Cervical cancer screening in Lithuania2005Maiori, Italy 2006-06-15Juozas Kurtinaitis Institute of Oncology, Vilnius Universitykancerreg@is.lt

Cervical cancer: Incidence and mortality

Cervical cancer 1978-2005Rapid increase of cases at age 35-49 years

Cases at 35-64 years are the major contributors of the rates

Cervical Cancer Screening in LithuaniaNation - wide screening started at July 1, 2004

750 000 women at age 30-60 are on the target, with interval of 3 years

Allocation of resourcesSTATE PATIENT FUNDDistribution of resourcesREIMBURSEMENT FOR THE SERVICE (invitation, smear taking, PAP assessmentInvitation systemDECENTRALIZEDPAP smear takingDECENTRALIZED

MethodsOrganization:The resources for the cervical cancer screening were allocated at State Patient Fund which is responsible to provide the reimbursement for the service. 5 regional State Patient Funds are responsable to manage contracts with primary healt centers (PHCC). The PHCC (more than 350 around the country) are responsible to join the screening programme and to implement the screening procedures The visit of the women to PHCC in Lithuania is free of charge if she is registered with the PHCC. The system is followed by the help of State Patient Found and does not allow simultaneous registrations of a women at different centers.Each GP is supposed to serve 1500-2500 of population.PAP smearsAccording to the guidelines, the PHCC is responsible to take the PAP smear. The GPs provides information to the woman about the screening programme during visits to center or at home.10 pathology laboratories around the country are certified to assess the PAP smears.

Cervical cancer screening programme:women and data managementREGIONALSTATE PATIENT FOUNDS N=5Population-basedCANCER REGISTRY N=1PRIMARY HEALTH CARE CENTERSN>350Sharing the listWoman 30-60Request of reimbur-sementWoman N=750.000InvitationRESPONDPATHOLOGY LABSN=10PAP BethesdaPAP BethesdaCOLPOS- COPY BIOPSYInvitations

Future developmentTREATMENTPopulation registryThe nation wide organized cervical screening was implemented along the state insurance based health care system. It is suggested to be a reasonable approach for cervical cancer screening

Cervical cancer 2005 impact of the programmeProgramme

Chart3

483

483

572

504

C53

Metai

Atv. skaiius

Sheet1

IM30-6060+iki 30Visoproc_30-60

2004Stadija20002831721947459.7

amz_skrynIIIIIIIVVisoproc.20013301512050165.9

30-6024140841181838467.120023101531547864.9

6.336.521.930.74.720033011431746165.3

60+133041622517129.920043841711757267.1

7.617.524.036.314.620051335218571.9

iki 30152173.02006

2007

I viso5722008

2009

2005Stadija2010

amz_skrynIIIIIIIVVisoproc.2011

30-602215767692233770.52012

6.546.619.920.56.52013

60+152530492214129.52014

10.617.721.334.815.6

iki 302126

I viso478

amz_skryn1234

30-6022157676922

60+1525304922

iki 302126

Nera

dgn2002200320042005

C53613167

D0672376156

Grand Total133692163

LVR

tlk10a2002200320042005

C53477470575489

D0677102198356

is viso

2002200320042005

C53483483572504

D0684125274517

Sheet1

00

00

00

00

2004

2005

Stadija

Atv. skaiius, proc.

Sheet2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

proc_30-60

Sheet3

00

00

00

00

C53

D06

Metai

Atv. skaiius

Cervical cancer 2005 invasive and in situ by county

County

Cervical cancer invasive

Stage I-II

Cervical cancer invasive, in situ

Ratio invasive/in situ

Ratio invasive/in situ,

cases before age 60 years

Vilniaus

125

85 ( 68,0%)

288

2,3

3,1

Kauno

101

59 ( 58,4%)

42

0,4

0,6

Klaipdos

44

28 ( 63,6%)

11

0,3

0,3

iauli

57

31 ( 54,4%)

11

0,2

0,3

Panevio

46

28 ( 60,9%)

28

0,6

0,9

Alytaus

31

22 ( 71,0%)

43

1,4

2,3

Marijampols

31

20 ( 64,5%)

28

0,9

1,2

Taurags

16

6 ( 37,5%)

5

0,3

0,6

Teli

26

15 ( 57,7%)

5

0,2

0,3

Utenos

27

14 ( 51,9%)

55

2,0

2,3

Lithuania, total

504

308 ( 61,1%)

516

1,0

1,4

Cervical cancer: changes in the target group (30-60 years) 2005 70% 2004 67%

Chart10

4.016913319259.619450317136.3636363636

3.992015968165.868263473130.1397205589

3.144654088164.989517819731.8658280922

3.671706263565.010799136131.3174946004

2.97202797267.132867132929.8951048951

073.205741626826.7942583732

60 m.

Atvej skaiius procentais

Sheet1

Sergamumas gimdos kaklelio viu 2000-2005 m.

200020012002200320042005

Carcinoma in citu586177100200137

I stadija8811312414418581

II stadija1821511139912443

328325314343509261

Carcinoma in citu17.718.824.529.239.352.5

I stadija26.834.839.542.036.331.0

II stadija55.546.536.028.924.416.5

Lokalizacija200320042005200320042005

Gimdos kaklelio vys463572209

601451715631.3229.9026.79

Lokalizacija200020012002200320042005

Gimdos kaklelio vys473501477463572209

6017215115214517156

Amius200020012002200320042005

60 m.36.3630.1431.8731.3229.9026.79

Sheet1

Carcinoma in citu

Sheet2

Carcinoma in citu

Atvej skaiius procentais

Sheet3

I stadija

Atvej skaiius procentais

II stadija

Atvej skaiius procentais

60

Atvej skaiius procentais

60 m.

Atvej skaiius procentais

MBD00078A3F.xls

Chart1

17.6829268293

26.8292682927

55.487804878

2000

2000 m.

II stadija 55,5 %

I stadija 26,8 %

Carci-noma in citu 17,7 %

Sheet1

Sergamumas gimdos kaklelio viu 2000-2005 m.

200020012002200320042005

Carcinoma in citu586177100200137

I stadija8811312414418581

II stadija1821511139912443

328325314343509261

Carcinoma in citu17.718.824.529.239.352.5

I stadija26.834.839.542.036.331.0

II stadija55.546.536.028.924.416.5

Sheet1

0

0

0

0

0

0

Carcinoma in citu

Sheet2

0

0

0

2000

Sheet3

0

0

0

2001

0

0

0

2002

0

0

0

2003

0

0

0

2004

0

0

0

2005

Cervical cancer prevention respond rate by month20052006

Problem: invitation systemDecentralized Lacking of ISDependent on local activityDifficult to trace the woman attendance

Solution: centralized invitation systemManagement from cancer registry in collaboration with primary health care centerIndependent on local activityEasy to trace the woman attendancePossibilities of measurements of indicators

Solution: pilot studyAgreement with one of the municipalitiesInstallment of ISSharing of local activityThe increase of the woman attendance

Action and interventionsProgrammePAP

Practical implementation

Expected resultsThe increase of attendance rates Sharing collaboration of PHCImprovement of the overall performance % coverage of the programme

Thank YOU