EPIDEMIOLOGY OF BREAST CANCER IN UKRAINE WITH CONSIDERATION OF THE FACTORS OF THE CHORNOBYL ACCIDENT. / EPIDEMIOLOGIIa RAKU MOLOChNOÏ ZALOZY V UKRAÏNI Z URAKhUVANNIaM FAKTORIV RYZYKU ChORNOBYL'S'KOÏ AVARIÏ.

OBJECTIVE: Assessment of the possible impact of the Chornobyl accident on the incidence of breast cancer in the female population of Ukraine as a whole and in some affected groups. OBJECT OF THE STUDY: The female population of Ukraine as a whole and in separate groups of victims - women par- ticipating in the clean-up works in 1986-1987, evacuaees from the exclusion zone and inhabitants of the territo- ries most contaminated with radionuclides. METHODS: Statistical, mathematical, cartographic. RESULTS: This study, covering a significant period of time (1976-2016), revealed a steady temporal and territorial agglomeration of regions with a higher incidence of breast cancer in the southern and south-eastern regions of Ukraine. Lower - in the western and northern regions. There is a steady increase in the incidence rate, but in recent years this growth has slowed down. The epidemiological situation regarding the incidence of breast cancer in the female population of Ukraine during the 30 years after the Chornobyl accident is generally stable. At the same time, a marked increase in the frequency of this pathology in the groups of the affected population, especially in women, participated in clean-up works in 1986-1987. CONCLUSIONS: A stable agglomeration of regions with high levels of incidence in the south and south-east, and low in the west and north of the country is determined. The dynamics of breast cancer in Ukraine as a whole is characterized by steady growth, although in recent years its pace has slightly decreased. Among the individual population groups affected by the Chornobyl catastrophe (female liquidators, evacuated women from the exclusion zone, residents of the most contaminated with radionuclides territories) only among female liquidators of 1986-1987 the significant in- crease was observed in the incidence of breast cancer, which exceeds the national indicators at 1.3-1.6 times.

Quarter of century since the Chornobyl accident: сancer risks in affected groups of population. / Chvert'' stolittja pislja Chornobyl''s''koi' avarii': ryzyk raku v grupah postrazhdalogo naselennja.

Objective. The goal of this study was to define levels and dynamic trends of cancer incidence at whole and some separate sites in groups of Ukrainian population affected by the Chornobyl accident during a long period of observation. Materials and methods. Those groups were Chornobyl accident recovery operation workers (CRW) of 1986-1987 years of participation, evacuees from Prypyat town and 30-km zone and residents of the most contaminated territories of Ukraine. Analysis was carried out with the standard methods of descriptive epidemiology: calculation of crude, age-specific and age-adjusted incidence rates with standard errors and confidence intervals. Results, discussion and conclusions. This study showed that all cancer incidences exceeded the national level only in CRW group. Decrease of cancer incidence rate in the recent years might be caused by shortened average life expectancy in Ukrainian population, especially in males. Statistically significant increase of leukemia incidence in CRW group was registered as well. Besides, in all three main affected groups there was revealed significant excess of thyroid cancer. Irradiation of thyroid due to radioactive iodine fallouts might be a main cause of this phenomenon. Increase of thyroid cancer incidence was registered not only in children, but also in adolescents and adults. Appearance of excess thyroid cancer cases as an effect of radiation exposure tends to increase during the time. Significant excess was also revealed for breast cancer in female CRW group. Because latency period for different nosological forms of radiation-induced malignant tumors varies widely, profound attention in further studies should be drawn not only to thyroid, breast cancers and leukemia, but also to malignancies with longer latent period: lung, stomach, colon, ovary, urinary bladder, kidney cancer and multiple myeloma.

Treatment of large osteosarcoma in children: new approach.

