Gynaecological oncology in Poland.

The control of gynaecological cancers in Poland has developed from three factors: 1) the organization of the Committee for Cancer Research and Control in 1906, which considered these activities as extremely important; 2) the personal commitment of Maria Sklodowska-Curie, and 3) the opportunity to train Polish physicians at the Foundation Curie in Paris after 1921, enhanced by the support of Head of the Fondation Professor Claude Regaud in introducing the "Paris Method" as a therapy against cervical cancer, to be provided for patients at the Radium Institute in Warsaw. The separation of gynaecological oncology as an independent branch of oncology occurred in Poland in 1951 when the Gynaecological Oncology Departments were opened first at the Institute of Oncology and later in other oncological clinics. The establishment of the Polish Gynaecological Society in 1992 was the next milestone.

History of 400 years of struggle against cancer in Poland.

The over 400-year history of struggle against cancer in Poland is presented in this work, from its beginning, marked by the establishment of the first hospital for cancer patients in Warsaw in 1592, up to the achievement of the main aim of the National Cancer Programme, i.e., the recent construction of a large modern cancer centre in Warsaw. In the meantime, a number of significant events have taken place in Poland for example, studies on cancer conducted in the 17th-19th centuries, a report on cancer mortality data which was published in 1888, and the Warsaw Committee on Cancer Research and Control, established in 1906. As regards the 20th century, the National Cancer Research and Control programmes were carried out (in 1924, 1952 and 1975), among other activities. An oncological network was built up in Poland based on 11 comprehensive cancer control centres and provincial outpatient clinics. At present, out of each 100,000 new cancer cases more than 70,000 die every year in Poland. The leading localizations in males are: lung (30.5%), stomach (9.8%), larynx (5.5%), prostate (5.1%) and urinary bladder (5.0%); in females: breast (17.5%), cervix uteri (9.8%), lung (6.6%), stomach (6.2%) and ovary (6.2%). Cancer patients' estimated probability of surviving 5 years is 26.4% (males) and 39.8% (females).

Epidemiology of cancer in Poland.

Poland is a Central European country with the population of over 38 million. Its system of cancer control is organized in a three-level oncological network. The number of cancer cases diagnosed each year is about 100,000 and over 70,000 die of cancer every year. Every 4th inhabitant of Poland will contract cancer, every 5th dies from it. Poland is a country of medium cancer incidence rate (men: 252.2 per 100,000 population, women: 208.0 per 100,000). The yearly incidence growth is 1.99% in men and 0.64 in women. The leading cancer sites in Polish men are: lung, stomach, larynx, prostate, urinary bladder, and large bowel; in women: breast, uterine cervix, stomach, lung, and large bowel. Mean 5-year survival is 26.4%.

Epidemiological evaluation of the efficiency of treatment of pre-invasive cervical cancer in Warsaw, 1969-1988.

An analysis of 2,281 cases of pre-invasive cervical cancer registered in Warsaw Cancer Registry during the years 1969-1988, showed that the rate of cervical cancers detected at the pre-invasive stage declined from 46.8% in 1970, to 26.8% in 1988. New cases of this cancer were diagnosed mainly in the age group up to 49 years of age (86.1%). Conservative treatment was applied relatively rarely (in 43.0% of cases) while the uterus with adnexes were removed fairly frequently (26.0%). The results of treatment were good (100.0% of 5-year survivals.). The 5-year survivals seem not to differ in relation to any particular treatment method used.

Screening for cervical cancer in Poland.

Despite the growing number of PAP tests performed in Poland every year, (approximately 3 million per year in 1992) the mortality rates of cervical cancer are stable or increasing. With the intention of changing this unfavourable situation, a team of specialists in 1988 has developed a model for cervical cancer screening in Poland. Six experimental centres were chosen for the implementation of this model. The principles of the screening system were as follows: 1) population-based; 2) individual invitations; 3) computer assisted; 4) reproducible; 5) cytotechnicians' participation; 6) target population 30-60 years; 7) frequency of PAP tests: every 3 years. Preliminary data from the population of 25,841 which was covered by the screening campaign in Warsaw showed a 70.1% attendance rate and detectability of 3 cases per 1,000 screened women.

Evaluation of selected prognostic factors in ovarian cancer.

Among the group of 367 women with ovarian cancer, 11 prognostic factors were examined. Eight of the factors had an important prognostic value regarding the longterm (5 and 10 years) survivals of ovarian cancer patients. There were the following significant prognostic factors: histological type, the degree of differentiation of the tumour, clinical stage, ascites, overgrowth of the capsule, or infiltration of the ovary surface, irregular shape of the tumour, cancer in both ovaries, and solid type of the tumour. The best prognosis was obtained for patients with mucous type of cancer (53.3%-5 and 26.7%-10 years survival). The poorest prognosis was obtained for the group of patients with undifferentiated cancers, respectively, 11.8 and 3.6%.

Epidemiology of breast and gynaecological cancers in Poland.

