A voice in the discussion concerning causes for late diagnostics of cancer of the reproductive organ in women, based on the example of the Lublin Region.

Cancerous diseases are the second cause of deaths in Poland, which results primarily from the fact of their late detection and low effectiveness of treatment, despite a constant improvement in the situation [1]. The number of cases of cancer in Poland is still alarming. At present, approximately 120,000 cases are noted annually, and for many years this number has been growing more rapidly than the number of the population. Cancerous diseases are the cause of approximately 40% of deaths among females and 30% of deaths among males aged 45–64, i.e. at reproductive age [2]. Since 2007, the number of the reported cases of malignant cancer in females has been systematically increasing. In 2010, 70,024 new cases were reported among the population of males, and 70,540 in females. In 2010, standard morbidity rates were 254/105 in males, and 205/105 in females. Per 100,000 cases of diseases, 365 are due to malignant cancer [3, 4]. For many years, epidemiologists have been interested in the geographic distribution of the values of standardized morbidity and mortality rates due to cancer in Poland. The presently observed distribution fluctuates around the standard which has been in effect for over three decades. The Gdansk and Poznan Regions are at the top of the list of regions according to the values of standardized morbidity rates due to malignant cancer (ICD-10 C00-D-09). The Lublin Region is placed in the middle of this list, preceding, among others, the Regions of Bialystok, Warsaw, and Opole [4]. Analysis of the health situation of the inhabitants of the Lublin Region in recent years confirms the all-Polish problem in the control of cancerous diseases. The Lublin region, located in the south-eastern part of Poland, occupies an area of 25,155 km2, and is poorly populated and urbanized. It is a typically agricultural region with centres of food, engineering and chemical industries, and is a coal mining area. In 2010, the population of the Region was 2,151,895 inhabitants – 1,042,109 males and 1,109,786 females [3]. During the same period, i.e. in 2010, in the Lublin Region more than 8,000 new cases of malignant cancer were registered – 3,888 among females. Compared to the previous decades, this number increased and came close to the number noted during the same period among males. Deaths due to cancer more frequently occurred in males; however, among the population aged 40–44, approximately 60% of deaths concerned females [3, 4, 5]. According to the incidence of cancer among females in 2010, as well as in previous years, in the Lublin Region there dominated breast, gastrointestinal, genital organs and lung cancers. Among cancers of the female reproductive system, endometrial cancer occupied the first position – 7.2% of cases (n=278), followed by ovarian cancer – 5.7% (n=222), and cervical cancer – 5.0% (n=184) [3, 4]. An increase was observed in standardized morbidity rates due to endometrial cancer from about 9/100,000 in 1990 to over 14/10,000 in 2010, which is a growth of more than 80%. A lower intensity of the growth trend was observed for ovarian cancer (from 10/100,000 in 1989 to nearly 13/100,000 in 2010 – a growth of more than 25%). In 2010, a decrease was noted in standardized morbidity rates due to cervical cancer (from 13.2/100,000 in 1989 and 13.0/100,000 in 2008, down to 8.2/100,000 in 2010). However, this may be a misleading phenomenon in the evaluation of the exposure to this type of cancer occurring among the population of women in the Lublin Region, because this growth was accompanied by an increase in the number of registered cases of this cancer in situ (D06) (66 cases in 2010; standardized morbidity rate 5.2/100,000 women). While analyzing the total number of invasive (C53) and non-invasive (D06) cases of uterine cancer, this location would be placed in the sixth position among the most frequent cancers in females [3]. Generally, in Poland, a slow downward tendency in morbidity due to this type of cancer has been observed; nevertheless, according to the data by the National Cancer Register, among Polish women, mortality due to cervical cancer still remains one of the main oncologic problems, despite the possibility of diagnosing the disease at its early stage [2, 3]. Analysis of the relevant literature allows the presumption that for many years, there have contributed to the present epidemiological situation, among other things, the unsolved problem of late oncologic diagnostics and insufficient involvement of women in preventive actions. This situation still maintains itself and, to some extent, is independent on actions undertaken within the National Health Programme, which has been functioning from 1996 until today – on one its strategic goals focused on malignant cancer control, as well as of the National Cancer Control Programme [1, 2, 3]. For many years, in many countries (Australia, USA and the countries of the so-called ‘old’ European Union) this problem has been systematically limited by mass prophylactic actions carried out at all levels of prevention, as well as studies of personal patterns of behaviours in the area of health [6, 7, 8, 9], and the results of these studies were used while developing promotion and prophylactic actions. Address for correspondence: Renata Domzal-Drzewicka, Chair and Department of Communal Nursing, Faculty of Nursing and Health Sciences, Medical University, Lublin, Poland e-mail: renatadd@op.pl