| Abstract | Cilj rada bio je istražiti pojavnost raka vrata maternice (RVM) kod stanovnica Splitsko-dalmatinske županije (SDŽ) u razdoblju 2003.-2012. godina. Pored utvrđivanja učestalosti pobola i smrtnosti istražene su razlike između zemljopisnih područja SDŽ te uspoređena pojavnost u Republici Hrvatskoj i europskim zemljama.
Važan dio ovog rada posvećen je mjestu i ulozi medicinske sestre u provedbi mjera sprječavanja nastanka raka RVM.
Metoda: U radu je korištena retrospektivna komparativna epidemiološka metoda usporedbe pobola i smrtnosti od RVM i zloćudnih novotvorina drugih dijelova maternice na području cijele SDŽ kao i između područja: priobalje, otoci, Zagora, te između gradova i općina. Promatrano razdoblje uspoređeno s prethodnim desetogodišnjim razdobljem 1993.-2002. Statistička obrada urađena je programom Statistica 7.
Rezultati: U razdoblju 2003.-2012. u SDŽ u primarnoj zdravstvenoj zaštiti zabilježeno je 2.176 bolesnica svih dobi od RVM, 700 bolničkih otpusta zbog Carcinoma in situ i 1.445 otpusta zbog RVM iz KBC Split. Umrle su 74 žene. Prosječna godišnja stopa smrtnosti u SDŽ bila je 3,15/100.000 statistički značajno manja od Republike Hrvatske 4,78/100.000. U razdoblju 1993.-2002. umrlo je 60 žena (p<0,01). Prosječna smrtnost u SDŽ bila je 2,52/100.000 što ju je tada svrstavalo među razvijene europske zemlje. Trend smrtnosti od RVM u stalnom je porastu, suprotno nego u razdoblju 1993.-2002. kada je bio trend pada smrtnosti. Između područja SDŽ nema statistički značajnih razlika u pobolu i smrtnosti osim što se kod žena u općinama značajno manje dijagnosticira Carcinoma in situ vrta maternice nego u gradovima (19,74/100.000 vs. 32,62/100.000), a što se pripisuje slabijoj dostupnosti i nedostatnosti citološke dijagnostikezbog veće udaljenosti od KBC Split. Značajno smanjenje broja urađenih Papa-testova posljednjih godina popraćeno je porastom smrtnosti od RVM uz istovremeni pad broja bolničkih otpusta zbog karcinoma in situ vrata maternice i RVM što neizravno govori da se RVM sve više dijagnosticira u kasnoj fazi visokorazvijenog tumora.
Zaključak: Pored sve većeg tehnološkog razvoja, boljeg obrazovanja, bolje prometne povezanosti i boljih komunikacija smrtnost od raka vrata maternice u SDŽ je u porastu. Uzrok tome je pored nedovoljne primarne prevencije od strane samih žena i u nedostupnosti i nedostatnosti pravovremene citodijagnostike početnih promjena.
Uvažavajući sve blagodati novog cjepiva protiv Papilloma virusa i kad bi ono bilo u sustavnoj masovnoj primjeni već danas, još uvijek je edukacija o značaju primarne prevencije i redovitim ginekološkim pregledima sredstvo broj jedan u borbi protiv RVM. Medicinske sestre u tim aktivnostima imaju nezamjenjivu vodeću ulogu. |
| Abstract (english) | The purpose of this research paper was to explore occurrences of cervical cancer among residents of Split-Dalmatia County (SDC) between 2003 and 2012. In addition to determining frequency of morbidity and mortality, differences between geographical areas of SDC were examined and results were compared between republic of Croatia and other European countries.
An important part of this research was devoted to the roles of nurses in implementation of measures preventing the occurrences of cervical cancer.
Method:
Retrospective comparative epidemiological method was used in this research paper to compare morbidity and mortality from cervical cancer and malignant neoplasm of other parts of the uterus throughout entire SDC and between regions (coastal areas, islands, Zagora), cities, and municipalities. Period that was researched was compared with the previous ten-year period 1993 - 2002. Statistical analysis was performed with the program Statistica 7.
Results:
During the period 2003-2012, there were 2,176 patients of all ages diagnosed with cervical cancer in SDC. 700 hospital discharges from KBC Split Hospital were diagnosed with carcinoma in situ and 1,445 discharges were diagnosed with cervical cancer.Out of 2,176 diagnosed patients, 74 women died. The average annual mortality rate in SDC was 3.15 / 100, 000 which is significantly lower than the rate in the rest of Croatia; 4,78 / 100,000. Between 1993 and 2002 60 women died (p<0.01). Average mortality in SDC was2.52/100, 000 which ranked this county among developed countries. Mortality from cervical cancer has been growing steadily in period 2003-2012 which was not the case in period 1993–2002 when the mortality was decreasing.
In the area of SDC, there wereno significant differences in morbidity and mortality compared to the last period, except that the women in the municipalities are significantly less diagnosed with carcinoma in situ of the uterus cervix than woman in the cities (19.74 / 100,000 Vs. 32.62 / 100,000). These differences are attributed to the lack of cytological diagnosis due to greater distances from Hospital KBC Split. In addition, significant reduction in the number of conducted Pap-tests in recent years was recorded, which resulted in increases of mortality from cervical cancer. At the same time, there was a decrease in the number of hospital discharges due to carcinoma in situ of the cervix and cervical cancer. These statistics indirectly indicate that cervical cancer is increasingly diagnosed at the later stage.
Conclusion:
Despite increases intechnological development, higher education, moretransportation opportunities, and bettercommunication,mortality fromcervical cancerin Split-Dalmatia Countyis on the rise.
Main reason for this rise islack ofprimary preventionbythe women themselvesandthe unavailabilityoftimelycytological diagnostic exams. There are numerous benefits ofa new vaccineagainstPapillomavirus, but education on cervical cancer and regulargynecologicalexaminations are still the most important factors in preventing cervical cancer.
Nurseshave a unique leadership role in educating woman and ultimately helping them in prevention of cervical cancer. |
