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Purpose We aimed to identify granular groups with an increased risk of suicide among adolescents and young adult (AYA) patients with a previous malignant neoplasm diagnosis. Methods We deployed a cohort of all cases of primary malignant neoplasms diagnosed between the 1st of January 2009 and the 31st of December 2019 among individuals aged 15–39 years registered in the Polish National Cancer Registry. To assess the risk of suicide in comparison with the general AYA population, we calculated sex–age–year standardized mortality ratios (SMR) with 95% confidence intervals (CI). Results A total of 50,298 cancer patients (22,111 men and 28,187 women) were included in this study. The risk of suicide for AYA after cancer diagnosis was 2.39-fold higher than that for AYA in the general population (SMR 2.39, 95% CI 1.69 to 3.28). The risk in women (SMR 4.18, 95% CI 1.68 to 8.62) was higher than that in men (SMR 2.18, 95% CI 1.48 to 3.09). A significantly higher risk of suicide was observed in men with testicular cancer (SMR 2.46, 95% CI 1.37 to 4.05). Conclusions Polish AYA diagnosed with cancer had an almost 2.5-fold higher risk of suicide than the general AYA population. The particular risk group was men with testicular cancer within 2–3 and 5–10 years after cancer diagnosis. Implications for Cancer Survivors To better identify patients at risk of suicide, there is a need to create or adapt screening tools, educate cancer care providers and family physicians, and integrate psychological services into select cancer care specialties.

Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.

Purpose The main aim of this study was to estimate breast cancer survival in Poland over the period from 2000 to 2019 in both sexes. Methods Data were obtained from the Polish National Cancer Registry. The presented metrics included age-standardized 5- and 10-year net survival (NS), median survival times, years of life lost (YLLs), and standardized mortality ratios (SMRs). Results Between 2000 and 2019, 315,278 patients (2353 men and 312,925 women; male-to-female ratio 1/100) were diagnosed with breast cancer in Poland. In this period, 721,987 YLLs were linked to breast cancer. Women presented a higher 5- and 10-year age-standardized NS than men (5-year NS: 77.33% for women and 65.47% for men, P P P Conclusion Over the last two decades, breast cancer survival in Poland has improved significantly. Nonetheless, special attention should be given to the disparities between sexes and the gap in overall improvement of survival rates compared with other European countries.

The aim of this study was to estimate the survival of Polish Burkitt lymphoma/leukemia (BL) patients diagnosed between 1999 and 2017, considering multiple covariates and periods, to reflect changes in BL treatment. We identified all BL patients registered in the Polish National Cancer Registry in 1999-2017. Observed survival (OS) was evaluated deploying the life table method. Univariate and multivariate Cox proportional hazards regression models were fit to generate hazard ratios (HR) and the corresponding 95% confidence intervals (95% CI), describing the association between exposures (sex, age at the diagnosis, year of diagnosis, and region of residence) and time-to-event (death). Two-sided log-rank test was applied to assess the significance of exposures. Overall, 937 BL cases were included in the study (654 men and 283 women). Between the periods 1999-2005 and 2015-2017, the 3-year OS changed from 56.0% (95% CI 50.4 to 62.2%) to 73.8% (68.1 to 80.0%; P 0.001), and the 5-year OS increased from 53.8% (48.2 to 60.0%) to 73.0% (67.1 to 79.3%; P 0.001). The death HR was significantly higher in adolescents and young adults' (AYA) and adults' groups than in pediatric patients (HR = 3.00, 95% CI 2.05 to 4.39, P 0.001, for AYA; and HR = 7.30, 5.14 to 10.3, P 0.001, for adults). During the last two decades, the survival of Polish BL patients has been systematically improving. The death hazard ratio is most significantly associated with the patients' age at diagnosis and year of diagnosis, and not associated with sex or region of residence.

Precancerous conditions for esophageal (EA) and gastric adenocarcinoma (GA) are Barrett's esophagus (BE) and atrophic gastritis (AG), respectively. The surveillance of which is crucial in the detection of early lesions.The study aimed to assess whether one-time esophagogastroduodenoscopy (EGD) in searching for precancerous conditions would be effective in a low-to-moderate esophageal and gastric cancer risk population.5984 individuals who underwent diagnostic EGD in 3 endoscopic centers from 03.2018 to 10.2019 were analyzed to assess the age of patients with precancerous conditions and cancers. Age distribution of patients with malignant gastric and esophageal tumors registered in the national cancer registry (KRN) from 2014 to 2017 was analyzed.The risk of diagnosis of EA and GA raised in comparison with individuals at age40 at age 60-64 (OR 12.1; 95%CI 1.5-98.6), gastric and esophageal dysplasia at age 55-59 (OR 3.6; 95%CI 1.3-9.7), and BE and AG at age 40-44 (OR 1.6; 95%CI 1.04-2.4). The number of procedures per one cancer that could be potentially avoided was 236, 235, 290, 360, 394, and 344 for age groups 40-44, 45-49, 50-54, 55-59, 60-64, and 65-69 respectively. The assessed ratio of potential benefits and harms was 47, 38, 31, 28, and 32 for age groups 40-49, 50-54, 55-59, 60-64, and 65-69 respectively.The one-time EGD in searching for precancerous conditions could be potentially applicable in individuals between 40 and 69 years of age.

Background A significant proportion of upper gastrointestinal cancers (UGICs) remain undetected during esophagogastroduodenoscopy (EGD). We investigated the characteristics and risk factors of UGICs missed during endoscopy. Methods In this nationwide registry-based study, we analyzed two large Polish datasets (National Health Fund and National Cancer Registry) to identify individuals who underwent EGD and were subsequently diagnosed with UGIC. Cancers diagnosed Results We included 4 105 399 patients (mean age 56.0 years [SD 17.4]; 57.5 % female) who underwent 5 877 674 EGDs in 2012–2018. Within this cohort, 33 241 UGICs were diagnosed, of which 1993 (6.0 %) were missed. Within esophageal neoplasms, adenocarcinomas were more frequently missed than squamous cell cancers (6.1 % vs. 4.2 %), with a relative risk of 1.4 (95 % confidence interval [CI] 1.1–1.8, P = 0.01). Most gastric cancers were adenocarcinomas, of which 5.7 % were classified as missed. Overall, a higher proportion of missed UGICs than prevalent cancers presented at an advanced stage (42.2 % vs. 36.2 %, P Conclusions Among UGICs, esophageal adenocarcinomas were missed most frequently. Missed cancers occur more frequently within the primary care sector and are found more often in women and individuals with multiple comorbidities.

