O.I. Apolikhin1, M.I. Katibov1, A.V. Sivkov1, I.V. Chernishev1, D.A. Roschin1, I.A. Shaderkin1, N.G. Moskaleva1, G.D. Efremov1, V.M. Kuraeva2
1Research Institute of Urology of Ministry of Health of the Russian Federation;
2Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
Abstract. The aim of the study was to predict problems of prostate cancer screening that could be induced by comprehensive medical examination of the Russian population. For that purpose current state of the art of the healthcare system was analyzed. The analysis identified the following issues of concern: lack of a universal standard of screening test performance – blood test for prostatic specific antigen, insufficient sensitivity and specificity of this test, sharp increase in demand for prostate biopsy, shortage of qualified staff, poor material and technical resources of health care facilities, overdiagnosis and over treatment. It is calculated that comprehensive medical examination can detect about 173589 new case of prostate cancer per year, which is six times higher when usually diagnosed without comprehensive medical examination – 28552 cases. Expenses for detection, staging and treatment of prostate cancer as a result of comprehensive medical examination can add up to 15.7 billion rubles per year. Therefore, to reduce implications of the comprehensive medical examination it is crucial to proactively conduct personnel training and improve material and technical resources of health care facilities, to apply the principle of “risk groups selection” during implementation of comprehensive medical examination and employ step-wise approach for care delivery on the basis of clinical and financial feasibility of each step.
To exemplify application of those principles to improve efficiency of screening programs the authors refer to the subprogram “Urology” developed by the Research Institute of Urology under the “Healthcare development in Voronezh region in 2011-2015” program.
Key words: screening; population survey; prostate cancer; prostate specific antigen; prostate biopsy.
References
- Malignancies in Russia in 2011 (morbidity and mortality). Chissov VI, Starinskiy VV, Petrova GV, editors. Moscow: P.A. Gertsen Research Oncological Institute of the Ministry of Health of the Russian Federation; 2013. 289 p. (In Russian).
- The results of All-Russian population census 2010. [Internet ]. [Cited 2013 Jul 19]. Available from: http://www.gks.ru/free_doc/new_site/perepis2010/croc/perepis_itogi1612.htm (In Russian).
- Maksimov VA, Pushkar' DYu, Umarov MS. The current view on the problem of screening for prostates cancer. Urologiya. 2009; (5): 74-77. (In Russian).
- The main directions of the budgetary policy for 2013 and the planning period of 2014 and 2015. [Internet]. [Cited 2013 Feb 03] Available from: http://minfin.ru/ru/reforms/budget/results/ (In Russian).
- On approving the clinical examination in the certain adult population groups: the Order of the Ministry of Health of the Russian Federation №1006n of December 3, 2012 [Internet]. 2012 [cited 2013 Jul 01]. Available from: http://www.rg.ru/2013/04/25/dispanserizaciya-dok.html (In Russian).
- Krivonos OV, Skachkova EI, Malkhasyan VA, Pushkar' DYu. The current status, problems, and futures of the development of urological service in Russia. Urologiya. 2012; (5): 5-12. (In Russian).
- Tariffs for medical service 2013. [Internet]. [Cited 2013 Sep 05] Available from: http://www.skfoms.ru/tarifimeduslugi/866--2013- (In Russian).
- Fletcher R, Fletcher S, Vagner E. Clinical epidemiology. The basics of evidence – based medicine. [Transl. from English.] Moscow: Media- sfera; 2004. 352 p.
- Gilbert SM, Cavallo CB, Kahane H, Lowe FC. Evidence suggesting PSA cutpoint of 2.5 ng/mL for prompting prostate biopsy: review of 36,316 biopsies. Urology. 2005; 65 (3): 549-553.
- Moses KA, Paciorek AT, Penson DF, Carroll PR, Master VA. Impact of ethnicity on primary treatment choice and mortality in men with prostate cancer: data from CaPSURE. J. Clin. Oncol. 2010; 28(6): 1069-1074.
- La Rochelle J, Amling CL. Prostate cancer screening: what we have learned from the PLCO and ERSPC trials. Curr. Urol. Rep. 2010; 11(3): 198-201.
- Andriole G.L., Crawford E.D., Grubb R.L. III, Buys S.S., Chia D., Church T.R., et al. Mortality results from a randomized prostate-cancer screening trial. N. Engl. J. Med. 2009; 360(13): 1310–1319.
- Schroder FH, Hugosson J, Roobol MJ, Tammela T.L., Ciatto S., Nelen V., et al. Screening and prostate-cancer mortality in a randomized European study. N. Engl. J. Med. 2009; 360(13): 1320-1328.
- Eckersberger E, Finkelstein J, Sadri H, Margreiter M, Taneja SS, Lepor H, et al. Screening for Prostate Cancer: A Review of the ERSPC and PLCO Trials. Rev. Urol. 2009;11(3): 127-133.