A vastagbéldaganattal és annak szűrésével kapcsolatos ismeretek, hiedelmek és attitűdök

Abstract

The World Health Organization predicts that colorectal carcinoma (CRC) will be the second most common cause of tumor-related mortality in 2018. The standardized mortality rate was the highest in Hungary (followed by Croatia) within the member states of the European Union in 2015. In Hungary, the second most common cause of death is CRC, a great challenge for public health. In countries running an effective campaign against smoking, CRC has become the most common malignant tumor, overtaking lung carcinoma. According to recent Hungarian data, 5 841 and 4 776 newly diagnosed CRC cases were recorded in 2015 among males and females, respectively; and CRC was responsible for 5 841 fatalities in 2017. In CRC, 70% of the cases are sporadic, 10-30% run in the family, and 7% is accompanied by diseases where the development of CRC is almost inevitable. In Hungary, most of the diagnosed cases are advanced (stages 3 or 4) where the yield of a curative therapy is humble. An approach to fixing this issue might be the introduction of CRC screening for people above 50 years of age as a proxy for the operating sporadic screening model. Although the preparations of the regular screening have been progressing for many years, the program has not been launched until the submission of this thesis. The initial step of the screening program would be the invitation of 1.8 million potential attendees between 50 and 75 years by volunteer family doctors or screening centers. Adenomatous polyps are present in 5-10% of the general population, which spikes up to 20-25% among those above 50 years and of average risk of CRC. The length of the preclinical period of CRC supports the idea of screening because the multistep adenoma-CRC sequence embraces a 10-15-year period. The incidence of adenomas is the highest between 55 and 65 years, whereas that of CRC is the highest between 65 and 75 years. The primary objective of CRC screening is the detection and removal of adenomas in average-risk persons and the early recognition of asymptomatic lesions, thereby providing better opportunities for curative therapy. The application of standard screening optimizes costs of care compared to the burden imposed by the management of advanced CRC. Data from the opportunistic CRC screening revealed a very low attendance rate (32%), for which several restraining factors are responsible. Besides, the rationale for carrying out this study is supported by the fact that knowledge of and attitude towards CRC have not been surveyed and published in Hungary.