[doktorska disertacija]
Dominika Novak-Mlakar (Author), Mateja Krajc (Mentor)

Abstract

Uvod. Namen dela je bil ovrednotiti rezultate drugega organizacijskega kroga slovenskega državnega presejalnega programa za raka debelega črevesa in danke z oceno vpliva dejavnikov na rezultat presejalnega imunokemičnega testa na prikrito krvavitev v blatu in analizo intervalnih rakov. Opazovanci in metode. V analizo je bila vključena populacija prebivalcev Slovenije v starosti od 50 do 69 let, ki je bila vabljena v presejanje od aprila 2011 do decembra 2012. V analizo vplivov na rezultat presejalnega testa na prikrito krvavitev v blatu in posledično na najdbe pri kolonoskopiji so bile vključene značilnosti opazovancev in vzorcev blata. Spol, starost opazovancev, leta šolanja, lokacijo in stadij raka ter histološko vrsto sem primerjala med osebami z intervalnim rakom, osebami z rakom, odkritim v presejanju, in neodzivniki z rakom. Za izračun občutljivosti presejalnega testa sem uporabila metodo sorazmerne incidenčne stopnje. Rezultati. Pozitiven izid presejalnega testa na prikrito krvavitev v blatu je bil pogostejši pri moških, pri starejših od 54 let, pri osebah, ki so se šolale manj kot 10 let, so bile presejane prvič in so bivale v vzhodnem delu Slovenije. Starost vzorcev blata in temperatura zunanjega zraka do 25 °C nista vplivala na izid presejalnega testa. Pri temperaturi zunanjega zraka nad 25 °C je bil nižji delež pozitivnih rezultatov presejalnega testa. Med 502.488 povabljenimi v presejanje je bilo odkritih 493 rakov po pozitivnem izidu presejalnega testa, 79 intervalnih rakov po negativnem presejalnem testu in 395 rakov med neodzivniki. Delež intervalnih rakov med raki, odkritimi v presejalnem programu, je bil 13,8 %. Pri vseh treh skupinah opazovanih oseb je bil rak pogosteje odkrit pri moških in pri osebah, starejših od 54 let. Med intervalnimi raki je bilo več odkritih rakov v desnem delu črevesa in v stadiju IV glede na rake, odkrite v presejanju. V presejanju je bilo več rakov v stadiju I in v levem delu črevesa. V primerjavi z raki, odkritimi med neodzivniki, je bilo intervalnih rakov in rakov, odkritih v presejanju, več med osebami, ki so se šolale 10 let ali več. Raki, odkriti med neodzivniki, so bili pogostejši med osebami z nižjo izobrazbo in odkriti v stadiju IV. Med skupinami oseb z rakom so bile razlike v histološki vrsti odkritega raka. Občutljivost presejalnega testa na prikrito krvavitev v blatu je bila 88,45 %. Zaključki. Na izid presejalnega imunokemičnega testa na prikrito krvavitev v blatu v Sloveniji vplivajo podobni dejavniki kot v primerljivih tujih presejalnih programih. Poleg višje starosti in moškega spola na pogostejši pozitiven rezultat testa vpliva tudi nižja izobrazba, bivanje v vzhodnem delu Slovenije in če je oseba presejana prvič. Temperatura zunanjega zraka nad 25 °C znižuje delež pozitivnih rezultatov presejalnega testa. V nižjem stadiju odkriti raki v presejanju dokazujejo pomen organiziranega presejanja. Intervalni raki po negativnem presejalnem testu se v slovenskem presejalnem programu pojavljajo v pričakovanih deležih, ugotovljenih v podobnih programih v tujini. S kompletom dveh testerjev je dosežena občutljivost testa, ki je med višjimi izračunanimi v primerljivih programih.

Keywords

presejalni program za raka debelega črevesa in danke;imunokemični test na prikrito krvavitev v blatu;intervalni rak;rak, odkrit v presejanju;rak med neodzivniki;občutljivost testa;Slovenia;Slovenija;

Data

Language: Slovenian
Year of publishing:
Typology: 2.08 - Doctoral Dissertation
Organization: UL MF - Faculty of Medicine
Publisher: D. Novak Mlakar
UDC: 614
COBISS: 4479461 Link will open in a new window
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Other data

Secondary language: English
Secondary title: Factors influencing immunochemical faecal occult blood test results and the interval cancer cases in slovenian colorectal cancer screening program
Secondary abstract: Background. The purpose of the work was to evaluate the results of the second organizational round of the Slovenian national colorectal cancer screening programme, to assess the effects on the faecal immunochemical occult blood test results and the interval cancer analysis. Patients and methods. The analysis included the population of Slovenian residents between 50 to 69 years of age, who were invited for screening between April 2011 and December 2012. The characteristics of the observed population and of stool samples were included in the analysis in order to analyse the effect on the screening test results and consequently the colonoscopy findings. Gender, age, years of schooling, the cancer site and cancer stage and the histological type were compared among interval cancers, screening cancers and cancers among non-responders. The proportional incidence method was used to calculate the screening test sensitivity. Results. Higher shares of positive outcome of the faecal immunochemical occult blood test were more frequently shown among the observed males, aged over 54 years, with less than 10 years of schooling, participating for the first time in the screening programme and residing in the eastern part of Slovenia. The age of stool samples and ambient air temperature up to 25 °C were not significant for the outcome of the screening test. However, the ambient air temperature above 25 °C had the effect of lowering the proportion of positive results of the screening test. Amongst 502,488 people invited for screening, there were 493 cancers detected after the positive screening test, 79 interval cancers after the negative screening test and 395 cancers in non-responders. The proportion of interval cancers equalled 13.8%. Among all three observed cancer groups, cancers were more frequent in men and in persons aged 54+ years. Interval cancers were more frequent in the right hemicolon and in stage IV when compared to screen detected cancers. Screen detected cancers were more frequent in stage I and in the left hemicolon. Interval and screen detected cancers were more frequently detected in persons with 10 or more years of schooling when compared to cancers detected among non-responders. Cancers detected in non-responders were more frequent among people with lower education and in stage IV. There were differences between cancers detected groups according to the histological type of cancers diagnosed. Test sensitivity of the faecal immunochemical test was 88.45 %. Conclusions. The outcomes of faecal immunochemical occult blood tests in Slovenian colorectal cancer screening are influenced by similar factors as in comparable foreign screening programmes. Besides higher age and male gender more positive results of the test were seen in persons with lower education, residing in the east of Slovenia, first screening episode. Ambient air temperature above 25 °C lowers the proportion of positive screening test results. More screen detected cancers in lower cancer stages prove the importance of organized cancer screening. Interval cancers after the negative faecal immunochemical occult blood test in Slovenian screening programme are detected in the expected proportions as in similar programmes. Test sensitivity is among the highest when compared to similar programmes and is accomplished by using two stool samples test kit.
Secondary keywords: Immunochemistry;Colorectal neoplasms;Diagnosis;Epidemiology;Early detection of cancer;Methods;Mass screening;Feces;Middle aged;Occult blood;Imunokemija;Kolorektalne novotvorbe;Diagnostika;Epidemiologija;Zgodnje odkrivanje raka;Metode;Masovni presejalni test;Blato;Odrasli srednjih let;Prikrita krvavitev;
Type (COBISS): Dissertation
Study programme: 0
Embargo end date (OpenAIRE): 1970-01-01
Thesis comment: Univ. v Ljubljani, Medicinska fak.
Pages: XII, 55 str.
ID: 11121716