Morbidity of Breast Cancer Among Women in Moscow and Approaches to Improving Medical-Social Assistance

The dissertation is devoted to a comprehensive study of breast cancer morbidity among women in Moscow and the development of approaches to improving medical-social assistance for this category of patients. The research encompasses the analysis of epidemiological indicators — morbidity, mortality, and cumulative risk of developing malignant neoplasms of the breast — in dynamics over 1989–2004, both in Moscow and in the Russian Federation. Special attention is given to the state of oncological care during the healthcare reform period, including diagnosis and treatment, as well as the assessment of social maladaptation of women who have undergone radical treatment. Based on the conducted complex of studies, approaches to improving medical-social assistance within the framework of voluntary medical insurance are justified.

Relevance of the Topic. Malignant neoplasms of the breast occupy one of the leading positions in the structure of general oncological morbidity and mortality of the female population not only in the Russian Federation but also in many countries of Europe and America.

Despite the constant expansion of age and professional groups of women undergoing preventive examinations using the latest diagnostic methods, the proportion of active detection of patients with cancer of this location remains, on the whole, quite low in the country as a whole (Chisov V.I., Starinsky V.V., 2004).

At the present time, scientifically grounded improvement of organizational forms of prevention, timely detection, staged effective treatment, and comprehensive rehabilitation of patients with malignant neoplasms of the breast, conducted simultaneously with improvement of the quality of care provided, is necessary (Garkavtseva R.F., 2000; Zaridze D.G., 2002; Ivanov V.G., 2002; Terent'ev I.G., 2004).

Particular significance is assumed by questions of rehabilitation and correction of social maladaptation of patients, the creation of associations of women who have undergone treatment for malignant neoplasms of the breast. Despite the successes of medicine, not all women are able to return to a full life after the therapy conducted. A number of studies indicate a significant decrease in the quality of life of patients with this pathology (Voznykh E.K., Malova Yu.V., 1999; Broadhead J.K. et al., 1998; Fairclough D.L. et al., 1998). In the process of treatment, the task of forming an adequate attitude toward one's own personality and health, work, family, and society as a whole stands before the medical personnel and before the breast cancer patient herself (Trapeznikov N.N. et al., 1996; Alyasov A.V. et al., 2002; Butler L.D. et al., 1999; Tashiro M. et al., 2000). At the same time, many aspects of social maladaptation of patients remain insufficiently studied, and there are insufficient scientific investigations with justification for improving organizational forms of rational detection, treatment, and rehabilitation of oncological patients. The above determines the necessity of optimizing the system of organization of medical-social assistance for patients with malignant neoplasms of the breast, which became the basis for choosing the topic and conducting the present research.

Goal of the Research: to develop approaches to improving medical-social assistance for women who have undergone radical treatment for malignant neoplasms of the breast, based on the study of morbidity of this pathology and mortality from it.

Tasks of the Research:

1. To analyze data from domestic and foreign scientific literature on morbidity, mortality, key indicators of oncological care, and social maladaptation of women with malignant neoplasms of the breast.

2. To study morbidity and mortality from malignant neoplasms of the breast of the female population of Moscow, determine the cumulative risk of developing this pathology, and compare them with analogous indicators in the Russian Federation.

3. To analyze the state of oncological care for women suffering from malignant neoplasms of the breast in Moscow, determine the accumulation index of contingents.

4. To conduct a comprehensive assessment of social maladaptation of women who have undergone radical treatment for breast cancer, study the features of their attitude toward their own illness.

5. To develop, within the framework of voluntary medical insurance, approaches to improving medical-social assistance for women suffering from malignant neoplasms of the breast.

Scientific Novelty of the Research. In the conducted comprehensive socio-hygienic research, for the first time:

- trends in morbidity in various age groups from malignant neoplasms of the breast among women of Moscow are presented in dynamics for 1989-2004, mortality from them is presented, and the cumulative risk indicator for developing this pathology is determined;

- the state of diagnostic and therapeutic measures for detection and treatment of malignant neoplasms of the breast among women of Moscow during the healthcare reform period is analyzed, and the accumulation index of contingents is determined;

- based on a developed questionnaire, a comprehensive assessment of social maladaptation of women suffering from malignant neoplasms of the breast in the occupational, family, domestic spheres, and sphere of self-service is provided, data on the features of their attitude toward their own illness are presented;

- within the framework of voluntary medical insurance, approaches to improving medical-social assistance for women suffering from malignant neoplasms of the breast are determined.

Practical Significance of the Research.

Over more than a decade, an analysis of morbidity from malignant neoplasms of the breast among women of Moscow has been conducted in comparison with data for the Russian Federation, mortality from them, and the organization of medical-social assistance provided to them during the healthcare reform period.

The study of patients' attitude toward their own illness, maladaptation in the occupational, family, domestic spheres, and sphere of self-service has been conducted; the obtained data allow targeted optimization of existing rehabilitation methods for this category of women.

Scientifically grounded approaches to improving medical-social assistance for women within the framework of voluntary medical insurance have been developed.

Implementation of the Research Results.

The materials of the research and the obtained results are used in the State Scientific Center of the Russian Academy of Medical Sciences National Radiation Epidemiological Register and in the State Unitary Enterprise State Scientific Center Institute of Biophysics of the Federal Medical-Biological Agency.

Presentation of the Research Results. The dissertation was presented at the joint scientific conference of the departments of public health and healthcare with a course in economics of the Moscow Medical Academy named after I.M. Sechenov, public health with a course in preventive medicine of the Healthcare Department of the Moscow Medical Academy named after I.M. Sechenov on December 13, 2005. The main provisions of the dissertation were reported at the scientific-practical conference "Health and Education in the XXI Century" (Moscow, December 10, 2005), at the scientific-practical conference "Healthcare of the Bogorodsky Region for 175 Years" (Noginsk, December 8, 2005), and at the scientific-practical conference "Influence of Socio-Economic Transformations on Health and Healthcare" (Izhevsk, September 2005).

Publications. Five scientific works have been published on the topic of the dissertation.

Main Provisions of the Dissertation to be Defended.

1. Over a 16-year observation period, a clear trend toward increasing morbidity from malignant neoplasms of the breast is traced. The average annual growth rate of the standardized indicator in the Russian Federation is 1.54%, and in Moscow is 2.28%, respectively. The simultaneously observed increase in the cumulative risk of developing this pathology and mortality indicators from it further aggravates malignant neoplasms of the breast as the most important medical-social problem.

2. Medical-social assistance provided to women suffering from malignant neoplasms of the breast in Moscow does not include social adaptation of this group of patients; measures developed for improving medical-social assistance should take into account the features of women's attitude toward their own illness.

3. Improvement of medical-social assistance for women suffering from malignant neoplasms of the breast should be comprehensive; solving this problem requires mobilization of all available resources, including resources of voluntary medical insurance.

4. Within the framework of voluntary medical insurance, the basic principles of improving medical-social assistance for women suffering from malignant neoplasms of the breast are prognostic monitoring of the risk of developing this pathology, expansion of basic programs by including high-technology methods of diagnosis and treatment, improvement of the organizational structure of medical supply for the insured and the system of rehabilitation of women's health as a unified complex including measures for correction of physical defect, social and psychological rehabilitation of the patient.

Volume and Structure of the Dissertation.

The dissertation consists of an introduction, an analytical literature review, methodology of the author's research, three chapters presenting the results of the author's research, conclusion, conclusions and proposals, a list of literature including 125 domestic and 68 foreign sources, as well as 4 appendices.