[The pitfalls of lung cancer coding practices based on the evaluation of the National Cancer Registry]. / A tüdorákhoz kötodo kódolási gyakorlat buktatói a Nemzeti Rákregiszter felmérése alapján.

The quality of input data determines the reliability of epidemiological assessments. Thus, the verification of cases reported to the National Cancer Registry is required. The objective of our study was evaluating the reliability of cases diagnosed by lung cancer, exploring the patterns of erroneous reports. The validation of the 11,750 lung cancer cases reported to the Cancer Registry in 2018 was performed with the involvement of the recording hospitals, analyzing the characteristics of reports by gender, age and attributes of the reporting institutions. 81.3 percent of the reported cases was confirmed, in 40.4 percent of the false reports, malignancy was not present at all. Among the erroneous cases women and the elderly age group were overrepresented. The highest deleted rate occurred in Borsod- Abaúj-Zemplén county. As a conclusion, there is a strong need for the improvement of the efficiency in encoding lung cancer. The most common errors: confusion of malignant-benign, cancerous-non-cancerous and primary-metastatic lesions. The reliability is not affected by the role of individual institutions in the hierarchy of health care. The availability of reliable epidemiological data is crucial in the fight against cancer, which requires broad professional cooperation.

[County differences in incidence and mortality of malignant neoplasms in Hungary between 2005 and 2019]. / A rosszindulatú daganatos betegségek incidenciájának és mortalitásának vármegyénkénti különbségei Magyarországon 2005 és 2019 között.

The objective of our study was to map county differences in incidence and mortality by cancers and examine their changes over time. Based on the database of National Cancer Registry and Central Statistical Office, age-standardized incidence and mortality rates per 100,000 person-years were calculated for each county for 15 cancer types and 3 time periods. East-West divide was apparent in incidence and mortality of lung cancer, with larger weight in East (Borsod-Abaúj-Zemplén, Heves, Jász-Nagykun-Szolnok, Békés counties). Concentration of lip and oral cavity malignancies was identified in the northeastern periphery (Borsod-Abaúj-Zemplén, Szabolcs-Szatmár-Bereg counties). Breast cancer incidence was the highest in Budapest. As a conclusion, changes in cancer incidence and mortality over time were similar to developed countries; however, values were higher. Differences in spatial distribution follow territorial pattern of social deprivation, which correspond to higher prevalence of health risk factors. Our study contributes to planning of public health programs by pinpointing regional inequalities in different cancer types.

[The epidemiology of primary brain malignancies]. / A központi idegrendszer primer rosszindulatú daganatainak epidemiológiája és etiológiája.

The occurrence of central nervous system malignancies is relatively low; however, these tumors exhibit poor prognosis and a high mortality rate. On epidemiological grounds, Hungary was placed in the last third among European countries: in the last decade annually 750 to 1000 new cases were diagnosed and the number of deaths was between 550 and 690, without any apparent trends. Age distribution analyses revealed childhood peak and a higher peak at around 65 years of age. Histologically, heterogeneity was apparent, but at least half of the cases were glioblastomas. The exact etiology of adulthood brain tumors is mostly unknown. Among environmental exposures the effect of ionizing radiation was confirmed, the identification of other potential risk factors requires further examinations. 7-10 percent of brain tumors were hereditary tumor syndromes (Li-Fraumeni, neurofibromatosis, sclerosis tuberosa, von Hippel-Lindau, Gorlin- Goltz). Therefore, genetic testing is recommended for families where the diagnosis of brain tumor is suspected.

Comparison of Hungarian Central Statistical Office's causes of death data with the database of the Hungarian National Cancer Registry / A Központi Statisztikai Hivatal halálozási adatainak összevetése a Nemzeti Rákregiszter adatbázisával. Egy adat-összekapcsolás tanulságai

Introduction: In international comparison, Hungary is in the forefront of cancer incidence and mortality statistics. Based on paper-based death certificates, mortality statistics are compiled by the Hungarian Central Statistical Office, while population-based measures of cancer incidences are performed by the Hungarian National Cancer Registry. Objective: Linking the records of these two independent databases can highlight their weaknesses and provide an opportunity to reconcile and verify collected data, which may emphasize the need to expand current data exchange protocols. Method: Based on the Hungarian unique health care insurance ID, the mortality database of the Hungarian Central Statistical Office between 2012 and 2020 was compared with the data of the Hungarian National Cancer Registry from 2001 to 2020. Deaths in 2018, in particular those related to lung cancer, were examined in more depth to demonstrate the biases resulting from erroneous data collection. Results: The mortality database of the Hungarian Central Statistical Office contained 32 586 cases with an underlying cause of death of malignant neoplasm for 2018, of which 29 970 were identified in the Hungarian National Cancer Registry. Out of the 8716 deaths coded to lung cancer, 7957 corresponding individuals were also found in the Registry. From the matches, 7381 cases were marked with lung cancer in the Hungarian National Cancer Registry. For the remaining 576 cases, the Registry recorded different types of cancers, of which in 69 cases with lung metastasis. Discussion: The differences between the two databases may be caused by methodological differences in data collection, incomplete, inaccurate reporting and differences in processing algorithms. Nevertheless, the majority of the data in the examined databases were found to be appropriate for epidemiological studies. Conclusion: Based on the outcomes of the present analysis, a revision of the data transfer between the two institutions is in order. The introduction of electronic Death certificate recording and validity checks are expected to improve the reliability of ID numbers and may shorten data processing times.

