Every year, more than 600,000 new cases of cervical cancer are diagnosed worldwide and more than 300,000 women die from this completely preventable disease. A disproportionately large burden of mortality falls on countries with a low and medium level of economic development. On the contrary, in countries where there is a state program of prevention and screening, cervical cancer is called a "forgotten disease." For the first time, the world has made a global commitment to eradicate cervical cancer, that is, to reach an incidence rate of 4/100,000 women and prevent 70 million new cases and 60 million deaths. The global strategy of the World Health Organization for the period until 2030 contains three main goals:
• 90% of all girls aged 9-14 should be protected by HPV vaccination
•   70% of women aged 30 to 60 should participate in HPV- cervical cancer screening
•   90% of women with precancerous conditions and invasive cancer should have access to high-quality treatment

How relevant are the issues of mass screening in Ukraine today, in the conditions of limited health care resources and a shortage of medical personnel? The problem of cancer during the war and after the end of hostilities will not eradicate. On the contrary, it will only intensify. According to some estimates, cancer morbidity and mortality in our country may exceed the pre-war level. One of the reasons for the increase in the incidence of cervical cancer during the war is the mass migration of the population, which increases the risk of infection with oncogenic human papilloma viruses. Realisation of PCR diagnostics to detect the DNA of this virus is critically important for Ukrainian women today, and our country has all the possibilities for this.

Self-sampling technology. 
Even before the war, pilot projects of cervical cancer screening by detecting HPV and other sexually transmitted infections in women using the Qvintip test of the Swedish company Aprovix AB were carried out in the territory of Zaporizhzhya region. The algorithm for self-sampling is very simple. A woman receives a Qvintip test from her family doctor or social worker and uses it at her convenience as shown in the instructions. The working part of the tool, consisting of a special material, gets wet with vaginal mucus and does not dry for five days. During this time, the instrument in a disposable transport container can be easily delivered to a certified laboratory for PCR testing to detect viral DNA in biological fluid. A woman can receive an answer with the results of the study by phone or e-mail within two days. In the case of a positive test, which revealed the DNA of an oncogenic strain of the human papilloma virus, the woman will be asked to make an appointment with a gynecologist for the purpose of conducting a detailed examination (colposcopy, biopsy) and, if necessary, to perform a therapeutic procedure. In our experience, in the pre-war period, 6 out of 100 examined women had the need to visit a gynecologist after passing the screening test. The Qvintip test can be used not only for the detection of oncogenic DNA strains of the human papilloma virus, but also for the PCR diagnosis of most sexually transmitted infections - bacterial vaginosis, candidiasis, gonorrhea, chlamydia, detection of trichomonads, ureaplasma, mycoplasma, trepanosomes. Thus, in wartime, the self-sampling procedure is not only the optimal method of oncological screening, but also allows anonymous diagnosis of bacterial, fungal and viral sexual infections without intervention at the stage of material collection by medical workers. Today in Ukraine, self-sampling technology for cervical cancer screening is indispensable and has no alternative. It allows for mass screening of the population, refugees and displaced persons affected by military operations, without diverting health care resources.


Articles:

1. ЧИ МОЖЛИВИЙ СКРИНІНГ РАКУ ПІД ЧАС ВІЙНИ?
2. ЄВРОПЕЙСЬКА МОДЕЛЬ УКРАЇНСЬКОГО СКРИНІНГУ: РОЛЬ ДЕРЖАВИ, ЛІКАРЯ ТА ПАЦІЄНТА
3. ВИЯВЛЕННЯ ВІРУСУ ПІПІЛОМИ ЛЮДИНИ МЕТОДОМ САМОЗАБОРУ (SELF SAMPLING): НОВА МОДЕЛЬ СКРИНІНГУ РАКУ ШИЙКИ МАТКИ
4. https://health-ua.com/article/41842-virus-papillomy-cheloveka-i-ego-vyyavlenie-metodom-samozabora-evropejskaya-

