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To examine the effects of war in Bosnia and Herzegovina on the occurrence of acute coronary syndrome among civilians.The incidences of acute myocardial infarctions (first and recurrent) and unstable angina pectoris were examined among the residents of Mostar and the nine neighboring districts. The study population was the population that lived in the area before the war (182,000 in the 1991 census). Others who immigrated into the area were not taken into consideration. Five consecutive years (1987-1991) before the war and 5 consecutive years (1992-1996) during the war were analyzed.In the 5-year period during the war, 267 men and 161 women suffered from acute myocardial infarctions, compared with 246 men and 119 women in the 5-year period before the war. The wartime increase in acute myocardial infarctions for the combined male-female population was statistically significant (p = 0.025). For women, the wartime increase was statistically significant only for the age group of 60 to 69 years (p = 0.007). The smaller increase among men was not statistically significant (p = 0.354). The increase to a wartime number of 52 cases of recurrent myocardial infarctions from a prewar level of 24 was statistically significant (p = 0.001). The percentage of fatal myocardial infarctions among women, however, was lower during the war (18.6%) than before the war (32.8%) (p = 0.048). During the war, 109 men with unstable angina pectoris were hospitalized, compared with 84 before the war; the cases among women were 76 and 41, respectively. The increase was statistically significant among women (p = 0.001) but not among men (p = 0.072). There was a statistically significant increase (p0.001) in the total number of unstable angina pectoris cases during the war (185 cases, compared with 125 prewar cases).The common population during the war in Bosnia and Herzegovina had increased numbers of acute myocardial infarctions and unstable angina pectoris cases.

Some of potential causes proposed to explain the reported increase of haematological malignancies in childhood during or after the war period in several countries include depleted uranium, chemical pollution and population mixing theory. The aim of this study was to define the population of Croatian children aged 0-14 years who were potentially exposed to each of those risks during the war and to investigate any possible association between the exposure and the incidence of haematological malignancies. The authors analyzed the data reported by the Cancer Registry of Croatia during the pre-war period (1986-1990), war period (1991-1995) and post-war period (1996-1999). In the group of 10 counties potentially exposed to depleted uranium and two counties where chemical war damage occurred, no significant difference in incidence of the studied haematological malignancies was noted in comparison to pre-war period. The incidence of lymphatic leukaemia significantly increased in four counties where population mixing had occurred during the war period, supporting the 'mixing theory'. In those counties, the incidence of Hodgkin's lymphoma decreased during and after the war. In Croatia as a whole, decreases in incidence of myeloid leukaemias during war and non-Hodgkin lymphoma after the war were noted.

The seroprevalence of Helicobacter pylori infection was studied in a population from two areas of Croatia with significantly different average gastric cancer (GC) cumulative incidence and mortality rates. In a random sample of 456 blood sera from both areas, which was tested with the ELISA Helicobacter pylori-antibody test, 48, 8% of people in the north and 53, 3% in the south of country were found to be infected. The difference between the two areas in the seroprevalence of the infection was not statistically significant, nor did their populations differ in age, sex, educational background, smoking habid or wine consumption. Our results do not point to any association between the prevalence of Helicobacter pylori infection and the level of cumulative incidence and GC mortality levels

AIM: To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program. ----- METHODS: Colorectal cancer (CRC) was the second leading cause of cancer mortality in men (n = 1063, 49.77/100,000), as well as women (n = 803, 34.89/100,000) in Croatia in 2009. The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare, and its implementation started in September, 2007. The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing (FOBT) to the participants, followed by colonoscopy in all positive cases. The FOBT was performed by hypersensitive guaiac-based Hemognost card test (Biognost, Zagreb). The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period. Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis. About 4% FOBT positive cases are expected in normal risk populations. A descriptive analysis was performed. ----- RESULTS: A total of 1,056,694 individuals (born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011. In total, 210,239 (19.9%) persons returned the envelope with a completed questionnaire, and 181,102 of them returned it with a correctly placed stool specimen on FOBT cards. Until now, 12,477 (6.9%), FOBT-positive patients have been found, which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union (EU) Guidelines]. Colonoscopy was performed in 8541 cases (uptake 66%). Screening has identified CRC in 472 patients (5.5% of colonoscopied, 3.8% of FOBT-positive, and 0.26% of all screened individuals). This is also in the expected range according to EU Guidelines. Polyps were found and removed in 3329 (39% of colonoscopied) patients. The largest number of polyps were found in the left half of the colon: 64% (19%, 37% and 8% in the rectum, sigma, and descendens, respectively). The other 36% were detected in the proximal part (17% in the transverse colon and 19% in ceco-ascending colon). Small polyps in the rectum (5-10 mm in diameter), sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases, with a low degree of dysplasia, and 40% were classified as hyperplastic. Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component, but still had a low degree of dysplasia. Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous, and among them, 32% had areas with a high degree of dysplasia, especially those polyps in the ceco-ascending or transverse part. The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows: relatively low percentage of returned FOBT, higher number of FOBT-positive persons but still in the range for population-based programs, and higher number of pathologic findings (polyps and cancers). ----- CONCLUSION: These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.

Rak dojke najčešća je maligna bolest u žena. Ranom dijagnostikom i sve uspješnijim liječenjem invazivnog raka dojke postignut je značajan pad mortaliteta, produljenje preživljenja i poboljšanje kvalitete života bolesnica. Postupak s neinvazivnim rakom dojke međutim povezan je s nekim dvojbama i sviješću o problemu predijagnosticiranja i pretjeranog liječenja nekih bolesnica. U tekstu koji slijedi multidisciplinarni tim stručnjaka donosi prve hrvatske smjernice čija je svrha standardizacija i optimalizacija kriterija i postupaka dijagnostike, liječenja i praćenja bolesnica s neinvazivnim rakom dojke u Republici Hrvatskoj., Breast cancer is the most common malignancy in women. Early diagnosis and more effective treatment of invasive breast cancer resulted in significant mortality reduction, improvement of survival and the quality of life of the patients. The management od non-invasive breast cancer, on the contrary, is still controversial and the problem of overdiagnosis and overtreatment of patients come to evidence. In the following text a multidisciplinary team of experts brings the first consensus guidelines aimed to standardize and optimize the criteria and management in diagnosis, treatment and monitoring of non-invasive breast cancer patients in the Republic of Croatia.

Colorectal cancer was the second leading cause of cancer deaths in the Split-Dalmatia County during the 1993-2005 period. The primary aim of this study was to analyze recent trends in the mortality caused by colorectal cancer in the Split-Dalmatia County. Secondly, the aim was also to analyze data on colorectal cancer patients operated on at Split University Hospital Center according to sex, age, localization of cancer and Dukes staging, in the period from January 1, 2003 to December 31, 2004. The colorectal cancer death rate was found to be on an increase in both men and women; however, it was higher in men in both study years. The colorectal cancer death rate was also found to increase with age in both men and women. Analysis of data on patients operated on for colorectal cancer yielded a 2:1 male to female ratio. Analysis of histopathologic staging according to Dukes produced a statistically significant difference (P0.0001). Dukes B or C was diagnosed in 84.3% and Dukes A in 9.3% of cases. According to cancer localization, sigmoid colon and rectum were involved 1.8 times more frequently than other sites of the colon. The data obtained in this study indicated that only 9.3% of patients were treated in the early stage of disease (Dukes A), pointing to the need of organized medical examinations for early detection of colorectal cancer in order to reduce the mortality rate associated with the disease.

