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MT S C IM DCH T HC QUA GHI NHN UNG TH TI H NI Trn Vn Thun, Bnh vin K v Vin nghin cu phng chng ung th Tm tt:

t vn : Ung th l mt trong nhng nguyn nhn gy t vong hng u cc nc ang pht trin,trong c Vit Nam. Mc tiu: (1)M t t l mc ung th ti H Ni trong giai on 2001-2005 (2) xut mt s gii php phng chng ung th cho cng ng dn c H Ni. i tng v phng php: Nghin cu s liu sn c theo phng php ghi nhn ung th qun th. Kt qu: t l mc ung th cao nht ti qun Hon Kim (164,2/100.000) v thp nht qun Long Bin (37,3/100.000). T l mc ung th bt u tng nhanh t sau tui 40 c 2 gii. C s khc bit c ngha thng k (P< 0,01) v t l mc ung th ph qun phi, ung th gan, ung th d dy, ung th h hng thanh qun gia nam v n. I. T VN Theo c tnh ca T chc Y t th gii (TCYTTG), mi nm trn ton cu c khong 11 triu ngi mi mc v 6 triu ngi t vong do ung th, trong trn 60% l cc nc ang pht trin[1]. Ti Vit Nam, theo nhn nh ca B Y t, m hnh bnh tt ca Vit Nam l m hnh bnh tt kp. Song song vi vic cc bnh ly nhim nh t, u ma, st rt ang tng bc c y li th cc bnh khng ly nhim nh ung th, tim mch, i tho ng, ri lon tm thn ang c xu hng gia tng ging nh m hnh ca cc nc pht trin[2]. H Ni l ni t cc n v u ngnh v phng chng ung th v cng l ni u tin c trin khai ghi nhn ung th[3]. S liu v ghi nhn ung th H Ni s phn no i din cho s liu ung th min Bc Vit Nam. S liu ny cng s gp phn quan trng cho cc nh hoch nh chnh sch v cc nh chuyn mn ra chin lc thch hp cho vic phng v iu tr bnh ung th cho tng vng ti Vit Nam. Chnh v vy, ti nghin cu ny nhm: 1. M t t l mc ung th ti H Ni trong giai on 2001-2005. 2. xut gii php phng chng ung th cho cng ng dn c H Ni II. I TNG V PHNG PHP NGHIN CU 1. i tng nghin cu: Tt c cc trng hp c chn on ln u l "ung th" hoc " u c tnh", bnh bch cu cp v mn tnh. C hay khng c chn on gii phu bnh l, c a ch thng tr ti H Ni v c ghi nhn t 1/1/200131/12/2005. 2. a im nghin cu: 25 c s y t ca H Ni c bao gm 9 Qun ni thnh v 5 huyn ngoi thnh.

3. Thit k nghin cu: Nghin cu s liu sn c da trn phng php " Ghi nhn ung th qun th" ca Hi nghin cu ung th th gii (IARC) 4. Cng c nghin cu: Phiu ghi nhn cc thng tin cn thit c thit k da trn cc khuyn co ca Hi nghin cu ung th th gii (IARC). Cc thng tin cn thu thp bao gm gii tnh, tui, ngy chn on ung th, c s chn on, loi ung th, cc xt nghim lm 5. Phng php thu thp thng tin: Vic thu thp thng tin c tin hnh theo 2 cch: ghi nhn th ng (c s gi thng tin cho cn b ghi nhn) v ghi nhn ch ng (cn b ghi nhn ch ng ti c s ly thng tin). Cc s liu chnh c ly t cc ngun sau ca 25 c s y t ca H Ni, bao gm: H s bnh n, s ca phng k hm (a khoa v chuyn khoa), s ghi kt qu t bo, gii phu bnh l, s i th, s ca cc phng xt nghim khc (ni soi, huyt hc, X quang, CTScan, siu m, sinh ho min dch), s bnh nhn ngoi tr. 6. X l s liu S liu c nhp v phn tch bng phn mm CANREG (cancer registry) s dng ring cho ghi nhn ung th. Phn mm ny c tc dng lc c cc trng hp bnh khng phi sng H Ni v nhng trng hp cng 1 bnh nhn nhng n khm nhiu c s y t khc nhau. Cc s liu c lc th trc khi nhp v vic nhp s liu c lm 2 ln m bo tnh chnh xc ca s liu. III. KT QU 1. Phn b t l mc ung th theo a d Tng s ca mc ung th ghi nhn c l 20351 ca trong nam gii l 11136 ca (54,7%) v n gii l 9215 (45,3%). Bng 1: Phn b s trng hp mc ung th theo a l hnh chnh giai on 2001-2005 Qun/Huyn S lng T l % T l mi Dn s* mc th (CR) 139,7 164,2 163,8 137,5 49,5 77,6 230500 178700 312300 372200 266000 288000