BACKGROUND Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0-14 years) and adults (aged 15-99 years) diagnosed with a haematological malignancy during 2000-14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0-24 years). METHODS We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0-14 years), adolescents (15-19 years), and young adults (20-24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. FINDINGS 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010-14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010-14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000-14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. INTERPRETATION This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group. FUNDING Children with Cancer UK, the Institut National du Cancer, La Ligue Contre le Cancer, Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, Rossy Family Foundation, US National Cancer Institute, and the American Cancer Society.

BACKGROUND. Pediatric palliative care applies to the conditions specified in the Regulation of the Minister of Health. The previous studies have proved that the conditions’ catalogue is incomplete and inadequate. AIM OF STUDY. The aim of the study was to verify completeness and adequacy of the Minister of Health’s catalogue and to develop a new catalogue based on available epidemiological data concerning the Polish population. MATERIALS AND METHODS. The data of the Statistics Poland on underlying causes of death of children (0-17 years old) and young adults (18-29 years old) who died in 1999-2018 were analyzed. Besides, the study includes data collected by the Warsaw Hospice for Children Foundation on diagnoses of 739 patients treated in 1994-2019, including 519 deceased. The catalogue developed on that basis was compared with the Minister of Health’s catalogue. RESULTS. The new catalogue of conditions that may require pediatric palliative care in Poland and the additional criteria of patient recruitment were developed. The incompleteness and inadequacy of the Minister of Health’s catalogue were demonstrated. CONCLUSIONS. The Regulation of the Minister of Health necessitates an amendment regarding the list of medical conditions entitling children to guaranteed palliative care and hospice services. The Minister of Health should introduce standards and medical procedures for pediatric palliative care. Patients should be recruited on the basis of recognized standards by physicians and not officials of the National Health Fund using incomplete and inadequate Minister of Health’s catalogue of medical conditions.

Current guidelines recommend a 10-year interval between screening colonoscopies, but evidence is limited.To assess the long-term risk for colorectal cancer (CRC) and death from CRC after a high- and low-quality single negative screening colonoscopy.Observational study.Polish Colonoscopy Screening Program.Average-risk individuals aged 50 to 66 years who had a single negative colonoscopy (no neoplastic findings).Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) of CRC after high- and low-quality single negative screening colonoscopy. High-quality colonoscopy included a complete examination, with adequate bowel preparation, performed by endoscopists with an adenoma detection rate of 20% or greater.Among 165 887 individuals followed for up to 17.4 years, CRC incidence (0.28 [95% CI, 0.25 to 0.30]) and mortality (0.19 [CI, 0.16 to 0.21]) were 72% and 81% lower, respectively, than in the general population. High-quality examination resulted in 2-fold lower CRC incidence (SIR, 0.16 [CI, 0.13 to 0.20]) and mortality (SMR, 0.10 [CI, 0.06 to 0.14]) than low-quality examination (SIR, 0.32 [CI, 0.29 to 0.35]; SMR, 0.22 [CI, 0.18 to 0.25]). In multivariable analysis, the hazard ratios for CRC incidence after high-quality versus low-quality colonoscopy were 0.55 (CI, 0.35 to 0.86) for 0 to 5 years, 0.54 (CI, 0.38 to 0.77) for 5.1 to 10 years, and 0.46 (CI, 0.25 to 0.86) for 10 to 17.4 years. Only after high-quality colonoscopy did the SIR and SMR for 10.1 to 17.4 years of follow-up not differ compared with earlier observation periods.The general population was used as the comparison group.A single negative screening colonoscopy was associated with reduced CRC incidence and mortality for up to 17.4 years. Only high-quality colonoscopy yielded profound and stable reductions in CRC incidence and mortality throughout the entire follow-up.Polish Ministry of Health.

Background: The EUROCARE-5 study revealed disparities in childhood cancer survival among European countries, giving rise to important initiatives across Europe to reduce the gap. Extending its representativeness through increased coverage of eastern European countries, the EUROCARE-6 study aimed to update survival progress across countries and years of diagnosis and provide new analytical perspectives on estimates of long-term survival and the cured fraction of patients with childhood cancer. Methods: In this population-based study, we analysed 135 847 children (aged 0–14 years) diagnosed during 2000–13 and followed up to the end of 2014, recruited from 80 population-based cancer registries in 31 European countries. We calculated age-adjusted 5-year survival differences by country and over time using period analysis, for all cancers combined and for major cancer types. We applied a variant of standard mixture cure models for survival data to estimate the cure fraction of patients by childhood cancer and to estimate projected 15-year survival. Findings: 5-year survival for all childhood cancer combined in Europe in 2010–14 was 81% (95% CI 81–82), showing an increase of three percentage points compared with 2004–06. Significant progress over time was observed for almost all cancers. Survival remained stable for osteosarcomas, Ewing sarcoma, Burkitt lymphoma, non-Hodgkin lymphomas, and rhabdomyoscarcomas. For all cancers combined, inequalities still persisted among European countries (with age-adjusted 5-year survival ranging from 71% [95% CI 60–79] to 87% [77–93]). The 15-year survival projection for all patients with childhood cancer diagnosed in 2010–13 was 78%. We estimated the yearly long-term mortality rate due to causes other than the diagnosed cancer to be around 2 per 1000 patients for all childhood cancer combined, but to approach zero for retinoblastoma. The cure fraction for patients with childhood cancer increased over time from 74% (95% CI 73–75) in 1998–2001 to 80% (79–81) in 2010–13. In the latter cohort, the cure fraction rate ranged from 99% (95% CI 74–100) for retinoblastoma to 60% (58–63) for CNS tumours and reached 90% (95% CI 87–93) for lymphoid leukaemia and 70% (67–73) for acute myeloid leukaemia. Interpretation: Childhood cancer survival is increasing over time in Europe but there are still some differences among countries. Regular monitoring of childhood cancer survival and estimation of the cure fraction through population-based registry data are crucial for evaluating advances in paediatric cancer care. Funding: European Commission.