Dobro organiziran i vođen program probira raka na populacijskoj razini mora biti znanstveno utemeljen, dugoročno isplativ, izgrađen na primjerima dobre prakse. Pozitivnima nakon probira mora se garantirati adekvatna dijagnostika i liječenje. Cilj rada je prikazati provođenje nacionalnih programa ranog otkrivanja raka dojke i debelog crijeva u Hrvatskoj. U prvom ciklusu probira na rak dojke (od kraja 2006.) pozvano je na mamografiju ukupno 720.981 žena, udio odazvanih je 58,5%, otkriveno je preko 1.500 karcinoma. Za program probira raka debelog crijeva (od kraja 2007.do početka studenog 2010. godine) poslano je ukupno 808.913 testova. Vraćeno ih je samo 19,9%. Pozitivnih testova je 7,7%. Na kolonoskopiji je bilo 77,5% patoloških nalaza:. 388 karcinoma (5,99%), 2.492 polipa (38,46%), ali i 1.641 nalaza hemoroida i 998 divertikula. Zaključeno je da javnozdravstvena djelatnost u nacionalnim programima ranog otkrivanja raka u Hrvatskoj koristi maksimalno sve svoje resurse. Pripremne aktivnosti, organizacija i koordinacija programa, kontakti i suradnja s obiteljskim liječnicima, specijalističkim jedinicama, medijima, regionalnom i lokalnom samoupravom, partnerstvo s nevladinim udrugama, nadziranje i evaluacija te kontrola kvalitete zahtijevaju ogroman napor i mnogo vremena uz neprestanu edukaciju svih onih koji u programu sudjeluju., Introduction: A well organized and conducted program of cancer screening at the population level should be scientifically based, cost-effective at long term, and designed on the good practice examples. Appropriate diagnosis and treatment should be warranted by high rate of target population inclusion, while appropriate diagnosis and treatment should be warranted for those with positive findings. Aim: The aim is to present implementation of the national programs of early detection of breast and colon cancer in Croatia. Results: In the first cycle screening for breast cancer (since the end of 2006), a total of 720,981 women were invited for mammography, of which 58.5% presented for screening, with more than 1500 cases of breast cancer detected. A total of 808,913 tests were distributed for colon cancer screening from the end of 2007 to the beginning of 2010, of which only 19.9% were returned, 7.7% of these positive. Colonoscopy yielded 77.5% of pathologic findings, including 388 (5.99%) carcinomas, 2492 (38.46%) polyps, 1641 hemorrhoids and 998 diverticula. Conclusion: In Croatia, the public health service has made maximal use of all its resources in the national programs of early cancer detection. Great efforts and time, along with continuous education of all those involved in the program, have been invested in preparatory activities, organization and coordination of the program, contacts and collaboration with family physicians, specialist units, mass media, regional and local authorities, partnership with non-governmental societies, monitoring, evaluation and quality control.

The aim of this study was to compare the prevalence of the hypertension and the increased body weight (BMI) between Croatian mainland and Adriatic island population. The data from the Croatian Adult Health Survey (N = 9,070) served as an estimate for the mainland Croatian population, while the data from "1001 Dalmatian study" (N = 1,001) were collected from four Adriatic islands; Rab, Vis, Lastovo and Mljet. The prevalence of increased body weight and hypertension was calculated for the four age groups and analyzed using chi-square test. The results indicate that men from the islands less frequently had normal body mass index (P0.001), and were more frequently overweight (P0.001). The prevalence of overweight and obesity were similar between the island and mainland women. The percent of normotensive respondents in men was significantly lower in islands (P0.001), while the prevalence of newly diagnosed hypertension was significantly higher among islanders in both genders (P0.001). Despite the traditionally prevalent Mediterranean diet and overall more favorable lifestyle islanders may not be as healthy as previously studies suggested, in terms of cardiovascular risk factors prevalence. This might be related to the poor access to health care and preventive measures or low interest for health care especially among men on the islands, reflected in the higher prevalence of newly diagnosed hypertension. These findings suggest that island populations represent good candidates for disease awareness programs and health promotion interventions.

The aim of this study was to analyze mortality and hospital morbidity from ischemic heart disease (IHD) and cerebrovascular disease (CVD) in the population aged 18+ years in different regions of Croatia, in 1997 to 2006 period. Mortality data were supplied by Central Bureau of Statistics, while hospital morbidity data were obtained from hospital discharge database at Croatian National Institute of Public Health. In Mediterranean region rates of IHD mortality were lower, while rates of hospitalization due to IHD have been higher than those for Croatia in the entire period. Rates of IHD mortality for Continental part have not been different from mean rates for Croatia while rates of hospitalization due to IHD have been lower than rates for Croatia in entire period. Rates of CVD mortality and rates of hospitalization due to CVD for Mediterranean part have been lower than rates for Croatia, while both rates for Continental part have been higher than rates for Croatia during entire period. This analysis identified the regions in which significant deviations from the general trend suggest the need for creation of a new national public health intervention model, focusing on changeable behaviour (lifestyles) risk factors.

Colorectal cancer was the second leading cause of cancer deaths in the Split-Dalmatia County during the 1993-2005 period. The primary aim of this study was to analyze recent trends in the mortality caused by colorectal cancer in the Split-Dalmatia County. Secondly, the aim was also to analyze data on colorectal cancer patients operated on at Split University Hospital Center according to sex, age, localization of cancer and Dukes staging, in the period from January 1, 2003 to December 31, 2004. The colorectal cancer death rate was found to be on an increase in both men and women; however, it was higher in men in both study years. The colorectal cancer death rate was also found to increase with age in both men and women. Analysis of data on patients operated on for colorectal cancer yielded a 2:1 male to female ratio. Analysis of histopathologic staging according to Dukes produced a statistically significant difference (P, Rak debelog crijeva bio je drugi vodeći uzrok smrti od raka u Splitsko-dalmatinskoj županiji u razdoblju od 1993. do 2005. godine. Glavni cilj ovoga istraživanja bio je ispitati novija kretanja smrtnosti od raka debelog crijeva u ovoj županiji. Drugi cilj je bio analizirati podatke o bolesnicima s rakom debelog crijeva koji su operirani u Kliničkom bolničkom centru Split prema dobi, spolu, lokalizaciji raka i stadiju prema Dukesu za razdoblje od 1. siječnja 2003. do 31. prosinca 2004. godine. Utvrđena je povećana stopa smrtnosti zbog raka debelog crijeva za oba spola. Stopa umrlih muškaraca bila je viSa od stope umrlih žena s ovim oblikom raka za obje godine. Također je utvrđena povećana stopa smrtnosti prema dobi za oba spola. Analiza podataka o bolesnicima koji su operirani zbog raka debelog crijeva pokazala je kako je bilo dvaput vise muškaraca nego žena. Analiza histopatoloških rezultata prema Dukesu pokazala je statistički značajnu razliku (P

Initial results of national mammographic breast cancer screening program in Croatia.

INTRODUCTION: The aim of this study was to investigate the utilization of breast, colon and prostate cancer screening in the adult Croatian population in a period without national cancer screening programs, with a special interest in respondents' rural versus urban origin. ----- METHODS: Self-reported screening utilization was investigated in the Croatian Adult Health Survey, which collected health-related information from a representative sample of the adult Croatian population. Breast cancer screening was investigated in women aged over 40 years, while colon and prostate screening was investigated in respondents aged over 50 years. The data were analysed using binary logistic regression. ----- RESULTS: One in five women reported breast cancer screening uptake in the year preceding the survey (22.5%), while only 4.5% reported a colon screening. A total of 6.1% men reported colon screening, while 13.7% of men reported having a prostate cancer screening. Respondents with rural origin reported all sites screening utilization less frequently than those of urban origin (breast: 14.5% vs 27.4%; prostate: 9.6% vs 16.3%; colon-men: 5.7% vs 6.3%; colon-women: 3.6% vs 5.1%; respectively). Multivariable models indicated that people with higher socio-economic status more commonly reported breast and prostate cancer screening uptake. Access to health care was the only independent variable associated with colon cancer screening in men, and the strongest variable associated with colon cancer screening in women. Rural origin was associated only with lower odds of breast screening (adjusted odds ratio 0.60 [95% confidence interval 0.48-0.74]), while in the remaining models, rural origin was not a significant predictor for cancer screening uptake. ----- CONCLUSIONS: Opportunistic cancer screening uptake is low in the Croatian adult population, with existing socio-economic differences in breast and prostate screening, and their absence in colon cancer screening. Rural origin was significantly associated with breast screening, even after adjustment to socioeconomic status and problems in access to health care. Lack of rural origin significance in the other screening sites could be related to small sample sizes of people who reported opportunistic utilization. Overall, access to health care is the strongest cancer screening predictor, and this should have a prominent role in the development of a systematic cancer screening program on a national level.

