongoing randomized-controlled screening trials.

[The state of the organised mammography screening in Hungary in 2006]. / Az emloszurés helyzete Magyarországon 2006-ban.

Breast cancer represents a serious public health concern in Hungary. The most promising way of mortality reduction is organised screening which applies personal invitation, recall and follow-up. Screening women between 50-65 years of age by mammography combined with clinical breast examination is a method of proved effectiveness. The effectiveness has not yet been proved in premenopausal women, however, as a result of the public and professional pressure on decision-makers, perimenopausal women (above 45 years of age) are not excluded. In Hungary, the National Public Health Programme has established the managerial, administrative, legal and financial frame for an organised screening, therefore, since 2002, the programme has been in operation. Screening is provided in every other year. In the first two screening cycles, approximately 40% of invitees attended the screening test. According to the National Health Insurance Fund (OEP), under the influence of personal call-and-recall programme, the annual numbers of diagnostic mammography examinations have substantially increased, indicating that many invited women are looking for screening facility outside the programme. The detection rate and the small cancer detection rate are in line with the international standard values. To establish the number of "interval cancers", establishment of a pathological database ("patho-bank") is in progress, in close cooperation with the screening registry. According to the health economical analysis, the organised breast screening program is "affordable" for the financing agency.

[The state of organized cervical screening program in Hungary in 2006]. / A népegészségügyi méhnyakszûrés helyzete Magyarországon 2006-ban.

Theoretically, there is a real prospect for full eradication of cervical cancer by cytology screening. In several countries the burden of cervical cancer significantly decreased due to regular screening of the population. In Hungary, the complex "gynecological screening", including colposcopic examination, has a long tradition, however, the efforts of several decades are not reflected in the mortality: about 500 women are killed by cervical cancer each year. The screening protocol represents a compromise between the traditional "gynecological screening" and the internationally recommended organized screening: taking sample for cytology is an essential element of the gynecological examination. The National Public Health Programme has established the technical and organizational preconditions of an organized screening programme. The early experiences with the "call-and-recall" organized screening -- started at the end of 2003 -- are unfavourable, because the compliance rates are unacceptably low. The majority of the women receive screening in a traditional way, i.e. outside the programme; another proportion of them simply ignores the invitation, and does not accept the offered screening. To improve the current situation, following the recommendation of "the-state-of-the-art", an attempt is made to intensify the involvement of the primary care personnel. There is a need to revise the current financing system by the political decision-makers in the health field. The access to the screening facilities needs to be improved, the attitude of the medical community changed, and the efficiency of the communication with the public significantly improved.

[The state of the organized screening in Hungary in 2006]. / A népegészségügyi lakosságszurés helyzete Magyarországon 2006-ban.

Hungary carries a heavy burden of cancer. At present, the organized screening of symptomless people seems to be the most promising strategy. According to the state-of-the art, those are the mammography-based breast screening, the cytology screening of cervix uteri, and the colorectal screening using immunochemical detection of the fecal occult blood satisfy the criteria of organized screening. The screening for cancers of the oral cavity, and the methods suitable for early detection of prostate cancer are not based on epidemiological evidence, therefore can only be applied opportunistically, as part of the medical practice. For the time belong, there are no suitable methods for detection of early lung cancer. The organized screening which applies personal call-and-recall has been incorporated in the National Public Health Programme. The concepts underlying the organized screening are fully in accordance with the recommendations by the European Union. The Chief Medical Officers' Office (OTH) is being charged with the organization, coordination and evaluation of organized screening programmes for the above screening modalities. In the past few years, an appropriate system for administration and information (including a country-wide screening registry) has been established, in addition to a regional coordination system based on the institutes of National Public Health and Medical Officers' Service (ANTSZ) and a nation-wide network of mammography and cytological laboratories, capable of meeting the requirements. This publication is to summarize the problems yet to be solved and the results expected from the organized screening programmes.