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Gynaecological Cancer Mortality in Serbia, 1991-2010: A Joinpoint Regression Analysis

  • Ilic, Milena;Ilic, Irena
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.1
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    • pp.157-162
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    • 2015
  • The descriptive epidemiological study aimed to analyse the mortality trends from gynaecological cancer in Serbia. Average annual percentage of change (AAPC) and the corresponding 95% confidence intervals (CIs) were computed for trend using joinpoint regression analysis. Nearly 25,000 gynaecological cancer deaths occurred in Serbia during the 1991-2010 period, with the average annual age-standardised mortality rate being 17.2 per 100,000 women. Increase of mortality was observed for cancer of the vulva and vagina (AAPC=+1.3%, 95% CI=0.1 to 2.6), ovarian cancer (AAPC=+0.8%, 95% CI=0.4-1.3) and for cervical cancer (AAPC=+0.7%, 95% CI=0.3 to 1.1). Mortality rates for gynaecological cancer overall declined in women aged 30-39 years, but mortality was increased in middle-aged women (for cervical cancer) and in the elderly (for ovarian cancer). Improvements to and implementation of the national cervical cancer screening programme conducted in 2013 and expected to be finalised in the following years throughout Serbia should contribute to improvement.

Cigarette Smoking and Breast Cancer: a Case-control Study in Serbia

  • Ilic, Milena;Vlajinac, Hristina;Marinkovic, Jelena
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6643-6647
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    • 2013
  • Background: Despite the fact that breast cancer is the most common female cancer worldwide, more than half of the breast cancer risk factors remained unexplained. The aim of this study was to investigate the association of cigarette smoking with risk of breast cancer. Materials and Methods: A case-control study was conducted in the Clinical Centre of Kragujevac, Serbia, covering 382 participants (191 cases and 191 controls). In the analysis of data logistic regression was used. Results: Breast cancer risk was significantly increased in those who quit smoking at ${\leq}50$ years of age (OR=2.72; 95% confidence interval - 95%CI=1.02-7.27) and in those who quit smoking less than 5 years before diagnosis of the disease (OR=4.36; 95%CI=1.12-16.88). When smokers were compared with nonsmokers without passive exposure to smoking, former smoking significantly increased breast cancer risk (OR=2.37; 95%CI=1.07-5.24). Risk for breast cancer was significantly increased in those who quit smoking at ${\leq}50$ years of age (OR=3.29; 95%CI=1.17-9.27) and in those who quit smoking less than 5 years before diagnosis of the disease (OR=5.46; 95%CI=1.34-22.28). Conclusions: These data suggest that cigarette smoking is associated with an elevated risk of breast cancer among former smokers in Serbia.

Skeletal Manifestations of Hydatid Disease in Serbia: Demographic Distribution, Site Involvement, Radiological Findings, and Complications

  • Bracanovic, Djurdja;Djuric, Marija;Sopta, Jelena;Djonic, Danijela;Lujic, Nenad
    • The Korean Journal of Parasitology
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    • v.51 no.4
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    • pp.453-459
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    • 2013
  • Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was $40.9{\pm}18.8$ years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.

Comparison of Male and Female Breast Cancer Incidence and Mortality Trends in Central Serbia

  • Sipetic-Grujicic, Sandra;Murtezani, Zafir;Ratkov, Isidora;Grgurevic, Anita;Marinkovic, Jelena;Bjekic, Milan;Miljus, Dragan
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.10
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    • pp.5681-5685
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    • 2013
  • Background: To compare breast cancer incidence and mortality trends in Central Serbia between males and females in the period 1999-2009. Materials and Methods: In this descriptive study, mortality data were obtained from the National Statistics Institute and morbidity data were derived from Institute of Public Health of Serbia for the period of interest. Results: Breast cancer is a leading cancer in the female population of Central Serbia, whereas in male population it is not on the list of 10 leading localizations, concerning both incidence as well as mortality. In the period 1999-2009 the average standardized incidence rates of breast cancer were 60.5/100,000 in women and 1.4/100,000 in men, while average standardized mortality rates were 20.4/100,000 and 0.4/100,000. The average standardized incidence and mortality rates were about 45 times higher in females than males. Male breast cancer comprises approximately 2.1% of all breast cancer cases. The average age-specific mortality and incidence rates increased with age in both sexes. In the observed period standardized mortality rates of breast cancer increased significantly only in men ($y=0.320+0.0215{\times}$, p=0.044). Conclusions: The increase of breast cancer incidence in both sexes and mortality in men, indicate an urgent need for Serbian health professionals to apply existing cancer control and preventive measures. Male breast cancer is more present than in other world regions, with an outstanding increase of mortality, which demands a timely identification (screening) and adequate treatment. A national policy including mammography should be considered in the light of the newest findings.

