Hrvatski

Danijela Lazarić-Zec and Olga Dabović-Rac are concerned about lack of preventive examinations

CARDIOVASCULAR DISEASES AND BREAST CANCER AS PUBLIC HEALTH PROBLEMS IN ISTRIA: IT IS EXTREMELY NECESSARY TO HAVE MORE CONTROL

More died from cancer in Istria than in Croatia

It is disturbing that, according to the survey, almost half of Istrians do not know that they have high blood pressure. Why does Istria which, like Italy, belongs to the Mediterranean region known for food that is good for the cardiovascular system, have a much higher mortality rate than that country? 81% of the time the breast cancer is detected in its late phase, and 30 to 40 women die from it each year in Istria. In Croatia, strokes are more frequent and in Istria it is heart attacks.

Cancer of the cervix is on the rise in the women of Istria. In Istria as in the entire developed world, the top cause of death is cardiovascular disease and the next highest is cancer. Because of that, men mostly die from cardiovascular diseases and women from breast cancer, which are recognized as the major public health concerns in Istria. These problems will be addressed in the next seven years within the health plan for the population of Istria, by addressing the problem of care for the elderly, the protection of drinking water, and the fight against addictions.

Up to 54% of all deaths are attributed to cardiovascular diseases, said Dr. Daniella Lazaric-Zec from the institute for public health. In contrast to strokes, which is the prevailing cause of death in Croatia, in Istria it holds second place. In other words, heart attacks are more frequent in the Istrian male, whereas among older Istrian women it is strokes.

Deaths due to heart diseases are twice as frequent as in Europe

Even though these diseases are normal for developed countries, deaths due to heart disease in Croatia are double the European average. It is disturbing that the problem is greater in the male working population aged 45 to 64 years. Why does Istria, which belongs to the Mediterranean environment known for foods that are good for the cardiovascular system, not have a health picture similar to that of Italy, a country with a very low death rate from these diseases?

The reason can be found in poor health awareness but also because a healthy environment is not financially accessible to most of the population, stated Dr. Olga Dabovic-Rac from the Istrian institute for public health. Stress, economic insecurity, high unemployment, continuous uncertainties (lack of control of ones own economic and political life), low standard of living, and with this an increase of abuse of alcohol and cigarettes, poor eating habits that cause weight gain, increase in blood fat and diabetes,  contribute to the cardiovascular diseases, especially for people who are genetically predisposed. No wonder that in 2003 in Istria 370 people below the age of 65 died of these diseases. These types of patients are the most numerous in the hospital statistics, so at the internal medicine section of the hospital in Pula cardiovascular problems are being identified in younger and younger patients.

In the primary prevention examinations, the blood pressure is measured on only 25 to 30% of adult patients. Picture from one of the Red Cross blood pressure examination drive.

Without controls the mortality is higher

In half of the cases the deaths are connected to poor controls. In other words, according to the statistics of the Institute for Public Health, in primary care, blood pressure in adults is measured only of 25 to 30% of patients and for healthy weight checkup of only 10% at 10% of patients, consultaton with patients on healthier lifestyles does not exist. It is disturbing that in Croatia 43% of the polled did not know that they had high blood pressure, 12% knew but did nothing about it, and only 10% are successfully being medicated.

Higher mortality of working age people will become more prevelent if the trend of bad habits continues. In other words, the statistics for 2003 are devastating – a third of the middle-school children are smoking, and drinking alcohol is considered “normal” behavior. It is interesting that 3% more girls than boys are participating in this sad statistic. If this trend does not change, thirty years from now when these children will be in their forties, the statistics will be even worse than they are today in the incidents of cardiovascular and cancer diseases.

In Istria 120 women are diagnosed with breast cancer

For men the leading disease is lung cancer, and for women that holds second place. For women breast cancer is in first place, which in the world inflicts one in every 11 women, and is the leading cause of death for women in ages 35 to 59. In Istria 120 women are diagnosed every year with breast cancer, 30 to 40 of them die, and half of them are younger than 65 years of age. The number is increasing but earlier diagnosis helps reduce the number of deaths in younger patients. However, most of our grandmothers do not go to a gynecologist, and cancer is discovered in them too late. Because of that, the mortality rate in  women over 65 is on the rise, explained Lazaric-Zec. Considering that early detection of breast cancer can save lives, we asked the doctor to tell us is the norm today in Istria for examinations and visits to doctors. Breast examinations must be made by family physicians and gynecologists. Gynecologists, however, examine every second woman and family practitioners only 5% of their female patients, she added. We also have to add that up to now there had been only one mammography station in service in Istria, which could check up to 5,000 women yearly, so that one had to wait up to 10 months for the examination. This is obviously inadequate considering that there are 56,000 women over 40 in Istria. That is why the statistics of the hospital in Pula shows that up to 81% of stricken patients, the cancer is discovered in its late phase. Many women are afraid or ashamed to have an examination, because these are private parts of the body and the awareness and education of women is also one of the obstacles for early detection, stressed Lazaric-Zec, adding that the Plan for Health will focus specifically on the prevention of these diseases

In Istria high blood pressure predominates  in the male population

Istria is a bit better off by comparison to Croatia for lung cancer. However, cancer of the cervix and of the uterus is on the rise, stated Lazaric-Zec. Stomach cancer is a lesser problem in Istria than compared to the continental part of Croatia, attributable to the differences in diet. In Istria specifically, deaths due to heart diseases is higher than in Croatia while strokes and lung cancer are below the Croatian average. According to statistics in Istria, 900 people are afflicted by cancer each year and 545 people die of it. This shows that the proportion of cancer deaths in Istria is one quarter of all deaths, higher that in Croatia. According to the 2003 health survey in Croatia, in Istria the percentage of people with high blood pressure is highest, for obesity we are in the average, and for smoking at the bottom of the scale. We emphasize that the research does not show the true Istrian health status since it is observed in conjunction with the western region that is together with the Primorsko-goranska and Lika-senj regions. Unfortunately, the institute for public health was able to give us more a precise picture of just our Istrian region, because such research would take more time to compile.

Original text by Maša JERIN
Translated by Pino Golja