The number of people diagnosed with rectal and colon cancer is increasing worldwide. Over the past 45 years, the incidence in Ukraine has increased 52 times! The increase in incidence is influenced by the aging of the population, and also probably by the Western fat and meat diet. Due to late diagnosis, cancer is diagnosed in half of the patients at the stage of intestinal obstruction, bleeding, perforation, peritonitis and the appearance of distant metastases. At a late stage of the disease, it is impossible to carry out full-fledged antitumor therapy. Usually, in patients with complicated cancer, the surgeon is limited to the imposition of an intestinal stoma without any further hope of radical treatment. At the same time, according to the WHO, at the beginning of the 21st century, medicine had all the means necessary to fight colorectal cancer. The experience of developed countries has shown that mortality from this disease can be reduced with the help of prevention and screening programs, the purpose of which is not to detect cancer, but to diagnose precancerous polyps. The time it takes for a polyp to turn into a malignant tumor is an average of 5-10 years. Obviously, this is quite enough for timely recognition of the disease and, if necessary, effective treatment (endoscopic removal of a precancerous polyp).

Who is at risk of colorectal cancer 
Not every person can get cancer of the rectum and colon, although theoretically such a risk always exists. The probability of developing the disease may increase in people who are part of the "risk group". The main risk factor is a person's age. The number of polyps in the colon progressively increases after the age of 50, after which the incidence increases more than 20 times. Thus, people who have reached the age of 50 are automatically an object for population screening. The risk of colorectal carcinoma is also increased in non-specific ulcerative colitis and Crohn's disease. There are lineal colon cancers.

Screening test
Although the colonoscopy method is considered the "gold standard" of colon cancer screening, it is impossible to apply this method in wartime. A simple, convenient, reliable, safe and inexpensive test is preferred for the procedure of mass diagnostic research. Fecal Occult Blood (FOB test) meets these requirements. This technique has long been used for colorectal cancer screening in Western Europe, North America, and Japan. Finding of hidden blood in feces is based on the fact that during the movement of fecal masses through the intestines, there is an injury to the mucous membrane of the polyp, where blood vessels are located, which leads to the development of microscopic bleeding. Traces of blood in feces can be detected using an appropriate immunochemical reaction. The Finnish QuikRead go iFOBT test detects the level of occult blood in the stool in a few minutes. The Finnish diagnostic company Aidian (formerly Orion Diagnostica) has almost 50 years of experience in manufacturing reliable, fast and easy-to-use diagnostic tests for healthcare requirements. Aidian's best-known product is the QuikRead go CRP device and the quantitative iFOBT tests used with it. The immunochemical reaction is highly specific and can detect traces of hemoglobin in minor bleeding from the lower intestines. The examination procedure is safe, simple and hygienic. It can be repeated many times. The advantages of the method are the absence of the need for patient preparation. A fecal sample for rapid testing is collected in a special test tube at home, after which the test is delivered to the medical center according to the instructions on the package. The laboratory technician of the screening center conducts the analysis of fecal masses and enters the results of the study into the database. The result can be obtained within 10 minutes during a visit to the medical center. Do not collect a stool sample during menstruation, bleeding from hemorrhoids, bleeding from the urinary system, and when straining during defecation. In case of negative results, the test should be repeated with an interval of 1 time per year, with questionable results - 2 times per year. If there is a positive reaction of feces to occult blood, a detailed examination is required (consultation of a specialist and colonoscopy).

Lung cancer is one of the most common forms of malignancy in both men and women, with a poor prognosis and high mortality. Every fifth cancer patient dies from lung cancer. Throughout the 20th century, the incidence increased more than 14,000 times, and today more than 2.1 million cases are detected in the world per year. According to the bulletin of the National Cancer Registry, 10,000 people die out of 13,000 newly diagnosed lung cancer patients in Ukraine. 60% of patients die within the first year after diagnosis. In almost 40% of patients, the tumor is detected in the IV stage. Risk factors for lung cancer include age over 50 years, history of smoking, household exposure to radon, occupational exposure, family history of lung cancer, pulmonary fibrosis, emphysema, passive smoking, and high body mass index. High risk includes people aged 55-75 years who have smoked more than 30 pack/years and those who stopped smoking less than 15 years ago. The medium-risk group includes people over 50 years of age with a history of smoking more than 20 pack/years or passive smokers without additional risk factors. Previously, it was believed that people under the age of 50 with a smoking history of less than 20 pack/years do not belong to risk groups, however, there are justified fears that after the end of the war in Ukraine, the incidence will increase in both the military and the civilian population. The reason may be an increase in the number of smokers and contact with carcinogens (smoke, asbestos, dust, fine particles in inhaled air, etc.). Therefore, young people participating in hostilities can also be classified as medium risk.