The proportion of colonoscopies with at least one adenoma (adenoma detection rate [ADR]) is inversely associated with colorectal cancer (CRC) risk and death. The aim of this study was to examine whether such associations exist for colonoscopy quality measures other than ADR.We used data from the Polish Colorectal Cancer Screening Program collected in 2000-2011. For all endoscopists who performed ≥100 colonoscopies we calculated detection rates of adenomas (ADR), polyps (PDR), and advanced adenomas (≥10 mm/villous component/high-grade dysplasia [AADR]); and number of adenomas per colonoscopy (APC) and per colonoscopy with ≥1 adenoma (APPC). We followed patients until CRC diagnosed before recommended surveillance, death, or December 31, 2019. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional-hazard models. We used Harrell's C statistic to compare the predictive power of the quality measures.Data on 173,287 patients (median age, 56 years; 37.8% male) and 262 endoscopists were used. During a median follow-up of 10 years and 1,490,683 person-years, we identified 395 CRCs. All quality measures were significantly associated with CRC risk and death. The relative reductions in CRC risk were as follows: for ADR ≥24.9% (reference12.1%; HR, 0.41; 95% CI, 0.25-0.66), PDR ≥42.7% (reference19.9%; HR, 0.35; 95% CI, 0.24-0.51), AADR ≥9.1% (reference4.1%; HR, 0.69; 95% CI, 0.49-0.96), APC ≥0.37 (reference0.15; HR, 0.35; 95% CI, 0.21-0.58), and APPC ≥1.54 (reference1.19; HR, 0.54; 95% CI, 0.35-0.83). AADR was the only quality measure with significantly lower predictive power than ADR (Harrell's C, 59.7 vs 63.4; P = .001). Similar relative reductions were observed for CRC death.This large observational study confirmed the inverse association between ADR and CRC risk and death. The PDR and APC quality measures appear to be comparable with ADR.

The purpose of this study was to estimate the high incidence cancers survival in Poland between 2000 and 2018, with the following aim to monitor the national polish cancer control program 2020-2030 effectiveness. We calculated survival in cancer of lung, breast, prostate, colon, rectum, ovarian, cervical cancers, and skin melanoma.Data were obtained from the Polish Cancer Registry (PLCR). We estimated age-standardized 5-year net survival (NS) with the life table method and the Pohar-Perme estimator using the International Cancer Survival Standard weights. The corresponding 95% confidence intervals (95% CI) were estimated with log transformation.Overall, 1,288,944 high incidence cancer cases were included in the study (622,486 men and 666,458 women). In 2015-2018 age-standardized 5-year NS was 85.2% (95% CI = 84.6% to 85.8%) in prostate cancer, 80.0% (79.5% to 80.4%) breast cancer, 77.3% (76.4% to 78.1%) melanoma, 58.5% (57.5% to 59.5%) cervical cancer, 57.9% (57.3% to 58.5%) colon cancer, 52.1% (51.3% to 52.9%) rectal cancer, 43.3% (42.4% to 44.3%) ovarian cancer, and 17.8% (17.4% to 18.1%) for lung cancer. Between the 2000-2004 and 2015-2018 the highest increase in survival was noted for prostate cancer (14.6% points [pp]; from 70.6% to 85.2%) and the lowest for lung cancer (4.5 pp; from 13.3% to 17.8%).Cancer survivorship has been consistently improving during the last two decades. Notwithstanding these overall encouraging results, more extraordinary efforts are needed to close the cancer survival gap in Poland.

Available epidemiological reports on follicular lymphoma (FL) often highlight a significant discrepancy between its high and low incidence rates in Western and Eastern Europe, respectively. The reasons behind that difference are not fully understood, but underreporting is typically presumed as one of the main factors. This study aimed to assess FL epidemiology in Poland based on 2000–2014 data from the Polish National Cancer Registry, which has 100% population coverage and over 90% completeness of the registration. All cases were coded according to ICD-10 and ICD-O-3 recommendations. The total number of registered FL cases was 3,928 with crude (CR) and standardized (SR) incidence rates of 0.72/105 and 0.87/105, respectively. The median age of FL diagnosis was 61 years, with the male to female incidence ratio of 1.06. The distribution of morphological types of FL: not otherwise specified (NOS), grades 1, 2, or 3 were 72.58, 4.81, 12.88, and 9.73%, respectively. Among all reported mature B-cell non-Hodgkin lymphomas, FL was ranked the fourth in incidence, just after chronic lymphocytic leukemia/small lymphocytic lymphoma (CR 3.62/105, SR 4.99/105), plasma cell neoplasms (CR 3.78/105, SR 4.97/105) and diffuse B-cell lymphoma, NOS (CR 2.13/105, SR 2.65/105). The systematic increase in FL incidence among females was observed. Our study confirms a lower FL incidence rate in Poland as compared to other European countries. Moreover, as our analysis was based on a registry with high data completeness, it provides evidence that reasons other than underreporting are responsible for FL incidence discrepancies between Eastern and Western Europe.

Paragangliomas of the head and neck are a group of neoplasms which occur very rarely. Most of them are benign tumours. Tinnitus, headaches and dysfunction of the cranial nerves are typical symptoms. Some paragangliomas have metastatic abilities and they can produce catecholamines. There are some typical imaging features in CT and MRI scans which help to determine the correct diagnosis without the necessity of performing a biopsy which can be associated with a haemorrhage risk. Therapeutic management consists of the choice between an active observation, surgical procedure, as well as radiotherapy and systemic therapy in the case of malignant paragangliomas.