The use of cytogenetic assays in the surveillance of populations occupationally exposed to genotoxic carcinogens originates from the assumption that chromosomal alterations might be causally involved in early stages of carcinogenesis. Historical cohort studies have since 1990s consistently reported an association between the level of chromosomal aberrations (CA) in peripheral lymphocytes of healthy subjects and the risk of cancer. Only in few cases, have these results been transformed into a regulatory tool for improving occupational safety. The cytogenetic surveillance program adopted for more than two decades in the Republic of Croatia is one of these few examples. Croatian workers exposed to genotoxic agents were systematically screened for CA, to identify occupational settings needing a priority intervention. Significant increases of mean CA frequency were observed in groups exposed to ionizing radiation, chemical agents, and mixed exposures when compared with a group of unexposed referents. CA data on 736 men and 584 women, monitored between 1987 and 2000, have been associated with cancer incidence. Although the small size of the cohort did not allow for reaching statistical significance, the medium tertile of the CA frequency distribution was associated with a doubling of cancer incidence rate ratio (IRR = 2.40; 95% CI 0.85-6.77) when compared with the lowest tertile. For chromosome-type CA, IRR was non-significantly increased for both the medium (IRR 1.53, 95% CI 0.58-3.99) and high categories (IRR 1.69; 95% CI 0.61-4.72). Recommendations for future strategies comprise the inclusion of predictive biomarkers in surveillance programs, the definition of a regulatory framework, and their possible use for the identification of individual risk profiles. © 2007 Elsevier Ireland Ltd. All rights reserved.

U Hrvatskoj je rak drugi najznačajniji uzrok smrti (četvrtina od svih umrlih). Od 1988. do 2005. godine porasla je stopa incidencije na 100.000 sa 303,9 na 466,8, a stopa umrlih na 100.000 porasla je sa 217,7 na 284,8. Ne računajući rak kože, godišnje (2005. godine) dijagnosticira se blizu 21.000 novih bolesnika od raka, a umire blizu 13.000 ljudi. Najučestalija sijela raka u muškaraca su rak pluća, kolorektalni rak, rak prostate, rak mokraćnoga mjehura i rak želuca, a u žena rak dojke, kolorektalni rak i rak jajnika. Iako su mnoga sijela raka lako dostupna dijagnostici i terapiji te iako danas raspolažemo suvremenom dijagnostičkom opremom, u našoj zemlji zabilježeno je nisko 5-godišnje preživljavanje. Vijeće Europske Unije 2003. godine pozvalo je zemlje članice da donesu nacionalne programe prevencije i ranoga otkrivanja raka i započnu njihovo provođenje. Testovi koji se preporučuju (uz osiguranu odgovarajuću kvalitetu rada) jesu ovi: mamografija za probir raka dojke žena u dobi 50-69 godina, okultno fekalno krvarenje za probir raka debeloga crijeva u dobi 50-74 godine i Papa-test za probir raka vrata maternice u žena, koji ne treba započeti u žena mlađih od 20 godina, a treba započeti prije 30. godine života. Prijedlog nacionalnoga programa prevencije i ranoga otkrivanja raka u Hrvatskoj predstavljen je na 2. kongresu Hrvatskoga onkološkoga društva 2004. godine i publiciran na hrvatskom i engleskom jeziku. Nešto revidiran program publiciranje 2007. godine pod nazivom Kako spriječiti i rano otkriti rak? Ciljevi su Programa sljedeći: 1. Promotivnim aktivnostima i zdravstvenim odgojem smanjiti prevalenciju poznatih rizičnih čimbenika u stanovništvu (kontrolom pušenja, pravilnom prehranom, tjelesnom aktivnošću i izbjegavanjem prekomjerne tjelesne težine, umjerenijom konzumacijom alkohola, smanjenjem izloženosti karcinogenima na radu i okolišu, imunizacijom protiv hepatitisa B, izbjegavanjem izloženosti suncu te zdravstvenim odgojem u odnosu na spolne i reproduktivne čimbenike povezane s rakom. 2. Smanjiti ukupni mortalitet od raka za 15% u pet godina nakon početka provedbe programa. 3. Povećati postotak bolesnika u kojih je zloćudna bolest dijagnosticirana u pretkliničkom i lokaliziranom stadiju, povećati uspješnost liječenja i preživljavanja i time smanjiti troškove skupoga liječenja te poboljšati kvalitetu života bolesnika. Ciljevi su ranoga otkrivanja raka dojke ovi: za 25% smanjiti mortalitet od raka dojke pet godina nakon početka provođenja programa; ciljna su skupina žene u dobi 50-69 godina svake druge godine s obuhvatom od najmanje 70%. Test za probir: visokokvalitetna mamografija, klinički pregled između probira kao i za žene koje ne će sudjelovati u programu. Nakon mamografije očekuje se 4% pozitivnih za daljnju obradu. Ciljevi su ranoga otkrivanja raka debeloga crijeva smanjiti mortalitet od raka debeloga crijeva za 15% pet godina nakon provođenja programa uz obuhvat populacije od 75% do 2010. godine. Test za skrining: testiranje okultnoga fekalnoga krvarenja (FOBT) ili imunokemijski test (FIT) jednom godišnje (ili makar svake druge godine, odnosno najmanje svake treće godine), kod pozitivnih ispitanika na okultno fekalno krvarenje treba učiniti kolonoskopski pregled kako bi se utvrdio uzrok okultnoga krvarenja i mogući karcinom debeloga crijeva (s istovremenom endoskopskom terapijom-polipektomijom, ako je ona potrebna). Očekivani broj pozitivnih ispitanika na okultno fekalno krvarenje je od 2-3%. Primjenom programa za rano otkrivanje raka vrata maternice očekuje se smanjenje invazivnoga karcinoma za žene u dobi od 25 do 64 godine za 60% devet godina od početka programa, a za žene u dobi od 25 do 69 godina smanjenje mortaliteta za 80% nakon 13 godina. Test za skrining: Papatesta za žene u dobi od 25 do 64. godine starosti svake 3 godine. Idealni obuhvat bi bio 85%. Treba težiti sljedećim metodama skrininga: za žene u dobi od 25 do 30 godina koristiti Papa-test (konvencionalna ili tekuća citologija, uz kontrolu kvalitete u citološkim laboratorijima sukladno uputama EU) 3 godine, a za žene iznad 31 godine do 64. godine koristiti kombinaciju Papatesta i HPV-testiranja svakih 5 godina. U pozitivnih žena provedba Programa nadopunjena je kolposkopijom i ciljanom biopsijom. U budućim se programima prevencije raka vrata maternice očekuje cjeloviti sustav prevencije koji obuhvaća i cijepljenje protiv HPV-a. Cilj je ranoga otkrivanja raka prostate smanjiti mortalitet od raka prostate pet godina nakon početka programa. Ciljna su skupina muškarci u dobi iznad 40 godina kod kojih postoji pozitivna obiteljska anamneza za rak prostate (njih oko 10%), muškarci u dobi iznad 50 godina sa simptomima prostatizma, te onih u toj dobi bez simptoma koji zatraže pregled za rano otkrivanje raka prostate. Testovi za skrining: digitorektalni pregled, određivanje prostatičnoga serumskoga antigena (PSA) jednom godišnje. Pozitivni ispitanici upućuju se na daljnje dijagnostičke pretrage (oko 5-10% ispitanika). Nositelji programa probira određuju se ovisno o sijelu raka, a nužne su intenzivne promotivne aktivnosti na svim razinama. Monitoring i vrjednovanje skrininga provode zavodi za javno zdravstvo. Hrvatski zavod za javno zdravstvo koordinira aktivnosti i redovito izvješćuje Ministarstvo zdravstva i socijalne skrbi. Krajem 2006. godine (listopad) započelo se s programom ranoga otkrivanja raka dojke mamografijom i to pozivanjem žena 1937., 1954. i 1955. godišta, a u 2007. godini pozivane su žene 1938., 1939.-1943. i 1948.-1953. godišta. Do studenog 2007. godine pozvano je 330.000 žena, odaziv za prva pozivana godišta bio je 51,9%, a broj otkrivenih karcinoma 353. Krajem 2007. započeo je i program ranoga otkrivanja raka debeloga crijeva FOBT-om i pozivanjem osoba 1933. i 1937. godišta., Cancer is the second most frequent cause of death (a quarter of all deceased) in Croatia. Number of cases increased in the period 1988- 2005 from 303,9 to 466,8 out of 100.000, and number of the dead increased from 217,7 to 284,8 out of 100.000. There are almost 21 000 new cancer patients (skin cancer excluded) diagnosed every year (year 2005) and almost 13 000 die. The most frequent cancer sites in men are lungs, colorectum, prostate, urinary bladder and stomach and in women breasts, colorectum and ovaries. Although these organs are easily available for both diagnosis and therapy and even though today we posses modern equipment for diagnosis, survival stretches up to a short period of 5 years. In the year 2003 the European Council invited the member countries to create and start implementing programs for cancer prevention and early detection. Tests, which were recommended (with adequate quality in performance) were: mammography for detecting breast cancer in women aged 50-69, occult fecal blood test for detecting large intestine cancer from the age of 50 to 74 and the Pap test for detecting cervical cancer, which should not be performed in women younger than 20, but should definitively be done before they are 30 years old. Proposal of the National Program for Cancer Prevention and Early Detection in Croatia was presented at the 2nd Congress of the Croatian Oncologic Association in 2004 and published in Croatian and English language. A somewhat reviewed program was published in 2007 under the title "How to Prevent and Early Detect Cancer?". Aims of the Program: 1. to reduce prevalence of known risk factors in the population by different promotional activities and health education (control of smoking, healthy diet, physical activity and avoiding excessive body weight, promoting moderate consuming of alcohol, reducing the exposure to carcinogens at work and in the environment, immunisation against hepatitis B, avoiding sun exposure and health education regarding sexual and reproductive factors connected to cancer; 2. to reduce total cancer mortality by 15% five years after the implementation of the program; 3. to increase percentage of patients, who were diagnosed with this malignant disease in preclinical and in situ stage, to increase success of treatment and survival and to reduce expenses of costly treatment and improve life quality of patients. Aims of early detection of breast cancer are the following: to reduce mortality from breast cancer by 25% five years after implementation of the program; target group are women aged 50-69 every two years with the scope of at least 70% of the population. Screening test: high quality mammography, clinical examination between screenings, as well as for women, who are not going to participate in the program. It is to be expected that after mammography 4% of women would have to be subjected to further treatments. Aims of early detecting a colorectal cancer are to reduce mortality from the colorectal cancer by 15% five years after implementation of the program with the scope of 75% of the population until 2010. Screening test: occult fecal blood test (FOBT) or immunochemical test (FIT) once a year (or once every two years, i.e. at least once every three years); with persons who were tested positive to occult fecal blood haemorrhage, colonoscopy should be performed, in order to determine the cause of occult haemorrhage and possible colorectal cancer (with endoscopic therapy - polypectomy performed at the same time, if needed). Expected number of people positive to occult fecal blood test is from 2 to 3%. By applying the program for early detection of cervical carcinoma, reduction by 60% of invasive carcinoma for women aged 25 to 64 is to be expected nine years after the program implementation and for women aged 25 to 69 the reduction of mortality by 80% after 13 years. Screening test: the Pap test for women aged 25 to 64 every three years. Ideal scope would be 85%. We should try to accomplish the following screening methods: for women aged 25 to 30 to use the Pap test (conventional or current cytology, with quality control in cytological laboratories pursuant to the EU instructions) every three years, and for women aged 31 to 64 to use a combination of the Pap test and HPV- testing every 5 years. In women, who were tested positive, the Program included also colposcopy and target biopsy. It is to be expected that the future programs for cervical cancer prevention will include the whole prevention system, which will include vaccination against HPV. The aim of early detection of prostate cancer is to reduce prostate cancer mortality five years after the program implementation. Target group: men older than 40 with a positive family prostate cancer history (approximately 10% of them), men older than 50 with symptoms of prostatism, as well as men of the same age without symptoms, who want to be examined for early detection of prostate cancer. Screening tests: digital-rectal examination, determining of prostate serum antigen (PSA) once a year. Those who were tested positive are referred to further diagnostic tests (approximately 5-10%). Participants in the screening program are determined according to cancer site and obligatory intensive promotional activities in all fields. Monitoring as well as evaluation of the screening is performed by public health institutes. Croatian Public Health Institute coordinates activities and informs the Ministry of Health and Social Welfare on regular basis. The program of early detection of breast cancer - mammography started at the end of 2006 (October) by inviting women born in 1937, 1954 and 1955, and in the year 2007 women born in 1938, 1939-1943, as well as those born 1948-1953 were invited. Until November 2007, 330 000 women were invited, the response of the first women invited was 51,9% and the number of detected cancers was 353. The Program for early detection of colorectal cancer by FOBT as well as invitation of people born in 1933 and 1937 started at the end of the year 2007.