Lung cancer screening 
The NELSON Study was completed in 2018, which showed that screening reduces lung cancer mortality by 26% in men and 40% in women. Since then, lung cancer screening programs have been incorporated into the national standards of most countries. A screening tool is low-dose computed tomography (CT), which can detect any small focal formations in the lungs. Nodules with a diameter of less than 3 mm do not pose a danger to patients. If a nodule with a diameter of 5 mm is detected, follow-up with repeated LDCT after 12 months is recommended. Nodules with a diameter of 6-7 mm require repeated LDCT after 6 months. For nodes with a diameter of 8-14 mm, LDCT is performed every 3 months or PET/CT is performed. For nodes larger than 15 mm, CT with contrast is performed in the usual diagnostic, not screening mode, or PET/CT is performed. At a low level of suspicion, these patients are examined every 3 months, at a high level of suspicion, a transthoracic or thorascopic biopsy is performed. Recently, artificial intelligence, neural connections, deep machine learning, and cloud technologies are being used to perform differential diagnosis between cancer and benign neoplasms. In recent years, several North American expert apparatus have issued guidelines for lung cancer screening for high-risk populations. Similar programs are actively developing in Great Britain, Italy, and many countries of the European Union. LDCT technology is recommended by the NCCN, and is also included in the national standards of countries with a high level of health care development.
For today's Ukraine, screening for cancer of the legends in the military and civilian population is of particular importance.

Article:
https://health-ua.com/article/45794-populyatcionnyj-skrining-raka-legkogo-vukraine

•      Every woman between the ages of 28 and 65 should be screened for cervical cancer
•      Every man and every woman over 50 should be screened for rectal and colon cancer
•      Men with a history of smoking should be screened for lung cancer
If you are reading this page, the first step to maintaining health has already been taken. No government programs and measures to intensify screening in the country will be effective if a person does not want to participate in it. The reasons for refusing a preventive examination can be fear, embarrassment, ignorance, lack of understanding of the purposes of the examination, fear of finding out a negative result.

The patient is at the center of the screening program. 
•      The screening procedure is performed only on the basis of official informed consent •      Screening measures will not disturb the work schedule 
•      During the examination the person will not have unpleasant feelings 
•      The whole process will be organized so that the results will be reported quickly and personally 
•      The patient is informed of the possibility of receiving false negatives and false-positive results
•      A plan of further measures is discussed with the screening participant in cases of both positive and negative screening tests
•      In the case of a positive test result, the patient gets the opportunity to immediately consult a specialist. The medical center has a pre-organized network for conducting such consultations
•      If necessary (positive or questionable test result), a clarifying examination (colposcopy, colonoscopy) is performed
•      If necessary, special treatment will be organized for the patient as soon as possible

Guidelines for cancer prevention
Below are the international guidelines for cancer prevention from the World Cancer Research Fund International, adapted for a lay audience.
1.     Eat as sparingly as possible, but you should not be underweight
•      Children and adolescents should have a body mass index (BMI) at the lower end of the normal BMI for the age of 21
•      Adults from the age of 21 should maintain a BMI within normal values, avoid increase in waist throughout adulthood.
 •      BMI (body mass index) is calculated using the formula: BMI=m/h2, where m is a person's body weight in kilograms, h is a person's height in meters. On the Internet, there is a convenient scale for automatically determining BMI.