Population screening programs should be efficient and cost-effective. Cervical cancer screening program was implemented in Poland in 2006 and so far it did not achieve the main goal of the screening, which is to reduce the mortality rate of cervical cancer in the entire female population. The main reason of this are: poor organization that causes low quality of the program at every stage of its activity, low participation of women in screening and lack of reliable program monitoring. The organization of screening program in Poland significantly deviates from the international recommendations what led to lack of cost-effectiveness of the program. It is time to make a bold decision and end the program until a modern strategy is developed that would account for the latest global recommendations including e.g. vaccinations against HPV virus and HPV test as a screening test.

Introduction. Survival rates are a tool that allows evaluation of healthcare quality and cancer treatment efficiency. The main aim of this article is to present tendencies in curability of Polish patients diagnosed between 1999–2010 and followed up until the end of 2015. Materials and methods. Survival analysis was performed using data from the Polish National Cancer Registry and Statistics Poland. The survival rates were calculated using Hakulinen method. Results. In Poland, five-year survival rates in men for all cancers increased from 32.9% (diagnosis 1999–2001) to 41.3% (diagnosis 2008–2010), whereas in women, from 50.9% to 56.1% respectively. The biggest improvement was found in therapy of prostate cancer (by 15.5 percentage points), hematological malignancies (7–13 p.p.), malignancies of bone and cartilage (10–14 p.p.), thyroid gland cancers (5–9 p.p.) and kidney cancer (7–9 p.p.). Discussion. Although survival rates are lower than in other European countries, survival of oncology patients in Poland has improved. Conclusions. 1. In Poland, survival of patients with majority of cancer types has improved. 2. The greatest increase in survival rates was observed for rare malignancies. 3. The improvement occurred during the time when the National Cancer Control Program was implemented.

Background & Aims The quality of endoscopists' colonoscopy performance is measured by adenoma detection rate (ADR). Although ADR is associated inversely with interval colorectal cancer and colorectal cancer death, the effects of an increasing ADR have not been shown. We investigated whether increasing ADRs from individual endoscopists is associated with reduced risks of interval colorectal cancer and subsequent death. Methods We performed a prospective cohort study of individuals who underwent a screening colonoscopy within the National Colorectal Cancer Screening Program in Poland, from January 1, 2004, through December 31, 2008. We collected data from 146,860 colonoscopies performed by 294 endoscopists, with each endoscopist having participated at least twice in annual editions of primary colonoscopy screening. We used annual feedback and quality benchmark indicators to improve colonoscopy performance. We used ADR quintiles in the whole data set to categorize the annual ADRs for each endoscopist. An increased ADR was defined as an increase by at least 1 quintile category, or the maintenance of the highest category in subsequent screening years. Multivariate frailty models were used to evaluate the effects of increased ADR on the risk of interval colorectal cancer and death. Results Throughout the enrollment period, 219 endoscopists (74.5%) increased their annual ADR category. During 895,916 person-years of follow-up evaluation through the National Cancer Registry, we identified 168 interval colorectal cancers and 44 interval cancer deaths. An increased ADR was associated with an adjusted hazard ratio for interval colorectal cancer of 0.63 (95% confidence interval [CI], 0.45–0.88; P = .006), and for cancer death of 0.50 (95% CI, 0.27–0.95; P = .035). Compared with no increase in ADR, reaching or maintaining the highest quintile ADR category (such as an ADR > 24.56%) decreased the adjusted hazard ratios for interval colorectal cancer to 0.27 (95% CI, 0.12–0.63; P = .003), and 0.18 (95% CI, 0.06–0.56; P = .003), respectively. Conclusions In a prospective study of individuals who underwent screening colonoscopy within a National Colorectal Cancer Screening Program, we associated increased ADR with a reduced risk of interval colorectal cancer and death.

Introduction The presence of gender differences is well known in a wide variety of areas, including employment, education, and income. In most European Union countries, size of the gender differences in tobacco smoking decreases with size of place of residence and education and increases with age until late adulthood. Measures aimed at narrowing the gender gap in socio-economic indicators are justified in the Partnership agreements on the European structural and investment funds which have been signed between the European Commission and member states. Methods This study analyses gender gap in tobacco-smoking behaviours according to the results of a two-wave study Awareness of Cancer and Prevention, which was carried out on a stratified random sample of n=2∙8,000 Poles aged 18+. Cramér’s V was used to assess the size of gender differences. The two-way analysis was followed by propensity score matching. Results According to the propensity score matching, being male currently affects tobacco smoking behaviours in terms of average treatment effect, even when controlling for socio-demographic characteristics, health status, and knowledge of lung cancer prevention. In Poland, in terms of Cramér’s V, the size of gender differences in tobacco non-use had not changed considerably between 2006 and 2014 (16.5 pp and 17.2 pp). The pattern of gender gap in tobacco non-use by size of place of residence and age had remained generally similar. However, a large increase in gender gap in tobacco non-use in the population with higher education was observed between 2006 and 2014 (2.5 pp and 11.8 pp). Men with higher education were the only gender-education group, which recorded a decrease in non-smoking. Conclusions Within the conceptualization by Rosenberg and Hovland (1960), high gender differences apply to the behavioural component of lung cancer prevention rather than affective and cognitive domains. Observed decrease in tobacco non-smoking in men with higher education demands additional actions.