In Croatia, there are about 355 incident cases and about 100 deaths from cervical cancer every year. The aim of this study is to present the trends of cervical cancer incidence and mortality and to propose preventive strategies for cervical cancer in Croatia. Age-standardised and age-specific cervical cancer incidence rates were calculated for the period 1985-2004. For cervical cancer mortality data, the WHO Mortality Database was used. After an early decrease of cervical cancer incidence and mortality following the introduction of opportunistic screening in Croatia, no further decrease has been observed since the 1990s. An increase in incidence over the last 20 years was observed in the age-groups 40-44 and 45-49 years. To reduce cervical cancer rates, an organised cervical cancer screening programme is essential. In addition, HPV vaccination should be introduced in the school vaccination programme to achieve further reductions in cervical cancer incidence in the future.

Background Our aim was to establish whether individuals who developed colon cancer have elevated blood levels of insulin-like growth factor-1 (IGF-1). Methods This was a case/control study in which 52 patients with colon cancer and a corresponding control group were investigated. Data on age, weight, height, and sex of subjects were recorded and levels of IGF-1 and growth hormone, as well as insulin and C-peptide levels, were measured in the morning before eating, 90 min after breakfast and again 90 min after lunch. Results We found significantly higher levels of IGF-1 in blood of colon cancer patients compared to the control group. No differences in the levels of growth hormone, insulin and C-peptide in blood were found between colon cancer patients and the control group. It was found that the increase of IGF-1 level was followed by a 3.15-fold increased risk for developing colon cancer. There were no differences in the levels of IGF-1 in blood in all three measurements in the group of colon cancer patients, whereas differences were found in the control group. We found differences in the levels of insulin and C-peptide in blood in all three measurements in both groups of patients. No differences were found in the levels of growth hormone in blood in all three measurements in both groups of patients. Conclusions The results of this study suggest a positive correlation between the increased levels of IGF-1 and colon cancer and are thus consistent with the hypothesis that the level of IGF-1 plays an important role in the development of colon cancer.

Standardization system includes development, publishing and promotion of standards, as well as their use in practice. Products, services and processes in a variety of human activities should be standardized. The goal of standardization is to achieve a high security level, a high quality, usefulness and effectiveness as well as limitation of variability, ensuring compatibility and replacement (of products), and to eliminate technical problems in the international exchange of people, work, products and services. The leading areas/objects of standardization in medical informatics are electronic health record, classification in health care, communication and message exchange as well as data security and protection of the whole health information system. Technical Committee for Standardization in Medical Informatics (TC215) has so far accepted fifteen standards and prestandards. The affiliate HL7 Croatia works on localization of communication standard HL7 and adaptation to the Croatian requirements.

