[Oral cancer screening: what can the healthcare system do to reduce the burden of disease?] / Szájüregi daganatszurés: mit tehet az egészségügyi ellátórendszer a betegségteher mérsékléséért?

Due to its high incidence and mortality, oral cancer makes a group of diseases of public health importance. Oral screening is a simple three-step procedure: the first step is questioning the patient about his/her smoking/drinking habits, secondly, visual inspection of the oral cavity, and finally, palpation of regional lymph nodes. If precancerous conditions or any form of oral cancer are suspected, the task is to send the examined person to oral clinical care. The examination can routinly be performed by dentists, but also by general practitioners and occupational health personnel. The difficulty of oral screening arises from the fact that most of the patients are of low socio-economic status. The organization of oral screening is the responsibility of the healthcare system personnel: their task is to identify the high-risk persons and to direct them to the scene of the screening. Orv Hetil. 2023; 164(38): 1497-1505.

[Quality and performance indicators of colorectal cancer screening pilot program in Csongrád County, Hungary]. / A Csongrád megyei vastagbélszûrési pilot program minõségi indikátorai és teljesítménymutatói.

Colorectal cancer is a major social and economic burden for developed countries. Our analysis aimed to evaluate the quality and performance indicators of colorectal cancer screening pilot program. The colon cancer screening pilot program was carried out in 2015 involving an average-risk population aged 50-69 in Csongrád county, Hungary. The analysis involved data from the Communication module of the Office of the National Chief Medical Officer. We recorded 21.1% invitation rate (22,130 persons), 51.2% attendance and 47.3% participation rates, with a higher female participation rate (p<0.001). Participation rate was far lower than the expected 65%. The rate of non-negative results (13.1%) exceeds the international reference rate. Participation rate on the colonoscopy screening (90.1%) reached the expected value. Compared to the number of actual colonoscopies performed, adenomas were found in 2.5% and malignant lesions in 0.3% of the cases. Our results highlight the deficiencies regarding the follow-up and data recording of screening results in the IT system as well as the lack of communication between the GP and the diagnostic laboratories.

[Quality and performance indicators of the pilot program for cervical cancer screening by health visitors]. / A védõnõi méhnyakszûrési pilotprogram minõségi indikátorai és teljesítménymutatói.

The aim of our analysis was the assessment of the qualitative and performance indicators of a pilot program for health visitors' cervical cancer screening. The analysis involved the data from the Communication module of the Office of the National Chief Medical Officer. In the examined period (October, 2013 - September, 2015) the participation indicators of women aged 25-65, the prevalence rates of human papillomavirus and the cervical intraepithelial neoplasia were determined. In the screening period, the call-in rate was 32.45% nationally, with the compliance of 8.26%. The occurrence of a positive result was 1.85% nationally, with the highest rate in Hajdú-Bihar county (7.24%). HPV infection was detected in 113 cases (0.45%) nationally, HPV prevalence was 37.44/100,000 persons. The willingness for participation among women was low concerning the indicators. Their raising should be an emphasized task for public health in favor of reducing mortality from morbidities.

[Assessment of the pilot program for cervical cancer screening by health visitors]. / A védonoi méhnyakszurési pilot program értékelése.

INTRODUCTION: Within the tender (6.1.3.A-13/1-2013-0001) supported by the European Union, we wished to involve health visitors into the organized cervical cancer screening program. AIM: The aim of our survey was to assess the satisfaction of health visitors, instructors, and that of the teaching aids. Furthermore, we wished to assess whether the teaching materials met the expectations. METHOD: Satisfaction of the health visitors was assessed by a survey, in four groups of questions. These involved the assessment of the instructors, the teaching aids, evaluation of the further training day, and the compliance with the knowledge of training. Period for completion of the questionnaires lasted from October to December in 2014. We used descriptive statistics for data evaluation. RESULTS: Data of 2148 health visitors was evaluated. They rated the performance of gynecologist-obstetricians 4.65, that of health visitors 4.61, that of public health professionals 4.56, and that of IT specialists 4.52. 98% of the teaching aids were useful for them and the acquired knowledge was appropriate with their expectations. CONCLUSION: The health visitors were satisfied with the theoretical instruction within the pilot program. The professionally well prepared health visitors may contribute to the success of the cervical cancer screening program. Orv. Hetil, 2017, 158(12), 461-467.

[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.

[Inequalities in cervical screening practices]. / Egyenlotlenségek a méhnyakszurésben.

Theoretically, the cytology-based cervical screening is capable of early detection of precancerous epithelial lesions of cervix uteri and its cancer, and of early referral to treatment. In this way, screening can inmprove the quality of life of the patients and reduce mortality from the target disease. Unfortunately, this often remains unexploited, because there might be inequalities on both "supply" and "demand" side of screening. In addition to the geopolitical situation of a country, inequalities might result from differences in the health care systems, and heavy access to the screening services. On the other hand, the socioeconomic status, the health-conciousness of the target population, and their knowledge and information of the benefits and potential harms of screening examination might have a bearing on the acceptance or refusal of the offered screening. Efforts need to be made to increase the uptake of cervical screening programmes.

[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.

[Attendance of the fourth (2008-2009) screening round of the Hungarian organized, nationwide breast cancer screening program]. / A szervezett országos emloszurési program negyedik (2008-2009) szurési körének részvételi arányai.