Introduction Lung cancer is the most common cancer among males worldwide and one of the most common cancers among females. Poland is among European countries of the high risk of lung cancer for men. Although there are several factors influencing the risk of developing lung cancer, tobacco smoking is well established as the main risk factor. Thus, changes in lung cancer mortality may reflect changes in smoking habits in a given population. Methods The population data and its forecast up to 2030 come from the Central Statistical Office and the lung cancer mortality data from the Department of Epidemiology of Maria Skłodowska Institue – Oncology Centre. The frequencies of smoking habits were smoothed based on the survey done by Central Statistical Office in 1996, 2004, 2009, 2014. The present model was based on model-based smoothing of the smoking habit – specific risk ratios estimated for males and females in Europe. Results Among men, the scenario in which about 20% of smokers quit smoking every 5 years turned out to be too pessimistic. The real change in lung cancer mortality turned out to be deeper. In 2015, lung cancer mortality among men was more than 25% lower than it was from the forecast. Among women, a scenario in which only 10% quits smoking works. This is too little to reduce women's lung cancer mortality. Conclusions The results obtained clearly indicate that cutting down on the number of smokers translates directly into a considerable reduction of the lung cancer incidence rate. Lung cancer is a disease to be easily avoided. Smoking cessation is the best way to reduce risk of lung cancer among human population.

Chronic lymphocytic leukemia (CLL) is a cancer that is epidemiologically difficult to describe arising from the definition of the blood cancers adopted in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems. In Poland CLL cases accounted for 1.3% and 1% in men and 1 women respectively in 2013 (1.2% and 0.9% of deaths). The incidence for men was 3.3/100,000 and 1.7/100,000 in women (mortality rates being 1.8/100,000 and 0.7/100,000 respectively). In Poland, the median patient’s age is 69 years. Indicators of 5-year relative survival for patients diagnosed in 2006–2009 were 55.8% for men and 68.1% for women.

Background & Aims Recommendation of surveillance colonoscopy should be based on risk of colorectal cancer and death after adenoma removal. We aimed to develop a risk classification system based on colorectal cancer incidence and mortality following adenoma removal. Methods We performed a multicenter population-based cohort study of 236,089 individuals (median patient age, 56 years; 37.8% male) undergoing screening colonoscopies with adequate bowel cleansing and cecum intubation at 132 centers in the Polish National Colorectal Cancer Screening Program, from 2000 through 2011. Subjects were followed for a median 7.1 years and information was collected on colorectal cancer development and death. We used recursive partitioning and multivariable Cox models to identify associations between colorectal cancer risk and patient and adenoma characteristics (diameter, growth pattern, grade of dysplasia, and number of adenomas). We developed a risk classification system based on standardized incidence ratios, using data from the Polish population for comparison. The primary endpoints were colorectal cancer incidence and colorectal cancer death. Results We identified 130 colorectal cancers in individuals who had adenomas removed at screening (46.5 per 100,000 person-years) vs 309 in individuals without adenomas (22.2 per 100,000 person-years). Compared with individuals without adenomas, adenomas ≥20 mm in diameter and high-grade dysplasia were associated with increased risk of colorectal cancer (adjusted hazard ratios 9.25; 95% confidence interval [CI] 6.39–13.39, and 3.58; 95% CI 1.96–6.54, respectively). Compared with the general population, colorectal cancer risk was higher or comparable only for individuals with adenomas ≥20 mm in diameter (standardized incidence ratio [SIR] 2.07; 95% CI 1.40–2.93) or with high-grade dysplasia (SIR 0.79; 95% CI 0.39–1.41), whereas for individuals with other adenoma characteristics the risk was lower (SIR 0.35; 95% CI 0.28–0.44). We developed a high-risk classification based on adenoma size ≥20 mm or high-grade dysplasia (instead of the current high-risk classification cutoff of ≥3 adenomas or any adenoma with villous growth pattern, high-grade dysplasia, or ≥10 mm in diameter). Our classification system would reduce the number of individuals classified as high-risk and requiring intensive surveillance from 15,242 (36.5%) to 3980 (9.5%), without increasing risk of colorectal cancer in patients with adenomas (risk difference per 100,000 person-years, 5.6; 95% CI –10.7 to 22.0). Conclusions Using data from the Polish National Colorectal Cancer Screening Program, we developed a risk classification system that would reduce the number of individuals classified as high risk and require intensive surveillance more than 3-fold, without increasing risk of colorectal cancer in patients with adenomas. This system could optimize the use of surveillance colonoscopy.

Introduction The aim of this study is to assess the changes in lung cancer mortality in Poland, being one of the highest in Europe, in relation to changes in smoking prevalence by the level of education. Methods Data come from the Central Statistical Office. Data on education are collected during the census surveys and covers years 1994-2012. The standardized mortality rate ratio (SMRR) is used to assess relative risk with higher education level as a reference category. Results Lung cancer mortality trends in men show a significant decreasing tendency in all education categories. SMRR increases due to decline in the level of education in all analysed periods (1994-1996, 2000-2002 and 2010-2012) and in the most recent period reached the value of 7.5 at age of 20-44, 5.4 at age of 45-64 and 2.6 at age of 65-79 for the lowest education. Lung cancer mortality trends in women show a decreasing trend only among the youngest women; in other age groups, mortality increases. SMRR increases due to decline in the level of education in all analysed periods. For women with the lowest education level SMRR amounts 10.5 at age of 20-44 and 3.3 at age of 45-64 in the most recent period. Among oldest women with basic education SMRR is lower in 1994-1996 (SMR = 0.6). Conclusions In Poland, there is a relationship between smoking prevalence and education. Education is a strong determinant of the risk of lung cancer. Public education should be one of the strategies to reduce the health consequences of smoking. Funding The work was done as part of the statutory activities of the MSCI. Authors declare no conflict of interest.

Starzenie sie spoleczenstwa i wzrastająca zapadalnośc na nowotwory hematologiczne jest wyzwaniem dla systemu ochrony zdrowia. Nowotwory hematologiczne stanowily okolo 5% wszystkich zachorowan na nowotwory ogolem w 2012 roku, a polowa chorych miala ponad 65 lat. Nowe standardy leczenia oraz technologie medyczne stwarzają szanse dla chorych, ale ich zastosowanie wymaga wnikliwych badan oraz potwierdzenia uzyteczności w ramach praktyki klinicznej. Warunkami adekwatnego dostepu pacjentow w Polsce do technologii medycznych w ramach aktualnych standardow terapeutycznych są optymalizacja i adekwatne finansowanie systemu opieki zdrowotnej. Wydaje sie, ze hematologia onkologiczna moze byc modelowym przykladem efektywnych rozwiązan systemowych — z pacjentem jako podmiotem tego systemu.

