Participants in an Economic Forum discussion devoted to the prevention and treatment of cancer – both practitioners and representatives of the Ministry of Health – debated how to fight breast cancer in a systemic way and, above all, how to build a preventive system in the fight against cancer and how to build awareness about the importance of this research.
At the beginning, participants and listeners to the debate learned statistics about the implementation of the mammography programme. – “The national average in Poland is 36%. This compares with Denmark at 83%, Sweden at 80%, Slovenia at over 77%, and the Czech Republic at over 58%. Breast cancer is the second cause of death from oncological diseases after lung cancer”, said Marcin Piasecki of “Rzeczpospolita” daily, who opened the debate.
Encouraging prevention
One of the main problems that were raised during the discussions was precisely the low rate of women’s attendance at preventive examinations. – “Certainly, these figures regarding the attendance of Polish women for examinations are not optimistic. As the Ministry of Health, we also see that the current results of breast cancer treatment, despite the fact that we have better and better techniques and new drugs appearing regularly on our list of reimbursed drugs, are not the same as in Western European countries”, said Waldemar Kraska, Deputy Minister of Health. – “This is for a simple reason. Women usually present at a stage when this treatment effect is considerably worse than if they had presented at the beginning, when the first symptoms appeared. We are preparing some new solutions”, the Deputy Minister announced. – “But I think what has happened recently in the prevention and treatment of breast cancer is quite a success story. Let me remind you that we have replaced all mammography units with digital ones”, added Waldemar Kraska.
Why do relatively few women in Poland register for preventive examinations? – “We do not have the data. There is no answer to this question”, said Anna Kupiecka, founder and President of the OnkoCafe Foundation – Better Together. – “It is also puzzling why some centres and some regions are able to implement a mammography prevention programme at 45 or 50% and other municipalities at 5%. This is something that should probably be looked into because access should be equal”, she stressed.
– “We run campaigns in cooperation with women’s associations as Prevention ambassadors. We provide training, including on self-examination, education, and the role of early detection. However, it’s an all-hands-on-board kind of situation”, said Anna Kupiecka. – “Perhaps the reason for the current situation is the lack of confidence in these tests. Perhaps a good solution would be to invite via the IKP system (Internet Patient Account – ed.) the patients who are entering an age associated with an increasing probability of disease”, she suggested.
The important role of the Primary Health Care Physicians
What else can positively contribute to the cancer early warning system? – “This is an important topic, but it needs to be approached systemically, looking at the whole diagnostic and therapeutic pathway for our patients. Also, to find a way to reach those healthy people who do not participate in preventive screenings”, pointed out Dr. hab. Adam Maciejczyk, General Director of the Lower Silesian Oncology Centre. – “In Lower Silesia, we defined problems with access to mammography examinations in various municipalities or districts during the pilot of the National Oncology Network. By basing our analysis on data, we were able to obtain funding from the Marshal’s Office for the purchase of four digital mammograms, which are linked to our diagnostics department”, the expert said.
– “What is important, what has worked in Poland, is the involvement of primary health care system (POZ) in this activity. The GPs have several thousand healthy people under their care, and they should also feel the burden of duty to persuade the ladies under their care to participate in these tests. As part of the pilot of the National Oncology Network, as we informed our friends, the GPs, that we are able to verify who is more effective in this area and who is not”, added Dr. Maciejczyk.
How does the Ministry of Health assess this approach? – “Certainly, when it comes to doctors from primary care, there is still untapped potential”, admitted Deputy Minister Kraska.
There was also a voice from the National Health Fund (NFZ) in the debate. – “Speaking of primary health care, it is already the case that those working in this area are involved in promoting prevention. It seems that the most important thing is to change the perception of all these prevention activities. It is very important that the patient does not go to the doctor with an advanced disease, but at its beginning”, stressed Małgorzata Dziedziak, Deputy President of the NFZ for operations.
The conversation about prevention took place in Karpacz on various levels. – “The Polish Pharmacoeconomic Society deals with health economics, and so do I in my daily work. If we are talking about breast cancer, the BRCA1 and BRCA2 genetic test is probably the most discussed in the public debate today. There is a NFZ programme under which it can be done, but it is not done universally”, said Michał Jachimowicz, Secretary of the Polish Pharmacoeconomic Society and co-owner of MAHTA.
Proposed actions
The subject of different incentives when it comes to screening also came up repeatedly during the discussion.
– “We have a 7% difference between a province where survival rates are 82% and one where they are 75%. This needs to be remedied so that every woman has this opportunity for treatment, regardless of location”, said Dr. Joanna Didkowska, Head of the National Cancer Registry. – “I would still like to touch on the subject of compulsion or the lack thereof, when doing screening. Finland has been very successful in this research, both in breast cancer and cervical cancer. There, it was made compulsory – the economic imperative was behind this. It was the 1960s. This was later abandoned as such an action was considered a violation of human rights. But it seems to me that it is the employer’s right to have a healthy employee. Therefore, if, for example, screening was incorporated into occupational medicine examinations, the participation of women in such examinations could increase dramatically”, Dr. Didkowska noted.
The discussion in Karpacz was also about prevention awareness. – “I’ll come back to building awareness of prevention – both primary and secondary – because, I think, that’s where you have to start. We still need a lot of education and work on women’s awareness because, at least in our province, Łódź, it is so that women do not want to be examined as they are afraid”, noted Magdalena Janus-Hibner, deputy director for projects, development and organisation of oncology, from the Nicolaus Copernicus Province Multispecialist Oncology and Traumatology Centre in Łódź – “This fear, however, determines that we do not show up for these examinations”, she stressed. – “So, we have built up such a network related to the fact that we go around the municipalities, we work with mayors, village heads, and commune heads. We organise transport to our hospital on Saturdays. We also organise childcare if women don’t have anybody to leave their children with”, she described.
Deputy Minister Waldemar Kraska pointed out that the system works differently when it comes to patients after a cancer diagnosis.
– “If we get that upsetting result, when our world sometimes turns upside down, there is a coordinator – a person who leads us by the hand through the system. At the moment, the patient is already aware that if s/he has a preventive examination and the diagnosis is not good, s/he will be cared for; there will be a person to guide such a patient through the system. I know that such coordinators are sometimes even called at night by patients to inform them that something is happening”, said the Deputy Minister. – “I think this is the element that should also make Poles willing to get tested and make them confident that they will not be left alone”, concluded Waldemar Kraska.