Informatization process of the Croatian health care system started relatively early. Computer processing of data of persons not covered by health insurance started in 1968 in Zagreb. Remetinec Health Center served as a model of computer data processing (CDP) in primary health care and Sveti Duh General Hospital in inpatient CDP, whereas hospital administration and health service were first introduced to Zagreb University Hospital Center and Sestre Milosrdnice University Hospital. At Varazdin Medical Center CDP for health care services started in 1970. Several registries of chronic diseases have been established: cancer, psychosis, alcoholism, and hospital registries as well as pilot registries of lung tuberculosis patients and diabetics. Health statistics reports on healthcare services, work accidents and sick-leaves as well as on hospital mortality started to be produced by CDP in 1977. Besides alphanumeric data, the modern information technology (IT) can give digital images and signals. Communication in health care system demands a standardized format of all information, especially for telemedicine. In 2000, Technical Committee for Standardization in Medical Informatics was founded in Croatia, in order to monitor the activities of the International Standardization Organization (ISO) and Comite Européen de Normalisation (CEN), and to implement their international standards in the Croatian standardization procedure. The HL7 Croatia has also been founded to monitor developments in the communication standard HL7. So far, the Republic of Croatia has a number of acts regulating informatization in general and consequently the informatization of the health care system (Act on Personal Data Confidentiality, Act on Digital Signature, Act of Standardization) enacted. The ethical aspect of data security and data protection has been covered by the Code of Ethics for medical informaticians. It has been established by the International Medical Informatics Association (IMIA), and the Croatian Society of Medical Informatics (CSMI) has translated it into Croatian and published it on its website. Based on a survey of medical staff attitudes toward health care system informatization, the Croatian health system appears to be ready for informatization. The only requirement is that the present and future health care providers have appropriate medical informatics education, proper computer equipment at their workplace, and an opportunity to participate in the development and/or improvement of the health information system. One of the EU health strategy priorities is the improvement of health information and knowledge. It means that integrated health information systems are required, i.e. systems able to provide key information on health and health care system to the politicians, health professionals and public in general.

Produženje očekivanog trajanja života i povećanje broja starijeg stanovništva ima za posljedicu veći broj oboljelih i umrlih od raka, što je sada slučaj u Hrvatskoj. Najčešća sijela raka u starijoj dobi jesu u muškaraca bronh i pluća, prostata, debelo crijevo, želudac, mokraćni mjehur i grkljan, a u žena dojka, debelo crijevo, želudac, bronh i pluća i tijelo maternice. Važno je usvajanje, odnosno održavanje zdravih životnih navika jer iste utječu na smanjeni rizik obolijevanja. Uspješnost liječenja ovisi pak primarno o ranom otkrivanju bolesti. Osim samopregleda, što je posebice važno za kožu, postoje testovi za otkrivanje raka dojke, vrata maternice, debelog crijeva i prostate. Šanse za izlječenje u starijih osoba slabije su zbog prisutnih kroničnih bolesti, narušenoga funkcionalnog statusa te težeg podnošenja agresivnih terapija. Prvi korak u donošenju odluke o probiru kao i o terapiji jest sveobuhvatna gerijatrijska obrada pacijenta koja uključuje evaluaciju svih prisutnih komorbidnih stanja, stupanj polifarmacije i prisutnost gerijatrijskih sindroma. S obzirom na specifi čnost problematike malignih bolesti u starijim dobnim skupinama, javlja se potreba za razvojem gerijatrijske onkologije kao posebne kliničke subspecijalnosti., The consequence of the life expectancy getting longer and the number of the elderly increasing is more and more cancer patients and people dying from cancer. This is now the case in Croatia. The leading sites for cancer among male elders are bronchus, lungs, prostate, colon, stomach, urinary bladder and larynx; meanwhile among female population are breast, colon, stomach, bronchus, lungs and uterus. What matters for reducing the risk of cancer is adopting, that is, maintaining healthy habits. The success of the treatment primarily depends on the early detection of the disease. Besides self-examination, particularly important when skin is in question, there are several tests for discovering breast cancer, cervix cancer, colon cancer and prostate cancer. The elderly have less chance for being cured because of the chronic diseases they suffer from, poor functional status and because they do not take the aggressive therapies well. The fi rst step in deciding about screening, as well as therapy, is overall geriatric patient treatment including evaluation of all of the existing comorbide states, the polypharmatic degree and the presence of geriatric syndromes. Regarding the problem specifi city of the malignant diseases affecting the elderly, there is a need for developing geriatric oncology as a separate clinic subspeciality.

Ubrzanim starenjem pučanstva Hrvatske mijenja se struktura mortaliteta, morbiditeta i struktura korištenja zdravstvene zaštite cjelokupnog stanovništva, iz čega proizlazi sve veće isticanje javnozdravstvenog interesa o povezanosti životne dobi populacije s objektivnim zadovoljenjem zdravstvenih potreba starijih ljudi. Gerontološka javnozdravstvena analiza udjela umrlih osoba starih 65 i više godina, kojih je u promatranom razdoblju (2000. - 2004.) umrlo ukupno 193.717 u odnosu na ukupan broj umrlih osoba, ukazuje na njegov konstantni porast: 75,1% u 2000., 75,5% u 2001., 76,8% u 2002., 77,9% u 2003. i 78,0% u 2004. godini. Opća stopa mortaliteta bila je najveća u 2003. godini: 11,8‰. Također je i specifi čna stopa mortaliteta, odnosno broj umrlih osoba starih 65 i više godina na 1.000 stanovnika jednake dobi, bila najveća u 2003. godini: 56,2‰. Gerontološka analiza udjela umrlih u dobi od 65 i više godina unutar pojedinačnih vodećih skupina bolesti kao uzroka smrti u 2004. godini ukazuje na njihov visoki udio od 87,4% u ukupno 24.959 umrlih od bolesti cirkulacijskog sustava (I00-I99) u Hrvatskoj i udjelu od 86,7% umrlih od 65 i više godina u Gradu Zagrebu. U Hrvatskoj 2004. godine umrli u dobi od 65 i više godina čine izrazito visokih 89,3% u ukupno 2.895 umrlih od skupine bolesti dišnog sustava (J00-J99), 68,0% u ukupno 12.408 umrlih u skupini novotvorina (C00-D48), 63,7% u ukupno 2.370 umrlih od skupine bolesti probavnog sustava (K00-K93) te 45,1% od ukupno 2.870 umrlih u skupini ozljeda, otrovanja i nekih drugih posljedica vanjskog uzroka (S00-T98). Fokusirani gerontološki javnozdravstveni pokazatelji o morbiditetu, funkcionalnoj onesposobljenosti i smrtnosti u starijih ljudi osnova su za izradu primjerenoga i učinkovitog Programa zdravstvenih mjera i postupaka u zaštiti zdravlja starijih ljudi, a koji uključuje i primjenu s evaluacijom Programa primarne, sekundarne i tercijarne prevencije za starije ljude. Cilj je sprečavanje njihove prerane smrtnosti, kao i unapređivanje zaštite zdravlja i funkcionalne sposobnosti hrvatske staračke populacije i u dubokoj starosti., The accelerated aging of the Croatian population changes the structure of mortality, morbidity and health care use in the entire population. This further increases the public health interest in the connection between the age of the population and the effective fulfi lment of health needs of the elderly. Gerontologic-public health analysis of the proportion of deceased people 65 years of age and older, with the recorded total number of 193 717 in the period from 2000 to 2004, shows its constant growth: 75.1% in 2000, 75.5% in 2001, 76.8% in 2002, 77.9% in 2003, and 78.0% in 2004. The general mortality rate was the highest in 2003 (11.8‰). A specifi c mortality rate, i.e. those for people of 65 years of age and older per 1000 inhabitants of the same age, was also the highest in 2003, i.e. 56.2‰. Gerontologic analysis of deceased persons of 65 years of age and older within leading groups of fatal diseases in 2004 shows their high ratio, i.e. 87.4% in the total number of 24959 of deceased due to circulatory diseases (I00-I99) in Croatia and 86.7% in the City of Zagreb. In Croatia in 2004, deceased persons of 65 years of age and older accounted for a high 89.3% per total of 2895 deceased due to respiratory diseases (J00-J99), 68.0% per total of 12408 deceased due to neoplasms (C00-D48), 63.7% per total of 2370 deceased due to gastrointestinal diseases (K00-K93), and 45.1% per total of 2870 deceased due to injuries, poisoning and some other external causes (S00-T98). The focused gerontologic-public health indicators on morbidity, functional disability and mortality in the elderly are the basis for the development of an adequate and effi cient Programme of Medical Measures and Procedures in Elderly Health Care, which includes the implementation and evaluation of the Programme of Primary, Secondary and Tertiary Prevention for the Elderly. Its objective is to prevent premature death and upgrade health care and functional abilities of senior citizens in Croatia up to old age.