Mortality from Stomach Cancer in Serbia, Excluding the Province of Kosovo, in the 1991-2009 Period

  • Ilic, Milena;Prodovic, Tanja;Milosavljevic, Zoran;Ljujic, Biljana
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.3
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    • pp.2067-2070
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    • 2013
  • Background/Aim: Stomach cancer is the second most common cause of death from all malignant tumors in the world (third in men, fifth in women), with a strong decreasing trend in most developed countries. The aim of this descriptive epidemiological study was to analyze mortality of stomach cancer in Serbia, excluding the Province of Kosovo, in the 1991-2009 period. Materials and Methods: In data analysis, we used mortality rates which were standardized directly using those of the world population as a standard. In order to analyze the mortality trend from stomach cancer, linear trend and regression analysis were used. Confidence intervals (CIs) for the average age-adjusted and age-specific mortality rates were assessed with 95% level of probability. Mortality data were derived from the data file of the Statistical Office of the Republic of Serbia. Results: During the 1991-2009 period, a significant downward trend in mortality of stomach cancer was recorded in Serbia (y=9.78 - 0.13x, p=0.000; average annual percent change was -6.3 (95%CI, -7.8 to - 4.8). During the same period, a significant decrease in mortality trend was found both in male (y=14.13 - 0.20x; p=0.000; % change was -7.7 (95%CI, -10.9 to -4.5) and female populations (y=6.27 - 0.08x; p=0.000; % change was - 4.4 (95%CI, -5.3 to -3.6). Conclusion: Decreasing trends in mortality from stomach cancer in Serbia are similar to those in most developed countries.

Multivariate Analysis of Prognostic Factors in Male Breast Cancer in Serbia

  • Sipetic-Grujicic, Sandra Branko;Murtezani, Zafir Hajdar;Neskovic-Konstatinovic, Zora Borivoje;Marinkovic, Jelena Milutin;Kovcin, Vladimir Nikola;Andric, Zoran Gojko;Kostic, Sanja Vladeta;Ratkov, Isidora Stojan;Maksimovic, Jadranka Milutin
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.7
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    • pp.3233-3238
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    • 2014
  • Background: The aim of this study was to analyze the demographic and clinical characteristics of male breast cancer patients in Serbia, and furthermore to determine overall survival and predictive factors for prognosis. Materials and Methods: In the period of 1996-2006 histopathological diagnosis of breast cancer was made in 84 males at the Institute for Oncology and Radiology of Serbia. For statistical analyses the Kaplan-Meier method, long-rank test and Cox proportional hazards regression model were used. Results: The mean age at diagnosis with breast cancer was $64.3{\pm}10.5$ years with a range from 35-84 years. Nearly 80% of the tumors showed ductal histology. About 44% had early tumor stages (I and II) whereas 46.4% and 9.5% of the male exhibitied stages III and IV, respectively. Only 7.1% of male patients were grade one. One-fifth of all patients had tumors measuring ${\leq}2cm$, and 14.3% larger than 5 cm. Lymph node metastasis was recorded in 40.4% patients and 47% relapse. Estrogen and progesterone receptor expression was positive in 66.7% and 58.3%, respectively. Among 14.3% of individuals tumor was HER2 positive. About two-thirds of all male patients had radical mastectomy (66.7%). Adjuvant hormonal (tamoxifene), systematic chemotherapy (CMF or FAC) and adjuvant radiotherapy were given to 59.5%, 35.7% and 29.8% patients respectively. Overall survival rates at five and ten years for male breast cancer were 55.0% and 43.9%, respectively. According to the multivariate Cox regression predictive model, a lower initial disease stage, a lower tumor grade, application of adjuvant hormone therapy and no relapse occurrence were significant independent predictors for good overall survival. Conclusions: Results of the treatment would be better if disease is discovered earlier and therefore health education and screening are an imperative in solving this problem.

Development of a Risk Index for Prediction of Abnormal Pap Test Results in Serbia

  • Vukovic, Dejana;Antic, Ljiljana;Vasiljevic, Mladenko;Antic, Dragan;Matejic, Bojana
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.8
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    • pp.3527-3531
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    • 2015
  • Background: Serbia is one of the countries with highest incidence and mortality rates for cervical cancer in Central and South Eastern Europe. Introducing a risk index could provide a powerful means for targeting groups at high likelihood of having an abnormal cervical smear and increase efficiency of screening. The aim of the present study was to create and assess validity ofa index for prediction of an abnormal Pap test result. Materials and Methods: The study population was drawn from patients attending Departments for Women's Health in two primary health care centers in Serbia. Out of 525 respondents 350 were randomly selected and data obtained from them were used as the index creation dataset. Data obtained from the remaining 175 were used as an index validation data set. Results: Age at first intercourse under 18, more than 4 sexual partners, history of STD and multiparity were attributed statistical weights 16, 15, 14 and 13, respectively. The distribution of index scores in index-creation data set showed that most respondents had a score 0 (54.9%). In the index-creation dataset mean index score was 10.3 (SD-13.8), and in the validation dataset the mean was 9.1 (SD=13.2). Conclusions: The advantage of such scoring system is that it is simple, consisting of only four elements, so it could be applied to identify women with high risk for cervical cancer that would be referred for further examination.