Ba nh Hon Kim Hai Trng ng a Sc Sn ng Anh

1610 1467

7,9 7,2 12,6 12,6 3,2 5,5

B 2558 2559 659 1118

Gia Lm T Lim Thanh Tr Ty H Cu Giy Thanh Xun Hong Mai Long Bin Khng qun Tng s
*

1144 1039 1095 663 909 1088 478 348 r 3616 20351

5,4 5,1 5,4 3,3 4,5 5,3 2,3 1,7 17,8 100

107,9 79,4 132,9 122,7 106,5 111,3 40,6 37,3

212000 261800 164800 108100 170.700 195.500 235.700 186.400

130,2

3126900

Dn s theo iu tra quc gia dn s 1999

Bng 1 cho thy t l mi mc ung th cao nht ti qun Hon Kim (164,2/100.000), th hai l qun Hai B Trng (163,8/100.000) v thp nht l qun Long Bin (37,3/100.000). 2. Cc hnh thc chn on ung th
GPB nguyn pht 47% L sng m 10% X-Quang, Siu m 29%

GPB di cn 2%

Tbo (huy t hc) 10%

Ni soi, MTD, sinh ho 2%

Biu 1: Cc hnh thc chn on ung th Biu 1 trnh by v cc hnh thc chn on ung th ti H Ni. 47% s trng hp ung th c chn on da vo gii phu bnh nguyn pht, 10% da vo kt qu thm khm lm sng. 3. T l mi mc ung th theo gii v nhm tui

1400 1200 1000 800 647 600 400 200 0


4 04 -1 10 4 -2 20

1163 1064 1008

498 598 542555 414 459 418 260 345 272 141 90 141 72
4 -3 30 4 -4 40 4 -5 50 4 -6 60 4 -7 70

Nam N

Biu 2: T l mi mc ung th theo gii v nhm tui Trong giai on 2001-2005, t l ung th tng dn theo tui c nam v n, nhng s khc bit r rt bt u t tui 50 (Biu 2) v tui cng cao th s khc bit cng ln. 4. T l mc chun theo tui v phn b tng loi ung th theo gii Bng 2: Phn b tng loi ung th ghi nhn c giai on 2001-2005 theo gii Loi ung th Nam (%) N (%) Tng (%) ASR Nam Ung th ph qun phi Ung th d dy Ung th gan Ung th i trc trng Ung th thc qun Ung th v Ung th c t cung Ung th vm 481 (67,3) 2374 (76,0) 1847 (64,0) 1244 (80,4) 852 (55,3) 634 (85,7) 60 (2,8) 750 (24,0) 1037 (36,0) 304 (19,6) 688 (44,7) 106 (14,3) 2076 (97,2) 675 (100,0) 234 (32,7) 3124 (15,4) 2884 (14,2) 38,5 29,2 N 10,5 14,3 4,3 9,8 1,4 28,5 9,0 7,2 3,2

1548 (7,6) 19,4 1540 (7,6) 13,5 740 (3,6) 2136 (10,5) 675 (3,3) 715 (3,5) 9,9 0,9

Ung th hch Ung th mu Ung th bng quang Ung th tuyn gip Ung th thanh qun

525 (58,1) 646 (68,0) 219 (78,2) 128 (22,9) 145 (85,8)