Aside from existing opportunistic screening, an organised screening programme (OSP) for cervical cancer (CC) was implemented in 2006/2007 in Poland. We applied joinpoint regression and age-period-cohort model to look for the impact of the OSP on CC incidence/mortality trends. Decline of age-standardised incidence rates (ASIRs) in the screening-age group (25–59 years) accelerated from −2.2% (95% CI −2.7 to −1.7%) between 1993 and 2008 to −6.1% (95% CI −7.7 to −4.4%) annually after 2008. In women aged 60+ years, ASIRs declined from 1986 until 2005 [annual percent change (APC) = −2.6%, 95% CI −2.9 to −2.4%] and stabilised thereafter. Decline of age-standardised mortality rates (ASMRs) in the screening-age group accelerated from −1.3% (95% CI −1.5 to −1.1%) between 1980 and 2005 to −4.7% (95% CI −5.6 to −3.8%) annually after 2005. In women aged 60+ ASMR declined between 1991 and 2004 (APC = −2.9%, 95% CI −3.5 to −2.3%) and stabilised thereafter. Relative risks of CC diagnosis and death were 0.63 (95% CI 0.62–0.65) and 0.61 (95% CI 0.59–0.63), respectively, for the most recent period compared to the reference around 1982. Implementation of the OSP possibly accelerated downward trends in the burden of CC in Polish women under the age of 60, but recent stabilisation of trends in older women requires actions.

Wstep. Populacyjne wskaźniki przezyc są narzedziem pozwalającym ocenic skutecznośc leczenia chorob nowotworowych.Dysponując danymi dotyczącymi roznych okresow, mozna ocenic zmiany w skuteczności leczenia wynikającezarowno z wprowadzenia nowych metod leczenia, jak i wszystkich dzialan z zakresu profi laktyki zdrowotnej.Przedstawione wskaźniki przezyc oszacowano dla chorych zdiagnozowanych w Polsce w latach 2003–2005. Nowedane zostaly porownane ze wskaźnikami obliczonymi dla okresu 2000–2002.Material i metody. Analize przezyc przeprowadzono w oparciu o zbior zachorowan na nowotwory, zgloszonych doKrajowego Rejestru Nowotworow. Do analizy wlączono 341 241 pacjentow w wieku 15–99 lat, u ktorych nowotworzlośliwy rozpoznano w latach 2003–2005. Oszacowane wskaźniki przezyc wzglednych wyliczone zostaly metodąHakulinena przy uzyciu programu SURV3. Analize wykonano dla 17 najczestszych nowotworow u mezczyzn i kobiet.Wyniki zostaly porownane ze wskaźnikami oszacowanymi dla pacjentow zdiagnozowanych w latach 2000–2002 orazze wskaźnikami zblizonych okresow diagnozy, przedstawionymi przez rejestry wojewodzkie, ktore takie wskaźnikiopublikowaly. Wyniki biezącej analizy dla Polski nie zostaly porownane ze wskaźnikami europejskimi, poniewazwskaźniki przezyc dla chorych zdiagnozowanych po 2003 roku przygotowywane przez EUROCARE-5 nie zostalyjeszcze opublikowane.Wyniki. Wskaźnik 5-letnich przezyc wzglednych oszacowany dla chorych na nowotwory ogolem (bez wzgledu naplec), zdiagnozowanych w latach 2003–2005 w Polsce, wynosil 45,5%. Średni wiek pacjenta w chwili diagnozy wynosil63 lata, a odsetek utraconych w wyniku choroby lat zycia szacuje sie na blisko 79%. Wartośc wskaźnikow przezyciachorych na nowotwory ogolem znacząco roznila sie w zalezności od plci. Ich wartośc byla nizsza u mezczyzn — 37,3%niz u kobiet — 53,5%. Wśrod wlączonych do analizy nowotworow najwyzsze wskaźniki przezyc w populacji mezczyznzanotowano u chorych na nowotwory: jądra (87,6%), chloniaka Hodgkina (77,8%), gruczolu krokowego (76,4%) orazpecherza moczowego (61,4%). Najnizsze wskaźniki zaobserwowano w przypadku nowotworow: przelyku (7,1%),pluca (11,9%) oraz zolądka (16,4%). W populacji kobiet najwyzsze wskaźniki przezyc zarejestrowano u chorychz nowotworami: tarczycy (93,3%), chloniakiem Hodgkina (82,7%), trzonu macicy (78,7%), piersi (77,2%) oraz czerniakiemskory (71,3%). Najgorsze rokowania zanotowano u pacjentek z nowotworami: pluca (16,9%) i zolądka (19,8%).W porownaniu z poprzednim analizowanym okresem (lata 2000–2002) nastąpila poprawa 5-letnich przezyc u chorychzdiagnozowanych w latach 2003–2005: u mezczyzn o 4,4 punkty procentowe, a u kobiet o 2,3 punkty procentowe.Porownując dlugośc przezycia chorych mieszkających w trzech wlączonych do analizy wojewodztwach, obserwujesie zroznicowanie w zalezności od lokalizacji nowotworu: o ± 4 punkty procentowe u mezczyzn oraz nieco wiekszeu kobiet — o okolo ± 6 punktow procentowych.Podsumowanie. Analiza przezyc chorych na choroby onkologiczne w Polsce, zdiagnozowanych w latach 2003–2005,wykazala wzrost 5-letnich wskaźnikow przezyc w porownaniu z obserwowanymi w latach poprzednich. Podobnekorzystne zmiany obserwuje sie we wszystkich wojewodztwach, ktore systematycznie liczą i analizują wskaźnikiprzezyc. Wzrost przezywalności chorych nowotworowych wynika prawdopodobnie z wielu przyczyn, z ktorychnajwazniejszymi wydają sie byc poprawa świadomości zdrowotnej pacjentow i związana z tym „czujnośc epidemiologiczna”skutkująca wcześniejszym zglaszaniem sie do lekarza oraz stopniowa poprawa leczenia wynikająca z ogolnejpoprawy standardow leczenia.