AIM: To improve the treatment results of patients with locally advanced osteosarcoma with large volume using neoadjuvant chemotherapy (NACT) (ifosfamide at a dose of 18 g/ml) and planning of organ-conserving surgery by evaluating the state of tumor pseudocapsule. PATIENTS AND METHODS: A study group included 46 children aged from 7 to 18 years, mean age - 12 years. In 68% of the patients tumor volume was larger or significantly larger than 200 ml (from 27 to 2400 ml), mean tumor volume was 342 ml. All patients have been examined by X-ray radiography, CT, Doppler ultrasound. Convenient chemotherapy consisted of methotrexate at a dose of 12 g/ml, cisplatin (120 mg/ml) in combination with doxorubicin (75 mg/ml). If such chemotherapy was considered ineffective with the use of an algorithm for determination of chemotherapy efficacy, 2 cycles of chemotherapy with ifosfamide at a dose of 18 g/ml per course have been applied. At the stage of planning of organ-conserving surgery, the state of tumor pseudocapsule was analyzed. In 6 months post-operative chemotherapy was carried out with the use of methotrexate, cisplatin with doxorubicin, ifosfamide at the same doses. RESULTS: Myelotoxicity of ifosfamide treatment at a dose of 18 g/ml is comparable to that of to a course of doxorubicin + cisplatin: the depth of leucopenia was significantly higher (p < 0.05), the duration of agranulocytosis is similar after such therapies. In the study group, 69.6% patients have reached grade 3-4 pathomorphosis. Organ-conserving surgery was performed in 86.9% of the patients. Local tumor recurrence was registered in 15.2% patients of the study group. 5-year relapse-free survival was achieved in 62 ± 10% (p = 0.02), the overall 5-year survival - 76.5 ± 9% (p = 0.02). CONCLUSIONS: Introduction of ifosfamide at a dose of 18 g/ml in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-operative chemotherapy, pre-operative analysis of NACT efficacy and the state of tumor pseudocapsule during planning stage of organ-conserving surgery significantly improves efficacy of the therapy in patients with large tumor volume.

Age and gender patterns of thyroid cancer incidence in Ukraine depending on thyroid radiation doses from radioactive iodine exposure after the Chornobyl NPP accident.

UNLABELLED: The objective of this study was to investigate the thyroid cancer incidence in a whole territory of Ukraine and to clear up its age and gender patterns depending on average regional (oblast) thyroid doses from radioactive iodine due to the Chornobyl accident. MATERIALS AND METHODS. On the basis of average accumulated thyroid doses from radioactive iodine the geographical regions of Ukraine with low and high average thyroid doses were identified for a comparative analysis performance. Methods of descriptive epidemiology were used. RESULTS: The level and dynamics of thyroid cancer incidence were analyzed in different gender and age groups (both for attained age and age at the moment of the Chornobyl accident). Results of this study confirmed the radiation excess of thyroid cancer in individuals who were children and adolescents in 1986. Some excess was observed in elder age groups too. Especial situation was observed in female age group 40-49 at the moment of the Chornobyl accident i.e. the age-specific thyroid cancer incidence rates were significantly higher in "high exposure" regions comparing with "low exposure" ones during all years of observation within 1989-2009. CONCLUSIONS: A probable radiation excess of thyroid cancer was suggested not only in children and adolescents but also in adult age groups. In elder age groups this excess was less expressed and manifested after a longer period of time. The origin of the phenomenon in female age group of 40-49 is unclear now. Hypothesis of combined effect of radiation and natural changing of hormonal status in this age should be checked in the future studies.

Cancer incidence and nuclear facilities in Ukraine: a community-based study.

