Cancer cell

Cancer second top cause of death

October 23, 2003

High rate of smoking, diet rich in fatty meats blamed for lung, colorectal diseases

The League Against Cancer Praha has its work cut out for it.

The league has been working since 1990 to support cancer research, assist patients and increase the public’s understanding of the disease and how to prevent it. On the group’s annual Flower Day in May, it launched a campaign on prevention and screening for cervical cancer. In early October it joined other European groups in marking a Week Against Cancer; this year’s goal was to reach hundreds of thousands of Praguers with information on the risks of smoking.

The group and its partners are facing an uphill battle. Statistics show that Czechs are not keeping up with their European neighbors in combating the disease.

Cancer remains the second most-common reason for hospitalization and the second most-common cause of death in the country, following cardiovascular diseases in both cases. According to the Health Ministry’s Institute of Health Information and Statistics (UZIS), Czech men are more likely to die from cancer than men in any European country except Hungary and Slovakia. Among women, only Denmark and Hungary have higher cancer mortality rates than the Czech Republic.

The numbers are more striking when compared with life expectancy, an indicator of overall health, in which the Czech Republic surpasses all its neighbors in Central and Eastern Europe except Slovenia.

Some doctors are wary of the statistics, warning that poor documentation in other countries may make their situations seem unrealistically positive. But there’s undoubtedly a gap in cancer incidence between the European Union and non-EU states. Early results from the EUROCARE-3 study, a large-scale cancer survey funded by the World Health Organization, show that although survival rates are rising in Europe overall, those improvements have barely been felt in Eastern Europe.

Risky behavior

“The main issue for us is prevention,” said Dr. Zdenek Dienstbier, director of the League Against Cancer. Lifestyle factors that raise the risk of cancer are the best targets for changing the trends of the disease, he said. They’re also a key reason for the high local incidence.

Smoking, though hardly unique to the Czech Republic, tops the list of risk factors. Czech cigarette consumption decreased in the 1990s but remains comparatively high; according to UZIS, annual per capita cigarette consumption was 1,850 in 2000, 10 percent higher than the EU average.

That difference contributes to an incidence of lung cancer greater than in the EU and most Central and Eastern European countries. Czech men bear most of the burden, accounting for five times more lung cancer fatalities than women.

The Czech diet presents another set of risks. Dr. Lenka Foretova, head of cancer epidemiology and genetics at the Masaryk Cancer Institute in Brno, says a diet high in fatty meats and low in vegetables contributes significantly to the risk of cancer of the digestive system — as does consumption of alcohol, including beer.

“It’s a problem of how we eat,” Foretova said. Compared with the shortages of the communist era, she said, “we can buy anything in the store now, but we still prepare the same kind of food as before, without much vegetables or fruit.” Accordingly, colorectal cancer is among the most common forms of cancer here, ranking second after lung cancer for men and second after breast cancer for women.

Environmental factors are “important, but not at the top,” Dienstbier said. “Pollution and industry probably account for 4 or 5 percent of cases.”

Foretova says the Czech Republic had its share of hazardous industries in the past but adds that many factories and mines have shut down or adapted to modern environmental and safety standards.

“Most of the industries are in better shape,” she said. “But that’s everywhere, not just here. Our environment is comparable with other countries.”

Foretova also notes that cancer is slow to develop: Environmental and occupational factors that have improved in the past decade may still be contributing to new cases.

Too late

Along with greater lifestyle risks, Czechs face a worse chance of surviving the disease than patients in the EU.

“The differences in survival are because of differences in diagnosis,” said Dr. Jerzy Tyczynski, a scientific coordinator at the WHO’s International Agency for Research on Cancer. While country-by-country numbers aren’t available yet, Tyczynski says preliminary results from the EUROCARE-3 study show that the chances of surviving cancer over a five-year period are lower outside the EU. “It’s quite clear that cancer in Eastern countries is being diagnosed at later stages,” he said, when the chance for successful treatment has diminished.

Late diagnosis depends largely on a lack of public awareness of the signs of cancer, he added. “In the West, there’s better public education on breast cancer and melanoma. People know what to look for and react quicker.”

Michaela did so after losing her mother to ovarian cancer three years ago. Her aunt and grandmother had already undergone treatment for different forms of the disease. The 26-year-old mother of one (who asked that her full name not be used) underwent genetic testing at the Masaryk Institute. She learned she had inherited a gene known as BRCA1 that is probably linked to the development of breast and ovarian cancer.

Knowing at a young age what her future likely holds, Michaela is doing what she can to minimize any risks by maintaining a healthy lifestyle and undergoing frequent examinations to catch the disease early if it does develop.

“It’s a big advantage for a person to know something like this about herself,” she said. “Cancer is a common illness, and most people don’t know if they’ll get it or not. I do.”

She also works in the institute’s education department, helping others who face similar choices.

Czech doctors say health-care professionals could also improve their strategies of catching cancer early.

General practitioners often face time and money constraints that make simple checkups a low priority, Foretova said. While every Czech has a right to receive a general cancer screening every second year, including a skin check and breast or testicular exam, “the law doesn’t say doctors have to invite the patients to do it. If people don’t know about it, it does nothing.”

Treating it right

Radka Rizkova, a health-care specialist at the Health Ministry, agrees that general practitioners need to take more responsibility for routine screening. She says the ministry is planning a program to educate nonspecialists on cancer prevention and testing.

“We want to cooperate with practitioners to improve preventative examinations, but it will take some time,” she said.

The Health Ministry recommends mammography every other year for women over 45 and testing for colorectal cancer for people over 50 every other year; health insurance fully covers those tests. The League Against Cancer is lobbying the ministry and insurers to make another examination fully routine and covered: the Pap test for signs of cervical cancer, which occurs here nearly twice as often as in EU countries, according to UZIS.

Dienstbier says the test is routine under EU health-care systems. “Why should we use anything different?” he said.

But if early diagnosis here falls short, Dienstbier is quick to defend the Czech health care system for the quality of treatment offered and the experience of its professionals. “Everything that’s done in the EU and United States is done here,” he said. Diagnostic techniques such as mammography, magnetic resonance imaging and positron emission tomography, a scanning method still rare in much of Europe, are available in the Czech Republic. The problem, Dienstbier says, is educating doctors and patients to make full use of their health resources.

Efforts to improve early treatment through public awareness and broader screening programs eventually may bring the mortality rate into line with Western Europe. Ironically, those improvements could bring a higher incidence of cancer as more cases are caught at an early stage.

“The incidence will go up,” Foretova said, “but the chances of survival will be better.”

Most common types of cancer in the Czech Republic:
• tracheal,• breast
bronchial• colorectal
and lung• cervical
• colorectal
• prostate
Source: Institute of Health Information and Statistics, Report on Health Care and Health Services in CR 2002

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