INTRODUCTION: Organised, nationwide screening for breast cancer with mammography in the age group between 45 and 65 years with 2 years screening interval started in Hungary in January 2002. AIM: The aim of this study is to analyze the attendance rate of nationwide breast screening programme for the 2008-2009 years. METHOD: The data derive from the database of the National Health Insurance Fund Administration. The ratio of women in the age group 45-65 years was calculated having either a screening mammography or a diagnostic mammography in the 4th screening round of the programme. RESULTS: In the years 2000-2001, 7.6% of the women had an opportunistic screening mammography while in 2008-2009 31.2% of the target population had screening mammography within the organized programme. During the same periods 20.2% (2000-2001) and 20.4% (2008-2009) of women had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.6% (2000-2001) to 50.1% (2008-2009). The attendance rate failed to change between 2002 and 2009. CONCLUSIONS: In order to decrease the mortality due to breast cancer, the attendance rate of mammography screening programme should be increased. Orv. Hetil., 154(50), 1975-1983.

[Participation rates in the third round (2006-2007) of the breast cancer screening program in Hungary]. / A szervezett emloszurési program harmadik (2006-2007) szurési ciklusának részvételi arányai.

Organised, nationwide screening for breast cancer with mammography in the age group of 45-65 years with 2 years screening interval started in Hungary in January 2002. The aim of this study is to analyse the attendance rate of breast screening programme for the 2006/2007 years, including the analysis of the ratio of screening and diagnostic mammography examinations. The data derive from the financial database of the National Health Insurance Fund Administration (NHIFA) covering the 8 years period between 2000 and 2007. The ratio of women in the age group of 45-65 years was calculated having either a screening mammography or a diagnostic mammography. The analysis was carried out for the years 2000-2001 before and 2006-2007 after the implementation of nationwide organised programme. In the years 2000-2001 7.26% of the women aged 45-65 years had an opportunistic screening mammography while in 2006-2007 29.4% of the target population had screening mammography within the organised programme. During the same periods 19.8% (2000-2001) and 21.8% (2006-2007) of women aged 45-65 years had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.2% (2000-2001) to 49.7% (2006-2007). The attendance of the Hungarian organised breast cancer screening programme slightly declined in 2006-2007 compared to 2002-2003/2004-2005, and to achieve the expected results in mortality decrease a further improvement of the uptake is necessary.

Cervical cancer screening practices in central and eastern Europe in 2012.

The burden of cervical cancer in central and eastern Europe is generally higher compared to western or northern Europe due to a history of mostly opportunistic cervical cancer screening practices and due to the strong influence of political and economic changes in post-communist transition. This article describes the current cervical cancer screening practices, organizational plans for the future, and main obstacles that need to be overcome in 16 countries in central and eastern Europe: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Montenegro, Poland, Romania, Serbia, Slovakia, Slovenia and The former Yugoslav Republic of Macedonia. Unfortunately, only a few countries have managed to establish an organized and well-functioning cervical cancer screening program in recent years, whereas most countries in the region are still struggling with implementation-related issues of organized cervical cancer screening. Encouragingly, even in the countries where only opportunistic screening is performed, well-prepared plans and strategies have been established for switching to organized screening in the near future.

[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.

[Attendance in the second phase (2004-2005) of the Hungarian organized breast cancer screening program]. / A szervezett emlôszûrési program második ciklusának (2004-2005) részvételi arányai.

AIM: Organised, nationwide screening for breast cancer with mammography in the age group of 45-65 years with a 2-year screening interval started in Hungary in January 2002. The aim of this study is to analyze the attendance rate of breast screening programme, including the analysis of the ratio of screening and diagnostic mammography examinations. DATA AND METHODS: The data derive from the financial database of the National Health Insurance Fund Administration (NHIFA) covering the 6-year period between 2000-2006. The ratio of women in the age group of 45-65 years was calculated having either a screening mammography or a diagnostic mammography. The analysis was carried out for the years 2000-2001 before and 2002-2003, 2004-2005 after the implementation of nationwide organised programme. RESULTS: In the years 2000-2001 7.26% of the women aged 45-65 had an opportunistic screening mammography, while in 2002-2003 34% and in 2004-2005 29.5% of the target population had screening mammography within the organised programme. During the same periods 19.8% (2000-2001), 22.1% (2002-2003) and 23.2% (2004-2005) of women aged 45-65 had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.2% (2000-2001) to 53.5% (2002-2003) and 50.8% (2004-2005). CONCLUSIONS: Attendance of the Hungarian organised breast cancer screening programme slightly declined in 2004-2005, and to achieve the expected results in decline of mortality further improvement of attendance is necessary.

[The coverage of cervical screening in Hungary]. / A méhnyakszurés részvételi mutatói Magyarországon.

UNLABELLED: The purpose of this study is to calculate the proportion of women having cytological examination (Pap smear) of cervix either within or outside of the Hungarian organized cervical cancer screening programme. METHODS: The data derive from the financial database of the National Health Insurance Fund Administration (OEP) of Hungary covering the period of 2000-2005. The period 2000-2002 was considered as a reference period of opportunistic screening, while 2003-2005 was the first screening circle of organized screening. RESULTS: Between 2000-2002 1 667 618 women underwent cytological examination of Pap smear, and it increased to 1 749 498 women between 2003-2005. In the age-group 25-64 years, the annual coverage varied between 22.0-23.3% in 2000-2002, and it increased to 23.4-24.3% between 2003-2005. In the target population the 3-years-coverage increased from 48.9% in 2000-2002 to 52.6% in 2003-2005 (+3.7%). CONCLUSIONS: The organized screening programme managed to increase moderately the coverage of target population. In order to realize the mortality decline due to cervical cancer, participation rate must be increased.

[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.