Wstep. Najnowsze dane na temat zagrozenia populacji Polski nowotworami zlośliwymi są przedmiotem zainteresowania zarowno instytucji organizujących i fi nansujących opieke zdrowotną, jak i lekarzy, naukowcow, studentow czy pacjentow. Wychodząc naprzeciw oczekiwaniom, prezentujemy raport „Nowotwory zlośliwe w Polsce w 2012”, ktory zawiera informacje dotyczące oczekiwanej liczby zachorowan i zgonow na nowotwory zlośliwe w Polsce w 2012 r. Liczby te są oszacowaniem wynikającym z wieloletnich trendow opartych na danych gromadzonych i analizowanych cyklicznie przez zespol Krajowego Rejestru Nowotworow. Raport prezentuje rowniez szeroki zakres informacji na temat zachorowan i zgonow na nowotwory zlośliwe w Polsce w 2010 roku (ostatnim roku sprawozdawczym). Material i metoda. Dane o zachorowaniach na nowotwory zlośliwe pochodzą z Krajowego Rejestru Nowotworow. W niniejszym opracowaniu zastosowano podstawowe wskaźniki statystyczne: liczby bezwzgledne, odsetki, wspolczynniki surowe, wspolczynniki standaryzowane wedlug wieku na populacje świata, zyciowe i skumulowane prawdopodobienstwo zachorowania i zgonu na nowotwor. Wyniki. Najcześciej rozpoznawanymi nowotworami w 2010 r. u mezczyzn byl rak pluca (21%), gruczolu krokowego (13%) i jelita grubego (12%). Najczestszą przyczyną zgonow u mezczyzn byl stanowiący ponad 1/3 wszystkich zgonow u mezczyzn rak pluca, wyprzedzający raka jelita grubego (12%) i gruczol krokowy (8%). Z szacunkow wynika, ze w 2012 roku czestośc wystepowania raka pluca zmniejszyla sie (do 20%), a czestośc zachorowan na raka gruczolu krokowego i jelita grubego wzrosla (odpowiednio do 15% i 13%), natomiast czestośc zgonow z powodu raka pluca, jelita grubego i gruczolu krokowego pozostanie na tym samym poziomie. W populacji kobiet najcześciej diagnozowanym nowotworem w 2010 r. byl rak piersi (22%), wyprzedzając raka jelita grubego (10%) i pluca (9%). Pierwszą nowotworową przyczyną zgonow u kobiet, podobnie jak w poprzednich latach, pozostal rak pluca (15%), przed rakiem piersi (13%) i jelita grubego (12%). Oszacowana czestośc poszczegolnych nowotworow u kobiet w 2012 roku pokazuje, ze udzial i kolejnośc wiodących nowotworow wśrod zachorowan i zgonow u kobiet nie zmieni sie. Podsumowanie. W ostatnich latach obserwuje sie spadek zachorowalności na nowotwory w populacji mezczyzn o 0,2% rocznie oraz wzrost zachorowalności u kobiet o 1% rocznie. W przypadku obu plci od konca lat 80. XX wieku obserwowany jest spadek umieralności, ktory w ostatnich latach osiąga wartośc 1,9% rocznie u mezczyzn oraz 1,5% rocznie u kobiet. Wedlug oszacowan w 2012 roku zachorowalo na nowotwory zlośliwe w Polsce 145 890 osob, a zmarlo okolo 98 500. W ciągu ostatnich 30 lat zarowno liczba zachorowan, jak i zgonow rosla w Polsce liniowo u obu plci. Liczba zachorowan w 2010 roku u mezczyzn i kobiet nie roznila sie znacząco (w obu przypadkach przekroczyla 70 0000), natomiast liczba zgonow byla wyzsza u mezczyzn (blisko 52 000 przypadkow) niz u kobiet (prawie 41 000 przypadkow).

Barrett's Oesophagus (BO) is a complication of chronic gastro-oesophageal reflux disease (GORD) and is a major risk factor for oesophageal adenocarcinoma. Current guidelines are based on data showing a 0.5% annual malignancy progression rate. The Polish Barrett's Oesophagus Registry (POBOR) was established to characterize Polish patients with BO and estimate the risk of malignant progression. POBOR was established in 1999 after a dedicated training of endoscopists and histopathologists. Physicians registered patients using a dedicated registry form. After excluding patients known to have endoscopic treatment for BO, follow-up1 year and adenocarcinoma found at index endoscopy we have linked patients personal identification numbers (PESEL) with the National Cancer Registry to identify those with a diagnosis of oesophageal or gastric cardia adenocarcinoma. In total, 843 patients were registered [609 men (72.2%), male to female ratio 2.6:1] with median age at diagnosis of 56 years (IQR:47-67). Long segment BE was found at index endoscopy in 294 patients (39.4%) whereas low grade dysplasia in 147 (17.4%). 112 patients (13.3%) fulfilled the exclusion criteria and the remaining 731 were followed for a median of 9.8 years (IQR: 9.3-10.0). After 6779 patient-years, 6 adenocarcinomas were diagnosed yielding an incidence rate of 0.89 per 1000 patients-years (95% confidence interval [CI 0.40-1.97]) which corresponds to annual malignancy progression rate of less than 0.1%. The malignancy rate in patients with low grade dysplasia was 3.70 per 1000 patient-years (95% CI 1.39-9.85). In Polish BO patients the risk of malignant progression was lower than previously reported. It was notably higher in patients with low grade dysplasia than in those with no dysplasia at index endoscopy, which may warrant strict surveillance in these patients.