379 (41,9) 304 (32,0) 61 (21,8) 430 (77,1) 24 (14,2) 23 (11,2) 103 (45,8) 372 (100,0)

904 (4,4) 950 (4,7) 280 (1,4) 558 (2,7) 169 (0,8) 206 (1,0) 225 (1,1) 372 (1,8) 156 (0,8)

8,1 5,6 3,5 1,7 2,3 2,8 1,8

5,3 4,2 0,9 5,4 0,4 0,3 1,4 5,0

Ung th h hng thanh qun 183 (88,8) Ung th phn mm Ung th bung trng Ung th tuyn tin lit Cc ung th khc Tng 156 (100,0) 1520 (48,0) 11136 122 (54,2)

2,6

1649 (52,0) 9215

3169 (15,6) 20351

Bng 2 cho thy ung th ph qun phi l ung th hay gp nht c 2 gii. Tip theo l ung th d dy, gan, i trc trng, thc qun, v, c t cung, vm hng, hch, mu v ung th bng quang. C s khc nhau c ngha thng k ca ung th ph qun phi, ung th gan, ung th d dy, ung th thc qun, ung th thanh qun gia nam v n (P < 0,01) IV. BN LUN 1. Bn lun v phng php nghin cu Ghi nhn ung th l phng php dng xc nh cc trng hp mi mc v xu hng bnh ung th c T chc nghin cu ung th th gii pht trin v c s dng cho 500 t chc ghi nhn ung th qun th. iu ny c ngha l phng php ghi nhn ny l phng php chun v m bo tin cy. Phiu s dng ghi nhn c pht trin t cc khuyn co ca T chc nghin cu ung th quc t m bo thu thp y cc thng tin cn thit. Vic nhp v phn tch s liu cng s dng phn mm c trng cho ghi nhn ung th m bo tnh chnh xc ca s liu ghi nhn.

Tuy nhin, vic ghi nhn ung th vn cn nhng hn ch nht nh. Th nht, khng phi tt c cc trng hp mc ung th ti cng ng u n khm v chn on ti cc c s y t. Mt khc, vic ghi nhn mang tnh cht m t nn khng th xc nh c nguyn nhn ca tng loi ung th. 2. T l mc ung th theo a d Kt qu nghin cu ca chng ti cho thy trong giai on ghi nhn, t l mi mc ung th cao nht qun Hon Kim v thp nht qun Long Bin. S d c s khc bit ny c th do qun Hon Kim l qun c t lu i nht, dn s y phn ln l dn s gi v ngi dn sng nhng nh cht chi, mi trng nhim trong khi qun Long Bin l qun tng i tr vi tnh cht dn c phn ln t ni khc ti, cu trc dn c tr v mi trng cng t nhim hn. Mt khc, trnh dn tr ca qun Hon Kim cng tng i cao nn ngi dn cng c nhiu kin thc v phng chng ung th hn nn cng thng i khm v pht hin bnh sm hn cc qun khc. T l mc ung th ph thuc nhiu vo a d cng c cp ti trong nhiu nghin cu trn th gii [4,5]. 3. Cc hnh thc chn on ung th Kt qu t ghi nhn ung th H Ni cho thy ch c 57% ung th c chn on v vi th. T l ny thp hn so vi mt s nc khc nh Thi Lan, Australia, M [6,7]. iu ny c th c gii thch do iu kin v k thut, s lng cng nh cht lng bc s gii phu bnh Vit Nam cn rt hn ch. V vy, vic o to nhn lc v tng cng trang thit b phng chng ung th cn c u t c th tng cng cht lng v mng li phng chng ung th trn ton quc. 4. Tnh hnh mc ung th theo gii v theo nhm tui T l mc ung th tng dn theo tui nhng bt u tng nhanh t sau 40 tui nam cng nh n. Kt qu nghin cu ca chng ti cng tng t nh nghin cu Massachuset [8].Kt qu ny cng ph hp vi gi thuyt nhn qu v c ch bnh sinh ung th. Phn ln nguyn nhn gy ung th l cc tc nhn mi trng nh mi trng ho cht, khng kh, sinh hc... V do vy khi tui cng cao cng ng ngha vi thi gian phi nhim cng di. V vy ung th hay gp nhm ngi nhiu tui hn l nhm tui tr. Kt qu nghin cu ca chng ti cho thy c s khc bit c ngha gia nam v n vi ung th phi, ung th gan, ung th h hng thanh qun. iu ny c th gii thch do c im vn ho Vit Nam, t l ht thuc cng nh ung ru nam gii nhiu hn hn so vi n gii. iu ny cng nh hng ti t l mc ca cc loi ung th c lin quan ti thi quen sng ny. 5. xut cc bin php phng chng ung th cho dn c H Ni Kt qu nghin cu ca chng ti v khuynh hng ung th ti cng ng dn c H Ni giai on 2001-2005 gi cho mt s chin lc phng chng ung th nh sau:

- Vic tuyn truyn phng chng ung th cho cng ng qua cc phng tin thng tin i chng vn c coi l chin lc quan trng. Chin lc ny cng ph hp vi khuyn co ca T chc y t th gii cng nh T chc nghin cu ung th quc t. - Phi hp vi Chng trnh phng chng tc hi ca thuc l hn ch t l ht thuc ngi tr tui v tng t l b thuc l cng l bin php quan trng trong vic phng nga v gim t l ung th lin quan ti vic ht thuc. - Sng lc pht hin sm mt s loi ung th thng gp nh ung th v, ung th c t cung l nhng loi ung th nu pht hin sm th vic iu tr s mang li kt qu rt kh quan cho ngi bnh. - Tng cng nng lc cho cn b y t v kh nng chn on v iu tr cc loi ung th thng gp cng l bin php cn y mnh. V. KT LUN T l mc ung th giai on 2001-2005 cao nht ti qun Hon Kim (164,2/100.000) v thp nht qun Long Bin (37,3/100.000). T l mc ung th bt u tng nhanh t sau tui 40 c 2 gii. C s khc bit c ngha thng k (P< 0,01) v t l mc ung th ph qun phi, ung th gan, ung th d dy, ung th h hng thanh qun gia nam v n. Tuyn truyn phng chng ung th kt hp vi sng lc, pht hin sm v tng cng nng lc cn b y t l nhng iu kin cn thit nhm nng cao cht lng chng trnh phng v kim sot ung th ti H Ni ni ring v Vit Nam ni chung.

VI. TI LIU THAM KHO 1. WHO (2004). Chronic disease: Vital investment. World Health Organization. 2. B Y t (2006). Nin gim thng k 2005. Thng k- tin hc. V k hoch ti chnh 3. IARC (1991). Cancer registry: Principle and Methods. World Health Organisation 4. Bernard W. Stewart (2003): The Global Burden of Cancer. World Cancer Report. Ed. of IARC, 11-20. 5. Parkin, D.M, Whelan,S.L., Raymond,L., and Young,J. eds (1997) Cancer Inscidence in Five Continents. Vol. VII (IARC Scientific Publication No 143) Lyon, France 6. Hutcha Sriplung, Sineenat Sontipong, Nimit Martin, Surapon Wiangnon, Visoot Vootiprux, Arkom Cheirsilpa, Chol Kanchanabat, Theeravud Khuhaprema (2005): Cancer Incidence in Thailand, 1995-1997. Research communication. Asian Pacific Journal of Cancer Prevention. Volume 6, Number 3, 2005. 276-281. 7. Alison Venn, Leight Bleizze et al. (2007). Cancer Registry in Tasmania. Annual Report 8. Deval L. Patrick, Governor Timothy P. Murray, Lieutenant Governor, JudyAnn Bigby(2008), Cancer incidence and mortality in Massachusetts 2001 - 2005: statewide report. Bureau of Health Information, Statistics, Research and Evaluation, Massachsetts Department of Public Health

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