To summarize the geographical and temporal variations in incidence of pleural mesothelioma in Europe, using the extensive data available from European general cancer registries, and consider these in light of recent trends in asbestos extraction, use and import in European countries.The data were extracted from the European Cancer Incidence and Mortality database (EUROCIM). The inclusion criteria was acceptance in Volume VII of Cancer Incidence in Five Continents. Truncated age-standardized rates per 100,000 for the ages 40-74 were used to summarise recent geographical variations. Standardized rate ratios and 95% confidence intervals for the periods 1986-1990 and 1991-1995 were compared to assess geographical variations in risk. To investigate changes in the magnitude of most recent trends, regression models fitted to the latest available 10-year period (1988-1997) were compared with trends in the previous decade. Fitted rates in younger (40-64) and older adults (65-74) in the most recent period were also compared.There was a great deal of geographical variation in the risk of mesothelioma, annual rates ranging from around 8 per 100,000 in Scotland, England and The Netherlands, to lower than 1 per 100,000 in Spain (0.96), Estonia (0.85), Poland (0.85) and Yugoslavia, Vojvodina (0.56) among men. The rank of the rates for women was similar to that observed for men, although rates were considerably lower. Between 1978 and 1987, rates in men significantly increased in all countries (excepting Denmark). In the following 10 years, there was a deceleration in trend, and a significant increase was detectable only in England and France. In addition, the magnitude of recent trends in younger men was generally lower than those estimated for older men, in both national and regional cancer registry settings.While mesothelioma incidence rates are still rising in Europe, a deceleration has started in some countries. A decrease may begin in the next few years in certain European populations considering the deceleration of observed trends in mesothelioma and asbestos exposure, as well as the recent ban on its use.

To describe the cohort of Croatian workers monitored for micronuclei in peripheral blood lymphocytes and validate predictive value of micronuclei for the risk of cancer development.Between 1985 and 1999, peripheral blood lymphocytes were analyzed with in vitro micronucleus assay in a cohort of 200 subjects occupationally exposed to genotoxic agents. The follow-up for cancer incidence and mortality was performed through the Croatian National Cancer Registry and records of occupational medicine physicians. Micronucleated cell frequency values were compared by Kruskal-Wallis test.The median micronucleated cell frequency value in the cohort was 49 (range, 30-79) per thousand cells. Micronucleated cell frequency was significantly higher in men than in women, which could be attributed to the different distribution of exposures. Micronucleated cell frequency increased with age for both sexes. Smoking habit had no influence on micronucleated cell frequency. The follow-up identified four cases of cancer. Three of them belonged to the highest micronucleated cell frequency tertile.Due to a small number of cancer cases, the predictive value of micronuclei for the risk of cancer development in the cohort of Croatian workers was not estimated, but 4 identified cases were more than expected in a similar non-exposed group. The Croatian cohort will contribute to the pooled analysis of the current European study of predictive value of micronuclei for the risk of cancer development.

The aim of this study was to compare the age-standardised incidence rates of gastric bowel and pancreatic cancer between two regions of the Republic of Croatia: (1) five middle Dalmatian islands (Brac, Hvar, Korcula, Vis and Lastovo) with "Mediterranean" nutrition; (2) the control population of Koprivnicko-krizevacka County (KKC) with "continental" nutrition. The characterisation of nutrition habits in the two study regions revealed very significant differences. The newly registered cases of gastric, bowel and pancreatic cancer between 1986 and 1995 were retrieved from the Cancer Registry of Croatia. The resulting incidence rates were standardised to the standard world population using the method of direct standardisation. Age-standardised incidence rates in the islands in comparison to the control KKC population per 100,000 inhabitants were 17.2 vs. 39.4 (p0.001) in males with gastric cancer, 9.1 vs. 16.5 (p0.01) in females with gastric cancer, 34.5 vs. 31.4 (p0.05) in males with bowel cancer, 18.3 vs. 20.3 (p0.05) in females with bowel cancer, 5.5 vs. 9.0 (p0.05) in males with pancreatic cancer and 2.7 vs. 5.0 in females with pancreatic cancer (p0.05). Standardised incidence rates of gastric and pancreatic cancer in the island populations were significantly lower from the standardized Croatian average. The study showed that "Mediterranean" type of diet could have a protective effect against gastric and pancreatic cancer.

The aim of our retrospective study was to analyze distribution of histological types, age of patients and hormonal dependency of breast cancer cases in the period 1980-2000 using computer database "Thanatos". This period was divided with regard to the war into a pre-war (1980-1990), war (1991-1995) and post-war period (1996-2000). We also paid attention to the Chernobyl accident (pre-Chernobyl from 1980-1986 and post-Chernobyl from 1987-2000). Special attention was focused on the period during the war mainly due to the fact that very little data exist in literature dealing with the war as a stress factor that may have induced and promoted carcinogenesis. During this twenty-one year period 2296 patients were diagnosed with breast cancer. In the female population of 2274, 2228 (98%) of these were ductal and only 46 (2%) were invasive lobular carcinomas. In all of the male cases (22) the cancer was pathohistologically verified as the invasive ductal type. The male:female ratio was 1:103. Comparing the pre-war and war periods we found a more than double increase in the male:female ratio (from 1:131 to 1:66). We observed similar results when we looked at the period after the Chernobyl incident where the ratio increased from 1:139 to 1:79. When we analyzed the distribution of histological types we found a significant increase in lobular carcinomas during the post-war period, from 1.1% to 5.5%; this increase was less significant for the post-Chernobyl period (1.0% to 3.3%). The average age of the patients with invasive ductal carcinomas increased from 56.7 yrs during the pre-war period to 59.7 yrs during the war and finally to 61.1 yrs during the post-war period. The average age of males with breast cancer decreased from 63.6 and 63.5 during the pre-war and war periods to 58.8 yrs during the post-war period. These results suggest that the war could have influenced the shift in the age of occurrence of breast cancer in both sexes appearing in younger males and in females in their postmenopausal period. The most commonly diagnosed stage of invasive ductal carcinoma during the war and post-war periods was T1N0MX, but in the controlled pre-war period the most frequently diagnosed stage was T2N1MX. With this we see that the increase in the age of the patient is not due to a more advanced pTNM stage which suggests that the increased age of our patients seeking medical help is not due to the incapacitating effects that the war may have on people needing medical attention. Our results showed that most of the patients were ER positive (72% throughout the twenty-one year period) and their average rate and number increase with the age of the patient. We found a significant drop in hormone dependent tumors in the period from 1991-95, which could mean that tumors in a war environment manifest a more aggressive phenotype. Our results show that the war within our region most likely had an effect on some clinical parameters involving breast cancer patients. Possible effects caused by "Chernobyl" could not be proved due to the overwhelming effect that war had upon the patients within this region.

Oral immunization with the urease of Helicobacter pylori was shown to induce protection against Helicobacter felis in mice. The first identification of a protective antigen (urease) was followed by the identification of the protective antigens, such as the heat-shock protein (HspA) and the vacuolating cytotoxin VacA. The final selection of the antigens to be used in a vaccine depends on the conservation of these antigens among Helicobacter pylori strains, their role as virulence factors and conservation of their immunogenic properties when expressed as recombinant proteins. Furthermore, therapeutic immunizations were also effective in eradication of Helicobacter from chronically infected animals. These encouraging results imply that immunization may also be useful in the therapy of Helicobacter pylori infection in humans. In this review, preliminary data and directions for future research on Helicobacter vaccines are described.

Infection with Helicobacter pylori induces antibodies, but these are not able to eradicate the bacterium from the gastric mucosa. Enzyme linked immunosorbent assay is the laboratory based method and most commonly used to measure qualitatively and quantitatively anti-Helicobacter pylori antibodies of different immunoglobulin classes in almost all infected patients. Quantitative serological tests are useful in the follow-up of eradication therapy. Serology is the method of choice in population studies and in the retrospective analysis of stored serum samples to study the natural course of this chronic infection.

About 50% of adults in the developed and 80-90% in the developing countries are estimated to be infected by Helicobacter pylori. Being 68% nationally, this rate is higher in the northern continental parts of Croatia, which also have higher gastric cancer rates. Low socio-economic status, poor living conditions in childhood (the age when Helicobacter pylori is typically acquired), and exposure to the stomach content of an infected person are risk factors for Helicobacter pylori. Most of the infected are symptomless, with 10 to 20% subsequently developing the disease, and this mainly from peptic ulcer, asymptomatic chronic gastritis and chronic dyspepsia. Less than 5/10,000 become affected with adenocarcinoma, MALT lymphoma or primary non-Hodgkin's gastric lymphoma. Helicobacter pylori is under intensive study for possible association with other diseases. As transmission route of the infection is still unclear, any mechanism allowing the bacteria entry into a non-infected individual's stomach is probably a possibility. In addition to improved socio-economic status, eradication or vaccination may be contributors to the reduction in the number of the infected.