Comparison of Cancer Survival Trends in Hungary in the Periods 2001-2005 and 2011-2015 According to a Population-Based Cancer Registry.

Background: Assessment of population-based cancer survival may provide the most valuable feedback about the effectiveness of oncological surveillance and treatment. Aims: Based on the database of the Hungarian National Cancer Registry, standardized incidence rates of lung, breast, colorectal, prostate and cervical cancer were compared to standardized mortality data of the Hungarian Central Statistical Office in the period between 2001 and 2015. Then survival analysis was performed on cleansed database. Results: The incidence of colorectal, breast and prostate cancer increased, while standardized rates of lung and cervical cancer declined. The survival of colorectal, breast and prostate cancer showed improvement. Contrarily, lung cancer exhibited a mild decline, while that of cervical cancer did not change significantly. In earlier stages survival was improved among almost every studied tumor type, while in advanced stages improvement was not observed. Comparison of stage distribution revealed that in the 2011-2015 period colorectal, breast and prostate cancer cases were diagnosed at earlier stages, while lung and cervical cancer patients were typically discovered at more advanced stages. Discussion: The outcome of advanced cancer treatments is better in earlier stages, which highlighted the importance of screening network. However, growth of oncological treatment costs with longer patient survival imposes a constantly increasing burden on society.

Smoking, chromosomal aberrations, and cancer incidence in healthy subjects.

Chromosomal aberrations (CAs) in peripheral blood lymphocytes can be used as biomarkers of cancer risk. Cytogenetic tests were conducted on 2396 healthy Hungarian individuals and cancer incidence was followed up from 1989 to 2018. Venous blood samples were obtained from the subjects and metaphases from lymphocyte cultures were prepared. We compared the CA frequencies of the various smoking (1-5; 6-10; 11-19; or 20-40 cigarettes/day) and exposure (irradiation; chemical industry; chemical research laboratory) groups. Chromatid break (p = 0.0002), total aberration (p = 0.002), and aberrant cell (p = 0.001) frequencies were higher in smokers than in non-smokers. For very heavy smokers, total CAs were significantly higher than for non-smokers (<0.001) or less intensive smokers (p = 0.003-0.0006). Intensity of smoking was a predictor of chromosomal aberrations, while duration was not. During follow-up, 177 (7.3 %) cancer cases were found. A Cox-regression model showed that subjects with cell values ≥2 CAs developed cancer more frequently (hazard ratio = 1.39; 95 % CI, 1.02-1.90). The relative risks of cancer were 1.06 (95 % CI 0.53-2.06) for light smokers and 1.74 (95 % CI 1.08-2.77) for very heavy smokers. The distributions of cancer sites showed differences between smoker and non-smoker groups: in male smokers, lung cancer, in non-smokers, prostate, and in females (both groups) breast cancer were most common. Cancer incidence correlated with chromosome aberrations; smoking was not a confounder in this relationship.

[And what about doctors? Associations between spontaneous chromosomal aberrations and cancer morbidity in healthcare workers]. / És mi van az orvosokkal? Egészségügyi dolgozók spontán kromoszómaaberrációi és rákmorbiditása közti kapcsolat.

Healthcare workers may be occupationally exposed to low dose rate radiation or different chemicals during their work. There are strong associations between the increased frequency of spontaneous chromosomal aberrations in blood lymphocytes and the risk of cancer. Cytogenetic tests were conducted on 1240 healthy medical workers and cancer incidence was followed up between 1997-2018. Both structural and numerical chromosome aberrations were evaluated and the results were compared taking into account gender, age, and smoking. The frequency of aberrant cells was significantly higher in smoker males than in non-smokers (p=0.009). Within the same study period, there was no significant difference in chromosome aberrations between the potentially exposed group of workers and the control group. Among 82 cancer cases (6.6%) the most common tumors were breast (16), colon (12), lung (7) and thyroid gland cancers (7). Our analysis showed 7.3% cancer occurrence among smokers compared to 6.2% among non-smokers. These results suggest that in our cases cytogenetic effects of smoking are more deleterious than occupational exposures.