Summary Barrett's Oesophagus (BO) is a complication of chronic gastro-oesophageal reflux disease (GORD) and is a major risk factor for oesophageal adenocarcinoma. Current guidelines are based on data showing a 0.5% annual malignancy progression rate. The Polish Barrett's Oesophagus Registry (POBOR) was established to characterize Polish patients with BO and estimate the risk of malignant progression. POBOR was established in 1999 after a dedicated training of endoscopists and histopathologists. Physicians registered patients using a dedicated registry form. After excluding patients known to have endoscopic treatment for BO, follow-up

Objective. The aim is to estimate the future lung cancer incidence in Poland and Finland based on forecasts on hypothetical changes in smoking habits. Material and methods. Data on population, lung cancer and smoking prevalence come from known sources. The simulation model utilized for forecasting was based on smoothing the smoking habit – specific risk ratios estimated for males and females in Europe. Results. Depending on the analyzed scenario in 2030 in Poland mortality rates among men would range from 8 to 125/105 and among women from 7 to 47/105; in Finland among men 5 to 60/105 and among women 4 to 22/105. Conclusions. The results obtained clearly indicate that cutting down on the number of smokers translates directly into a considerable reduction of the lung cancer incidence rate.

Tobacco smoking is the cause of 30% of deaths among men and 7% among women in Poland. Such data call for detailed analysis. Previous researche on frequency of smoking was focused on the analysis of all-Poland population. The following research was aimed at the description of tobacco smoke exposure in population of Wielkopolska in the late 1990s. Smoking habits in Wielkopolska is more prevalent in men than women and this prevalence is sustained in time. The smoking habit among men decreased during the last 5 years of the 20th century, however it is higher among women (1996: 47.5% men and 27.7% women, 2000: 41.9% men and 29.9% women). The positive fact is the raising percentage of both men and women who give up smoking. The results show that the level of education is a strong predictor of smoking among men: the higher education, the lower percentage of smokers. This relation does not seem to be that obvious in women. The place of living is another factor influencing the percentage of smoking people--the prevalence is lower in cities, especially among men. Presented results show that there are similar changes in smoking habits in Wielkopolska as observed nationwide. The difference concerns slightly lower percentage of tobacco users among men and higher among women in Wielkopolska than in nationwide population. Distribution of involvement of subsequent categories (i.e. gender, age, education and place of living) follow the pattern observed in general population. The knowledge about smoking habits in Wielkopolska forms the ground for actions within the frame of evidence based medicine, systematic assessment of frequency of smoking would allow taking up appropriate preventive actions such as youth education and therapeutic (treatment of smoking habit) actions.

Over the last century, lung cancer from the rarest of diseases became the biggest cancer killer of men worldwide and in some parts of the world also of women (North America, East Asia, Northern Europe, Australia and New Zealand). In 2012 over 1.6 million of people died due to lung cancer. The cause-effect relationship between tobacco smoking and lung cancer occurrence has been proven in many studies, both ecological and clinical. In global perspective one can see the increasing tobacco consumption trend followed by ascending trends of lung cancer mortality, especially in developing countries. In some more developed countries, where the tobacco epidemics was on the rise since the beginning of the 20th century and peaked in its mid, in male population lung cancer incidence trend reversed or leveled off. Despite predicted further decline of incidence rates, the absolute number of deaths will continue to grow in these countries. In the remaining parts of the world the tobacco epidemics is still evolving what brings rapid increase of the number of new lung cancer cases and deaths. Number of lung cancer deaths worldwide is expected to grow up to 3 million until 2035. The figures will double both in men (from 1.1 million in 2012 to 2.1 million in 2035) and women (from 0.5 million in 2012 to 0.9 million in 2035) and the two-fold difference between sexes will persist. The most rapid increase is expected in Africa region (AFRO) and East Mediterranean region (EMRO). The increase of the absolute number of lung cancer deaths in more developed countries is caused mostly by population aging and in less developed countries predominantly by the evolving tobacco epidemic.

Malignant neoplasms are in Poland a major social problem not only in the older age groups, but they are the main cause of premature mortality (before age 65). This phenomenon is observed particularly in women - for several years cancer have been leading cause of death before age 65 (about 30% of deaths among young women and nearly 50% of deaths among middle-aged women). The projected increase in the number of cancer cases and deaths is attributable to demographic changes of the Polish population. Central Statistical Office in Poland estimates that the number of people over 65 years will increase by almost 75% by 2025. These changes translate into an increase in the number of new cases of the most common cancers in elderly (prostate, colon, lung among men and lung, breast, endometrial among women). The health phenomena taking place in the Polish population requires building a strong tool to monitor and analyze the processes involved. In case of cancer such tool is the cancer registry. In response to this need the National Cancer Registry launched a project aimed at creating a central database of cancers, establishing social baseline of conducting modern epidemiological research using information society technologies.

Although rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain.We used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer.A total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0%, 11.0 to 14.9%, and 15.0 to 19.9%, as compared with a rate of 20.0% or higher, were 10.94 (95% confidence interval [CI], 1.37 to 87.01), 10.75 (95% CI, 1.36 to 85.06), and 12.50 (95% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons).The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy.

Lung cancer is the main cause of cancer deaths around the world. At 12% of all cancer incidents, lung cancer is the most frequent single cause of death, of both males and females. In 2002 among male population in Po­land, lung cancer was the second, following heart failure, cause of death, ranging at 8% of deaths in general. It was third cause of death among females ranging at 2.3% in general. Considering cancer deaths in 2002 in Wielkopolska, lung cancer was most frequent cause of death among males (30%) and second frequent among females (10.4%). The last 25 years the number of deaths decreased among younger generation of males (first in the age group 20–44, later in the middle age group) and this phenomenon has dominated the general picture of cancer among males. However the increase of mortality rates in the older age group might be still observed. The constant increase of mortality has been observed among females, especially in the middle age group (45–64). It should be highlighted that the level of mortality has been equalled in both genders in the youngest age group (20–44), which means sud­denly growing risk among young population of women in Wielkopolska.