UNLABELLED: The study goal was to investigate malignant tumors incidence in 5 Ukrainian cities with nuclear hazardous enterprises: extractive, processing enterprises of uranium ore (Zhovti Wody and Dniprodzerzhynsk of Dnipropetrovsk region) and nuclear power stations (Energodar of Zaporizhska region, Pivdennoukrainsk of Mykolayivska region, Netishyn of Khmelnytska region). MATERIALS AND METHODS: average annual population of the cities under study in 2003-2008 was 439 600 persons. Total and specific cancer incidence was investigated. Site specific incidence was analyzed for malignancies proved to be radiosensitive in previous studies: trachea, bronchus and lung, breast, kidney, thyroid cancer and leukemia. Data on cancer cases were received in National Cancer Registry of Ukraine (National Cancer Institute). There was used the data of the State Statistics Committee of Ukraine on the size of the studied population by gender - age groups. Standardized incidence ratio of cancer at a whole and for each of five specific forms of malignancies were calculated for the population of each city and group of cities depending on the nature of industrial activity. RESULTS: During the observed period there were registered 9 381 cancer cases in inhabitants of Ukrainian cities with radiation hazardous facilities. There was stated that cancer incidence rate in population of 5 cities significantly exceeded national and regional levels. Among specific forms of malignancy there were observed excess of lung, trachea, bronchus, breast, kidney cancer and leukemia in population of extractive, processing uranium ore cities. No excess of thyroid cancer was identified. In cities with nuclear power station there were registered excess of kidney cancer. CONCLUSION: Results of the study suggest the necessity to explore the role of various factors in forming the identified cancer incidence features in the Ukrainian population living near the nuclear power facilities.

[Cancer morbidity risks among workers of asbestos-cement productions].

The retrospective assessment of morbidity rates and cancer pathology risks in workers of asbestosis-cement enterprises of Ukraine has been made. It was established that annual cancer morbidity among workers makes 88,1 per 100 000 of workers (RR = 0.26, CI 95 % 0.06-1.01). The most often cancer pathology was located in digestive organs (48.1%), respiratory organs (18.5%) (lung cancer--11.1%). The mesothelioma of pleura, peritoneum and pericardium were not found. The risks (odds ratio--OR) of cancer morbidity were increased for such organs as: respiratory organs (OR = 2.37), skin (OR = 1.78), digestive organs (OR = 1.34).

[Primary multiple malignant neoplasms in patients with skin melanoma].

The problem of primary multiple malignant tumor (PMMT) of skin melanoma in Ukraine is analyzed. During the period from 2000 to 2006, 16760 cases of skin melanoma have been diagnosed, and in 873 patients from them PMMT has been registered. So, the part of the patients with multiple tumors among all patients with skin melanoma was 5.2%. Most often PMMT appears in the case of skin melanoma of head and neck (6.6 +/- 0.4%). Most commonly skin melanoma is accompanied by other skin malignant neoplasms (40.9 +/- 1.6% of all PMMT cases). Upon malignant skin melanoma, PMMT occurs more often in males (5.7 +/- 0.7%) than in females (4.9 +/- 0.7%). Most often the diagnosis of skin melanoma at PMMT is detected synchronously (48.3 +/- 1.6%), and simultaneous detection of PMMT predominates in all polyneoplasms and in all age groups. The most favourable course of skin melanoma is characteristic for metachronous cancer of II type when melanoma is diagnosed after manifestation of other malignant tumor.

[Informative value of the specialized registers in research of leukemia in Chernobyl accident liquidators in Ukraine].

The article considers the possibility of the use of current infrastructure of specialized population registers of Ukraine to study leukemia and other systemic blood diseases revealed in Chernobyl accident liquidators. Advantage and limitation of such registers in the use are discussed in the article. Ukrainian state register of people who suffered from Chernobyl accident and Ukrainian national cancer registers are the largest population registers in the country, which cover all the territory of Ukraine and contain information on each individual and may serve as source base for epidemiological studies. To solve issues on leukemia and other oncological diseases is recommended to use in complex data of specialized registers of Ukraine. It should be also taken into account necessity of using late registered cases and verifying registered diagnoses.

[Primary multiple malignant tumors of the stomach and colon]. / Pervichno-mnozhestvennye zlokachestvennye opukholi zheludka i tolstoi kishki.

Experience of diagnosis and treatment of primarily-multiple gastric cancer, combined with malignant colonic tumors in 27 patients was summarized. One-stage combined radical treatment of the patients is the most effective one.