Differencies in the Level of Knowledge on Cervical Cancer among Health Care Students, Midwives and Patients in Serbia

  • Antic, Ljiljana Gojko;Djikanovic, Bosiljka Svetozar;Antic, Dragan Zivojin;Aleksopulos, Hristos Georgios;Trajkovic, Goran Zivojin
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.7
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    • pp.3011-3015
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    • 2014
  • Background: Level of midwife knowledge is particularly important because of their role in the cervical cancer prevention programme. The aim of this study was to examine differences in the level of knowledge among health care students, midwives and women in the general population of Serbia. Materials and Methods: A cross-sectional approach was used with health care students of the medical shool, midwives in their practice, and women visiting a chosen general practitioner as respondents. Results: In comparison with the students and midwives, women had lower level of knowledge of causative agents of the cervical cancer, genital warts, HPV types, screening for cervical cancer as well as about the target population for vaccine and its role. Differences in the numbers of right answers of respondents were statistically significant (p<0.001). Four or more correct answers were obtained from 22.7% women, 35.3% from midwives and 83.8% from students. Conclusions: Midwives should improve their own level of knowledge related to preventive practice for cervical cancer, as well as their personal compliance with recommended practices, in order to be qualified and credible promoters of cervical cancer control among women in Serbia.

Variability of Stem-Base Infestation and Coexistence of Fusarium spp. Causing Crown Rot of Winter Wheat in Serbia

  • Jevtic, Radivoje;Stosic, Nemanja;Zupunski, Vesna;Lalosevic, Mirjana;Orbovic, Branka
    • The Plant Pathology Journal
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    • v.35 no.6
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    • pp.553-563
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    • 2019
  • Investigations related with factors influencing root and crown rot are rare and mainly related to farming practice and soil management. The main objective of this study was to examine broader range of factors influencing stem-base infestation of winter wheat in the field conditions. The effect of spatial distribution of infected plants on disease index (DIs) assessments was also investigated. Analysis of factors influencing DIs of crown rot of wheat demonstrated significant influence of the growing seasons (P < 0.001) and extreme fluctuations in winter temperatures (P < 0.001). In addition to that, localities together with their interaction with the growing season also significantly influenced DIs (P < 0.001). Aggregation of infected plants influenced variability of DI estimations, and it was pointed out that more extensive investigation should be conducted on broad range of DI in order to establish sampling method giving uniform sampling precision. Fusarium graminearum was shown to be predominant Fusarium species in Serbia (72.6%) using sequence-characterized amplified region analysis. Interestingly F. oxysporum was isolated in higher frequencies (27.4%) than it was reported in the literature. Given that there were no reports on the diversity of Fusarium species causing crown rot of wheat in Serbia, this study presents first report on this important subject. It also indicated that more attention should be focused on combined effects of abiotic and biotic factors influencing stem-base infestation of winter wheat. This knowledge will contribute to better understanding of factors influencing root and crown rot of wheat which would ensure sustainable disease management in the future.

Glutathione S-Transferase T1 and M1 Polymorphisms and Risk of Uterine Cervical Lesions in Women from Central Serbia

  • Stosic, Ivana;Grujicic, Darko;Arsenijevic, Slobodan;Brkic, Marija;Milosevic-Djordjevic, Olivera
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.7
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    • pp.3201-3205
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    • 2014
  • The aim of this study was to investigate the frequencies of GSTT1 and GSTM1 deletion polymorphisms in newly-diagnosed patients with uterine cervical lesions from central Serbia. Polymorphisms of GST genes were genotyped in 97 patients with cervical lesions and 50 healthy women using a multiplex polymerase chain reaction (PCR). The GSTM1 null genotype was significantly more prominent among the patients than in controls (74.2% vs 56.0%), the risk associated with lesions being almost 2.3-fold increased (OR=2.26, 95%CI=1.10-4.65, p=0.03) and 3.17-fold higher in patients above >45 years old (95%CI=1.02-9.79, p=0.04). The analysis of the two genotypes demonstrated that GSTM1 null genotype significantly increased risk only for low grade squamous intraepithelial lesion-LSIL (OR=2.81, 95%CI=1.03-7.68, p=0.04). GSTT1 null genotype or different genotype combinations were not found to be risk factors, irrespective to lesion stages, age or smoking. We found that the risk of cervical lesions might be significantly related to the GSTM1 null genotype, especially in women aged above 45 years. Furthermore, the GSTM1 polymorphism might have greater role in development of early stage lesions.