To evaluate the actual incidence of malignant pleural mesothelioma in Croatia, geographical distribution of the disease, and relevance of occupation and some other characteristics of diseased subjects.Data on the incidence of pleural mesothelioma over a seven-year period (1991-1997) were collected from the Croatian Cancer Registry. In each case, the tumor diagnosis was histologically verified. Registration of the patients was based on their place of residence. Also, in 2001, a short questionnaire was sent to patients' families to gather additional information on patients' occupation (exposure to asbestos), smoking habits, and length of residence in the registered place. In many cases some of the answers had to be clarified by telephone or through a personal contact. Data obtained from 20 counties (administrative units) of Croatia were grouped into two larger areas: coastal and continental. The data for the city of Zagreb were presented separately.During the 1991-1997 period, the Registry recorded a total of 248 malignant pleural mesotheliomas (197 in men and 51 in women). The poll gathered additional data for 194 patients (78.2%): 153 (77.7%) men and 41 (80.4%) women. Eight in a million people on average were diagnosed with malignant pleural mesothelioma per year. Age standardized incidence rates (per 100,000) by residence showed an uneven geographical distribution for men: 2.66 in coastal area, 0.69 in continental area, and 0.75 in the city of Zagreb. Goodness-of-fit test for observed rates vs expected for Croatia were chi-square=145, df=2, p0.001; post-hoc tests: coastal vs continental area chi-square=12.3, df=1, p=0.001; and coastal area vs city of Zagreb chi-square=4.4, df=1, p=0.035. In women with mesothelioma, these rates were 0.38, 0.24, and 0.18, respectively, and the differences were not statistically significant.Assuming that the information obtained by the poll on the occupation of diseased subjects was a true characterization of all recorded cases of pleural mesothelioma, more than two-thirds of subjects with the studied tumor had an occupational exposure to asbestos. Uneven distribution of the tumor, with higher rate in men in the coastal area, may be related to shipbuilding and other industrial sources of asbestos exposure in that part of the country.

A Thyroid Cancer Registry containing data of patients treated at our department during a 20-year period (1980-1999) has been established. The aim of the study was to analyze the possible effects of the 1990-1995 war in Croatia on the prevalence, type, and age and sex distribution of thyroid carcinoma. Three different 2-year periods were analyzed: distant prewar (1980-1981), immediate prewar (1989-1990) and postwar (1998-1999) period. There was no statistically significant difference in age at diagnosis and sex ratio among the three study periods. The incidence of follicular cancer was at the upper limit for countries with normal iodine uptake when the 20-year period was analyzed, however, in the 1980-1981 period follicular cancer accounted for 34.9%, and in 1998-99 for only 2.8% of all cases. Papillary cancer was diagnosed in less advanced stages than others. Five-year survival for papillary, follicular and anaplastic cancer was 100%, 100% and 0%, respectively. Analysis of the 2-year periods for all cancer types except anaplastic cancer showed the mean age at onset to be on a decrease. In the 1998-1999 period, papillary cancer was diagnosed in a more advanced stage. The number of follicular cancer cases decreased from 22 in 1980-1981 to 3 in 19891990 and 2 in 1998-1999. Analysis of the epidemiology of thyroid cancer in the pre- and post-Chernobyl period did not reveal any increase in the number of papillary cancer in younger patients. It was concluded that in the postwar period, patients presented in more advanced stages of the disease. However, the effects of war on the epidemiology of thyroid carcinoma and other malignant tumors should be further investigated., Na našoj Klinici uspostavljeni Registar raka štitne žlijezde sadrži podatke o svim bolesnicima obrađenim u Klinici u 20godišnjem razdoblju (1980.-1999.). Cilj ovoga istraživanja bio je utvrditi moguće učinke rata u Hrvatskoj na učestalost, histološki tip te spolnu i dobnu raspodjelu bolesnika sa zloćudnim tumorom štitne žlijezde. Analizom su obuhvaćena 3dvogodišnja razdoblja uključujući vrijeme znatno prije rata (1980.-1981.), neposredno prije rata (1989.-1990.) i nakon rata(1998.-1999.). Nije utvrđena statistički značajna razlika u starosti i spolnoj raspodjeli tumora između tri navedena razdoblja. Učestalost folikularnog raka bila je na gornjoj granici učestalosti za zemlje bez gušavosti, s tim da je u razdoblju 1980.-1981. bilo ukupno 34,9%, a u razdoblju 1998.-1999. samo 2,8% folikularnog karcinoma. Petogodišnje preživljenje bilo je 100%, 100% odnosno 0% za papilarni, folikularni i anaplastični rak. U uspoređivanim razdobljima prosječna starost bolesnika se snižavala, ali se rak dijagnosticirao u sve uznapredovalijem stadiju. Analiza populacije prije i nakon Černobila nije pokazala povećan broj mladih bolesnika s papilarnim karcinomom. Na temelju rezultata ovoga istraživanja zaključeno je da nije bilo povećanja učestalosti karcinoma štitnjače u poratnom razdoblju, međutim, bolesnici su se javljali s uznapredovalijim stadijima tumora. Ovaj i moguće druge učinke rata na karcinom štitnjače, kao i na druge zloćudne tumore, valja dalje istraživati.

Za podatke registara za rak najviše se zna zbog njihova potencijala opisivanja incidencije raka, preživljavanja i prevalencije u nacionalnim i međunarodnim okvirima. Često se za usporedbu rabe mortalitetni podaci, posebice stoga što su dostupniji za mnogo više zemalja nego podaci o morbiditetu. Ispitivanja incidencije raka u svijetu daju spoznaje o etiologiji raka, na primjer, putem opažanja razlika incidencije izme|u pojedinih područja, studija migranata ili specifično izloženih grupa. U epidemiološkim istraživanjima registar koristi za korelacijske studije, za identifikaciju slučajeva u case control studijama, za definiranje kohorte ili krajnje točke praćenja kohorte. Zbog povezivanja podataka na nivou osobe, registri su korisni i za područje genetičke epidemiologije. Cilj ovog rada je na temelju konkretne zemljopisne distribucije incidencije nekih izabranih sijela raka, a koristeći se Registrom za rak, pretpostaviti različito djelovanje uzročnih čimbenika. Primijenjena je analiza za 17 definiranih zemljopisnih područja Hrvatske. Analizirana je dobno-standardizirana prosječna godišnja stopa incidencije za izabrana sijela raka za razdoblje 1991–95. Razlike izme|u pojedinih područja prisutne su gotovo za sva prikazana sijela raka. Rezultati upućuju na potrebu daljnjih istraživanja, etioloških i drugih. Dobivene razlike u incidenciji raka između pojedinih područja Hrvatske odraz su djelovanja mnogobrojnih čimbenika: značajki populacije, makro i mikrookoline., Systematic collection of data on cancer incidence started in the US and Europe in 1930s. Today, cancer registries have an increasingly universal coverage. The application of a cancer registry may extend to include follow-ups, cancer etiology research, and cancer control programs. Of course, the applicability of a cancer registry depends on reliability and utility of the data. Cancer registries are best known for their potential to describe incidence, survival, and prevalence of cancer on a national and international level. Although poorer in quality, mortality data are frequently used in comparisons, as these are more readily available in many countries than the morbidity data. Studies of cancer incidence reveal etiology of cancers, through, for instance, observations of differences in incidence between areas, through migrant studies, or through studies of specific exposed groups (descriptive studies). A registry may serve as a referential point for a hypothesis on the roles of diet, environmental hazards, infections, and so on in the development of cancer. In epidemiological studies, the registry is used for correlational studies, case identification in case control studies, as well as to define cohorts, or the end-point of a cohort followup. Recently, the recording of data has extended not only to the anatomical site, but also to the morphology of a tumour, which serve more adequately to etiological studies. However, the assessment of a specific exposure is of ten poor, as the scarcity of cases often forces the researchers to group the data. Registries may also help to link data on an individual level, that is, in the area of genetic epidemiology. This study made use of the Croatian cancer registry founded in 1959 to investigate specific geographical distribution of cancer incidence by site – esophageal cancer, gastric cancer, colonic cancer, rectal cancer, biliary bladder cancer, lung cancer, cancer of the mammae, melanoma, cancer of the prostate, urinary bladder cancer, renal cancer, thyroid cancer, and myeloic leukemia. The objectives of the study were to see how causative agents differed in impact and to define the scope of investigations in cancer epidemiology. The investigation involved age-standardized average annual incidence rates in 17 geographical areas in Croatia for the period 1991–95. Nearly all geographical areas differed from one another in the incidence by cancer site. Interregional differences in cancer incidence in Croatia may reflect the action of multiple factors such as population characteristics, macroenvironment, and microenvironment. The results indicate a need for further studies and invite the use of epidemiological modelling, given the potentials of information technology.