The epidemiological data on breast cancer and cancer of the female reproductive organs are presented in the light of data provided by the National Cancer Registry and the Warsaw Cancer Registry. Estimates say that cancer of the breast and the reproductive organs attacked 19,764 women in Poland, 1989, of whom 9,436 died. This number represents 41.2% of the total cancer incidence in women. The standardized incidence rates calculated for these cancers per 100,000 and arranged according to localization, were as follows: breast 34.4; cervix 19.5; ovary 12.4; corpus uteri 10.6. Mortality: breast 15.5; cervix 8.0; ovary 6.8; corpus uteri 2.5. Comparing with the average rates in EC countries, the risk in Poland of breast cancer was lower but was higher in cervical and uterine cancers. The risk of ovarian cancer was similar in Poland and the E.C. The relative 5-year survivals estimated for the years 1978-1982 in Poland were as follows: breast 49.3%; cervix 50.7%; and corpus uteri 66.1%, which was lower than in Switzerland, Finland, Australia, and USA (Caucasians); and similar in patients with ovarian cancer (35.1%). Particularly unfavourable 5-year survival rates were given for cancer of the breast and cervix in the rural areas. Unfavourable trends are observed in the control of the breast and cervical cancer in Poland which confirms inadequacy of the existing preventive programmes based on screening. According to estimates, the introduction of preventive measures could reduce cervical cancer mortality by 60% during 10 years and breast cancer mortality by 40% within 7 years, which means saving about 3,000 lives yearly.

Changes in the incidence and survivals of ovarian cancer in Poland.

The incidence and mortality trends, as well as survivals, are presented according to the Warsaw Cancer Registry data concerning 4,112 ovarian cancer cases registered in the years 1963-1988, in two populations, the urban of Warsaw City and the rural of the Warsaw Rural Areas (WRA). The standardized incidence rate in Warsaw in 1988 was 13.44/100,000 and it has not changed significantly in relation to the 1963 figure, but statistical significance characterized the increase of incidence in WRA population and the general population of Poland. The standardized incidence rates were as follows: WRA 1963 6.8, 1988 11.7; in Poland as a whole respectively, 6.5 in 1960 and 11.7 in 1988. The most rapid increase of incidence occurred in the 1960s, then the trend stabilized, and another increase began in 1984. The incidence growth was accompanied by similar trends in mortality. The mortality rates in 1988 were: 8.3 in Warsaw; 6.9 in Poland, and 6.9 in WRA. The mortality increase was statistically significant in WRA and in the total population of Poland. The analysis of mortality and incidence trends in Warsaw City and in Poland as a whole justifies the identification of Warsaw as a high-risk population, while Poland appears to be a population of rapidly growing ovarian cancer risk. Despite a statistically insignificant growth of ovarian cancer incidence and mortality in Warsaw, the risk keeps increasing as can be seen in the permanent increase of incidence and mortality rates which began in 1973, in increasingly age-specific incidence and mortality rates in almost all age groups, and in a shift of top incidence and mortality rates towards younger age groups. The risk of this cancer is higher in Warsaw City than in rural areas, but the urban/rural ratio was declining from 2.5 to 1.3 during the study period. The relative 5 years survival rates in Warsaw are similar to those observed world wide, and they are 37.3% against 38.5% in WRA. Compared with the previous period between the years 1963 and 1968, there has been an improvement in the 5-year survival rates in both populations and in all age groups, except the oldest, resident in Warsaw.

Striking differences in the epidemiological picture of breast cancer in urban and rural areas in Poland.

Poland is a European country of medium female breast cancer risk but a steady, mean incidence growth of 3.5% per year makes this cancer the most frequent malignancy and a leading cause of cancer-related deaths among the women of the 1980s. Our analysis is based on data collected by the Warsaw Cancer Registry in the years 1963-1987. The crude incidence rate in Poland doubled against 1963 and was nearly 40/100,000 in 1988. In 1988 eight thousand women developed breast cancer. In Poland, the incidence of 37.7 was higher in Warsaw than the rate of 16.6 obtained for Warsaw Rural Areas (WRA) in 1963. The trend continued until 1988 to reach 59.7 and 33.5 in the respective areas. Incidence rapidly grew with age, starting in the group of 30 to reach its peak of 149.2 at 65 and over in Warsaw and 86.6 in WRA. Mortality rates in Warsaw grew from 16.6 in 1963 to 30.7 in 1988 and, from 10.8 to 17.4 in WRA in the respective years. The urban/rural ratio declined from 1.7 to 1.5 during this period. The unfavourable proportion (patient distribution according to clinical staging in Warsaw was: 0 + I-17.2%; II-34.1%; III-29.1%; IV-23.6%. The relative 5-year survivals in Warsaw were 58.7% and they improved little compared to the former periods. These figures were even lower in WRA and they showed a downward trend for women aged over 65. A steady increase in breast cancer risk observed after 1963 and the large proportion of advanced breast cancers diagnosed, were followed by poor results of treatment causing about 5,000 breast cancer deaths in Poland annually.

[Evaluation of thyroid cancer morbidity in Warsaw in 1987-1997]. / Ocena zachorowalnosci na nowotwory zlosliwe tarczycy w Warszawie w latach 1987-1997.

The crude and standardized thyroid cancer incidence rates calculated for the period 1987-1997 in Poland increased from 0.5 to 0.9 and 0.5 to 0.8 per 100,000 men, and from 1.8 to 3.6 and 1.4 to 2.8 per 100,000 women. The incidence of the cancer in women in Warsaw doubled during the same period. The upward trend only slightly showed up in the male population of Warsaw. Mortality rates caused by the thyroid cancer in both sexes in Warsaw population declined over the years 1963-1997. The 5-year relative survival rates, calculated for the period 1985-1989, were lower in men than in women (respectively 66 and 49%). This fact can be partly explained by more frequent occurrence of anaplastic tumours in men than in women (respectively 14.2 and 7.8%).