Lies, damn lies, or statistics? Why the debate about the method of forming cancer registries — the acquisition and interpretation of medical data on incidence and mortality from cancer are among domestic experts is not the first year, explains Anton master, PhD, ecoepidemiology, Executive Director of the Association of oncologists of North-West Russia.
Yesterday “Doctor Piter” has published a letter addressed to the colleagues from the Oncology clinics, Professor Vakhtang Merabishvili, Chairman of the scientific-methodical Council for information systems development of cancer services in the North-West region of Russia and head of the research Department of the organization of cancer control SMRC Oncology. N. N. Petrov. His assessment of the objectivity of the data, national statistics on cancer do not agree Anton, the master researcher of the same SMRC Oncology. N. N. Petrov and the University of Tampere (Finland).
Cancer statistics are kept in Russia since 1953, the orders of Ministry of health No. 420 and No. 135 dated 19.04.1999 year reglamentary registration of cancer patients in accordance with international standards approved by the who for cancer registries and relevant at the time. Today cancer registry in Russia, one of the largest in terms of population, the local registers cover 85-95% of cancer patients. These figures are unattainable for many countries, but the coverage is not the only indicator of important quality data.
In Western Europe they are processed before publishing for two years. For example, data for 2018 will be released only in 2020 — 2021. During this time, verified primary data. We have reports on cancer statistics appear at the end of January of the year following the reporting year. However, we must not forget that, unlike other countries, in Russia the centralized system of cancer care: in most regions of all patients concentrated in a single medical establishment — the cancer center. This allows you to obtain information about new cases of cancer quickly.
So says Anton the master of allegations of inaccurate data, lack of verified statistical information is an exaggeration that does not reflect the real state of the system of registration of cancer: “However, this practice really is necessary to gradually move away. Because there are objective flaws that are procedural in nature, they must be important to resolve, but this is not strongly reflected in the overall picture of morbidity and mortality.”
An objective comparison of the relevant Russian data on one-year mortality (the number of patients who die of cancer within the first year after diagnosis) with the European only possible on the basis of “fresh” numbers. In Europe now it is Eurocare-5, which reflects statistics for the years 1999-2007. And “fresh” statistics show that there is a one-year mortality rate in men was 31%, women — 25% in England and Wales, this figure is 35-40%. In Russia this figure is about 20%. Why?
In domestic practice is considered to be the indicator, including skin tumors — basal cell carcinoma, which along with the high proportion of cancer incidence are characterized by a high detection rate at the first stage and almost no mortality. Overseas data for these malignancies do not include in the statistics, — says Anton master. — These features of the technique is no secret. For a correct comparison of foreign and domestic data makes sense to analyze one-year mortality for malignant disease, comparing mortality from lung cancer, breast cancer, prostate cancer, and so forth individually. In this case, the European and Russian statistics do not contradict each other.
Why Russian statistics indicate that the cancer detection rate in the early stages of growing? This is due to the appearance of the country programs of medical examination and routing. In some regions, indeed, there has been a surge in the incidence by identifying the early stages of breast cancer, prostate cancer, and malignant tumors at other sites, said the master.
— Argue about the increase in diagnosis of malignant tumors at early stages is possible on the basis of growth in the proportion of patients admitted to hospital with early forms of cancer that we see, — he said.
To objectively evaluate the survival rate and mortality in the world practice, the index of registration accuracy is GOING, it is calculated it as the ratio of mortality to incidence with reference to the survival. It is very different for different types of tumors, can approach and exceed 1 for pancreatic cancer and lung cancer, indicating a high mortality from these diseases, widespread throughout the world. However, he hardly reflected the quality of cancer registration, since the increase in the share of early stages in any case it will decline. The only way to compare morbidity and mortality in time, between different periods and regions — standardised age-indicators. Now they are available and free, we use them in scientific work. The Federal register data on morbidity and mortality in Russia, including use of our foreign colleagues.
— Yes, matters to the quality of the statistics is our task — to analyze data of each region of Russia, to account for local bottlenecks in collecting and processing information. This work is still ahead of us. As the work on a regulatory framework orders, which operates in the industry, have not kept pace with modern realities. All this is provided within the framework of the national concept in Oncology, says Anton master. Last year we translated it into Russian language of the international classification of oncological diseases, and this year the Ministry of health recommended its use in all cancer registers of the country. But the process of introduction of new registers for classification also takes time.
The basis for the modernization of cancer registries would be the creation of a system that will take into account in real time of all patients with cancer, as well as the types of provide medical care — surgical, radiation, drug treatment, rehabilitation, palliative care.
There are problems with the “tracking” of patients to death. Without this information, statistics on survival will always be incomplete. But this problem must be solved within each region, as it involves the interaction of cancer registries and Registrar.
Should the information space from which to draw essential data as clinicians and ecoepidemiology. On the basis of SMRC Oncology. N. N. Petrov has already carried out the integration of registers of subjects of the Northwest Federal district, which is translated into a single software. This is essentially a pilot project that will transfer the collection and reporting of data to a new, digital level. Nevertheless, especially for ecoepidemiology remains the problem of their interpretation, which will help to assess, in particular, and the quality of medical care. Using a limited set of indicators, which today falls in the cancer registries, we deprive ourselves of a unique opportunity to fully discover their potential and realize their value.