2. Physical activity is determined by metabolic equivalence (MET), which should become a part of daily life. 
•      Moderate physical activity should be a mandatory daily habit (defined as brisk walking for 30 minutes) 
•      Aim for moderate physical activity for more than 60 minutes/day or vigorous physical activity for 30 minutes/day
 •     Jogging for 1 hour, cycling, playing tennis or swimming - 7 MET points 
•      Mowing the lawn or aerobic exercise for an hour - 6 MET points 
•      Walking for an hour for 6 days a week - 18 MET points 
•      Long daily sitting habits (e.g. sitting in a chair or watching TV) should be eliminated
Recently, there have been recommendations to increase physical activity, which apply to both elderly healthy people and cancer patients. All these groups are advised to engage in ballroom dancing, which is both a great aerobic exercise, a stress reliever and a mood booster.
3. It is necessary to limit the consumption of high-calorie foods and avoid sugary drinks.
4. Eat mostly plant-based foods 
•   Eat at least 400g of a variety of vegetables and fruits daily 
•   Eat whole grains and/or legumes with every meal 
•   Limit refined starchy foods
5. Limit consumption of red meat and avoid consumption of smoked meat
•      Eat less than 500 g of red meat (beef, pork, lamb) per week
•      Very limited use of meat that is salted, smoked or treated with chemical preservatives
6. Limit the consumption of alcoholic beverages
•      If it is still impossible to avoid the consumption of alcoholic beverages, they should be limited to 20-30 g of ethanol per day for men and 10-15 g of ethanol per day for women
7. Limit salt intake and avoid consumption of moldy grains (cereals and legumes)
•      Avoid foods that have been preserved with salt
•      Daily salt intake should be 2.4g
•      Store food without using salt (e.g. freezing)
8. Do not use dietary supplements to prevent cancer
9. Mothers should breastfeed newborns, babies should be breastfed
•      Babies should be breastfed until 6 months and then continue with complementary foods
10. Cancer patients who have completed cancer treatment should follow the same cancer prevention recommendations that healthy people receive relatively diet, healthy weight, and physical activity.


Articles:

1. https://health-ua.com/article/65615-rak-umolodyh-patcientov-problemy-profilaktiki-skrininga-lecheniya-ireabilit
2. https://health-ua.com/article/50048-profilakticheskaya-immunizatciya-onkologicheskih-patcientov
3. https://health-ua.com/article/44801-virusy-chelovecheskogo-raka
4. https://health-ua.com/article/41848-vaktcina-proti-vrusu-paplomi-lyudinivazhlivij-nstrument-dlya-pervinno-profl

Treatment in oncology means not only clinical recovery, but also the return of the patient to the former way of life
Today, the success of cancer treatment is measured both by the number of lives saved and by the number of people who are able to become full members of society again. In 1947, rehabilitation was officially declared by the American Board of Medical Specialties as an independent discipline, and in 1971, this direction was separated in the USA into a special interdisciplinary direction of clinical oncology. Currently, the rehabilitation of patients includes a multi-stage process of a system of professional medical, socio-economic and psychological measures

Tasks of the psychological service: 
•   Communication with patients, their family members and all members of the support service 
•   Coordination of this interaction 
•   Control of mental symptoms of the disease 
•   Continuity of care, including after-hours 
•   Training of family members to care for patients

The main fears experienced by oncology patients: 
•   Patients do not want to feel pain 
•   They want confirmation of respect for their personality 
•   They consider it important to have trust in the medical institution and medical worker 
•   They do not want to burden the family

One of the tasks of the "World Against Cancer" Foundation is psychological support, support and rehabilitation of cancer patients, as well as their family members. For this purpose, the foundation closely cooperates with certified psychologists, members of Ukrainian and international professional organizations. Oncology patients are supported and assisted at all stages of treatment - at the time of initial diagnosis, during radical or palliative treatment, as well as during the observation and rehabilitation period. Depending on the wishes of the patients, individual and group consultations are held in off-line or on-line mode, psychological rehabilitation sessions with the help of dance-motor therapy, as well as with the help of adaptive horse riding, the uniqueness of which is a harmonious combination of body-oriented and cognitive techniques impact on the mind of patients. Our specialists actively interact with the Zaporizhzhia city center of social services (at the level of a hotline), the Caritas-Zaporizhzhia charity fund, which actively accepts refugees and displaced persons during the war, including those diagnosed with oncological diseases, the "Deimos" horse club and a charity organization «Sribna Pidcova»

With the help of the World Against Cancer Foundation, the following areas of therapy are used in the center of psychological rehabilitation: 
•   Dialogic model of Gestalt therapy 
•   Biosuggestive therapy 
•   Cognitive-behavioral therapy 
•   Systemic family therapy 
•   Dance-motor therapy 
•   Hippotherapy

Articles:
ПСИХОЛОГІЧНА РЕАБІЛІТАЦІЯ В ОНКОЛОГІЇ