The project 'The Register and Preventive Programs for Accidents and Injuries' enabled data collection on all the injured who sought medical aid in Koprivnica County (population 61,052), Croatia, since 1992. Children aged 1-4 years are 5.03% of the whole population of the district. Complex injury attributes were analysed. Binary attributes were classified as input: age, gender, place of injury; and output: severity of injury. A new application of information entropy was introduced and applied to the classification of injury-causes attributes. The information entropy was calculated for the classification of input attributes according to the minimum information content. The decision procedure is given as a sequential procedure separating important from unimportant causes of injury at each decision level. Thus a decision tree with increasing entropy, i.e. decreasing determinism, was obtained showing that age (0.5347 N), place (0.6062 N) and gender (0.6105 N) are measurable attributes in child injury ascertainment in a descending pattern. It was shown that this method is, at the same time, an optimal way of using an attribute decision process of injury causes classification.

Specifične kulture bakterija mliječne kiseline koje se upotrebljavaju u fermentaciji mlijeka, pripadaju, prema nekim istraživanjima, u antimutagene i antikarcinogene tvari. U svjetlu tih istraživanja razmatra se uloga jogurta, maslaca i sira. Naime, postoji bazični odnos između intestinalnih bakterija, njihovih metaboličkih proizvoda te prehrane i zdravlja. U eksperimentima je utvrđena smanjena aktivnost fekalnih enzima koji proizvode karcinogene u osoba koje su dobivale kulture laktobacila. Studije "in vitro" humanih limfocita pokazale su da laktobacili stimuliraju lokalni i sistemski imuni sustav, a neke kulture imaju i antioksidativna svojstva. Fermentirani mliječni proizvodi znatno pridonose i unosu kalcija u organizam. Pri tome kalcij, odnosno kalcijev fosfat veže slobodne masne i žučne kiseline pa tako smanjuje učinke toksičnih doza na epitelne stanice crijeva i njihovu proliferaciju. Znatno smanjenje rizika za rak debelog crijeva pri konzumiranju fermentiranih mliječnih proizvoda nađeno je u nekim američkim istraživanjima, ali ne i u istraživanjima u Nizozemskoj. Ta se razlika u rezultatima objašnjava razlikama u primijenjenim bakterijskim kulturama. Smanjeni rizik za rak dojke i rak egzokrinog pankreasa također se povezuje s konzumiranjem fermentiranih mliječnih proizvoda., According to some reports, the specific cultures of lactic acid bacteria which are used in milk fermentation belong to antimutagens and anticarcinogens. The roles of yoghurt, butter and cheese are considered in the light of these studies. There is a fundamental relationship between intestinal bacteria, their metabolic products, nutrition and health. Experiments have shown that the persons, who had received lactobacillar cultures, produced less fecal enzymes which produce carcinogens. The "in vitro" human lymphocyte studies indicate that lactobacilli stimulate the local and systemic immune system, and that some cultures have antioxidative properties. Fermented dairy products are also a significant factor in calcium ingestion. In the process, calcium with calcium phosphate, binds with free fatty and biliary acids, resulting in weaker toxic effects of the doses in intestinal epithelial cells and in their lower proliferation. While some American studies found the occurrence of colonic cancer to be significantly reduced by taking fermented dairy products, this was not the case with the Dutch studies. This difference has been explained by the use of different bacterial cultures. The lower risks of breast cancer and exocrine pancreas cancer are also associated with the ingestion of fermented dairy products.

Primary prevention and early detection of cancer are areas of growing interest in oncology as they present the most powerful weapon in fighting cancer and the curability rates increase with earlier disease detection. Breast cancer is one of the most often diagnosed tumors and one of the biggest public health issues and importance of high-risk individuals detection has been recognized decades ago. Such high-risk individuals are candidates for earlier and more frequent implementation of breast cancer screening methods. To recognize high-risk women, it is necessary to individually investigate the presence or absence of all risk factors known up to date and express them as a single number which will present one's risk for breast cancer development. PrOnDi (Preventive Oncology Diagnostics) questionnaire is designed to detect high risk persons for tumors of 18 different localizations. It consists of 84 questions in total and 18 of those are related to breast cancer risk factors. All the anwers to the PrOnDi questionnaire are linked to certain relative risk value, connected to a specific breast cancer risk factor. As a person completes the questionnaire, all the relative risks for breast cancer are summarized according to the carefully designed formula and a person is being classified into one of three possible risk groups (traffic-light concept): red-high risk (breast cancer risk is significantly higher compared to general population) ; yellow-moderate risk (risk is moderately higher than in general population) ; green-low risk (risk is comparable to the one in general population). In the pre-pilot testing of the PrOnDi questionnaire, 59 women with previously diagnosed breast cancer were given the questionnaire. The results were very encouraging: 98, 3% of patients were classified in the moderate (28, 81%) or high risk (69, 49%) groups, and only 1, 7% were classified in the 'green' group. According to these results, PrOnDi questionnaire could present a mighty tool in breast cancer prevention, early diagnosis and detection of high risk individuals. Of course, prior to definite conclusions, a survey on much bigger number of healthy individuals must be performed, but preliminary results are very optimistic and we might have a valuable tool for the future of oncology.

Nekoliko je istraživanja upozorilo na povezanost između kalcija, vitamina D, uzimanja mlijeka i smrtnosti od raka debelog crijeva. Mlijeko je pritom, kao najbogatiji izvor kalcija u hrani, prepoznato kao protektivni čimbenik. Nedostaci većine tih istraživanja mogli su utjecati na rezultate. Zaštitna uloga kalcija bila bi u tome što ioni kalcija smanjuju izloženost epitela debelog crijeva mastima i žučnim kiselinama, stvarajući s njima netopljive kalcijeve sapune. Smatra se da masti i lipidi stimuliraju rad tumora iz stanica izloženih inicijalnoj karcinogenezi. Pretpostavka da vitamin D može djelovati protektivno kod raka debelog crijeva temelji na opažanju da je smrtnost od tog raka veća u područjima s manje sunčanog svjetla. Uloga vitamina Dje pritom usko povezana s njegovom funkcijom u metabolizmu kalcija. Dokazi o uzročnoj povezanosti između kalcija i raka debelog crijeva još su nedovoljno čvrsti. Značajni su oni koji upozoravaju na povezanost s osteoporozom i hipertenzijom. Važno je stoga hranom osigurati dovoljan dnevni unos kalcija u organizam., Several studies have shown that there is a link between calcium, vitamin D, milk consumption and colon cancer mortality. They recognized milk, as the richest source of food calcium, as a protective factor. Most of them have flaws capable of affecting the results. Purportedly, the protective role of calcium consists in calcium ions reducing the exposure of colonic epithelium to fats and gallbladder acids by binding with them into insoluble calcium soaps. Fats and lipids are considered to simulate tumor growth in the cells exposed to the initial carcinogenesis. The observation that in colonic cancer the action of vitamin D may be protective is based on the reports of areas with less sunlight having a higher mortality from this cancer. At it, the role of vitamin D is closely related with its function in calcium metabolism. The evidence for a causal relationship between calcium and colonic cancer is not strong enough yet. More significant is that indicating its relationship with osteoporosis and hypertension. It is thus important to insure a sufficient daily calcium intake thorough food.