Cervical cancer screening: Cervical cancer screening: problems and barriers in Estoniaproblems and barriers in Estonia

Piret VeerusPiret VeerusDepartment of Epidemiology and BiostatisticsDepartment of Epidemiology and Biostatistics

National Institute for Health DevelopmentNational Institute for Health DevelopmentTallinn, 02.04.2007Tallinn, 02.04.2007

Cervical cancer in EstoniaCervical cancer in Estonia

ASIR (w) of cervical cancer 15.6 per ASIR (w) of cervical cancer 15.6 per 100,000 women yrs in 2004100,000 women yrs in 2004

In 2004, 181 new cervical cancer cases In 2004, 181 new cervical cancer cases detected detected

Among the female population, the 6th most Among the female population, the 6th most common cancer site common cancer site

In the age-group from 20 to 49 yrs the In the age-group from 20 to 49 yrs the incidence rates almost doubled from 1980-incidence rates almost doubled from 1980-1982 to 1998-20001982 to 1998-2000

ASIR (w) for cervical cancer in Estonia, 2000-2004

15,6

14,315,0

14,1

17,5

0,0

2,0

4,0

6,0

8,0

10,0

12,0

14,0

16,0

18,0

20,0

Cervical cancer screening in Estonia Cervical cancer screening in Estonia in 2003in 2003

Opportunistic cervical cancer screening Opportunistic cervical cancer screening started in 2003 in three regionsstarted in 2003 in three regions

The Estonian Health Insurance Fund mailed The Estonian Health Insurance Fund mailed invitations to a random sample of female invitations to a random sample of female population aged 30 to 40 yrspopulation aged 30 to 40 yrs

Only 21.7% of the 12,960 invited women Only 21.7% of the 12,960 invited women attended the screening, in 7% the results attended the screening, in 7% the results was abnormalwas abnormal

Cervical cancer screening in Estonia Cervical cancer screening in Estonia in 2004 and 2005in 2004 and 2005

Since 2004, all Estonian regions were includedSince 2004, all Estonian regions were included Target group in 2004 and 2005 women aged 35 to Target group in 2004 and 2005 women aged 35 to

40 years and being insured40 years and being insured Women invited to cervical cancer screening tests Women invited to cervical cancer screening tests

via mediavia media In 2004, 5264 women attended, 6% abnormal testIn 2004, 5264 women attended, 6% abnormal test In 2005, invitations mailed in 6 districtsIn 2005, invitations mailed in 6 districts In 2005, 6552 women attended, 7% abnormal In 2005, 6552 women attended, 7% abnormal

resultsresults

Cervical cancer screening in Estonia Cervical cancer screening in Estonia since 2006since 2006

Organized cervical cancer screening started in Organized cervical cancer screening started in 20062006

Target group for cervical cancer screening women Target group for cervical cancer screening women aged 30 to 59 yearsaged 30 to 59 years

Screening interval 5 yrs after a negative resultScreening interval 5 yrs after a negative result Trained midwives take Pap-smears at 19 clinics, Trained midwives take Pap-smears at 19 clinics,

tests preformed at 7 labstests preformed at 7 labs Pathological results handled according to clinical Pathological results handled according to clinical

guidelinesguidelines

Cervical cancer screening in Estonia Cervical cancer screening in Estonia in 2006in 2006

Preliminary results:Preliminary results: Altogether 5559 tests performed, in 6.6% of Altogether 5559 tests performed, in 6.6% of

tests results abnormaltests results abnormal Overall attendance rate very low (18.45 %)Overall attendance rate very low (18.45 %) Attendance rates were higher in the Attendance rates were higher in the

countryside, lower in the capital area and countryside, lower in the capital area and Eastern EstoniaEastern Estonia

The number of Pap-tests outside the The number of Pap-tests outside the screening programme is increasingscreening programme is increasing

National Cancer StrategyNational Cancer Strategy

National Cancer Strategy launched in 2007National Cancer Strategy launched in 2007 Funding from the State Budget will be Funding from the State Budget will be

provided for mailing invitations and provided for mailing invitations and reminders to women, for education of the reminders to women, for education of the personnel, and for quality assurance personnel, and for quality assurance

The Estonian Health Insurance Fund is The Estonian Health Insurance Fund is funding the performance of tests and funding the performance of tests and additional investigationsadditional investigations

Objective of the Eurochip-2 Objective of the Eurochip-2 Task Force in EstoniaTask Force in Estonia

To produce knowledge for improving the To produce knowledge for improving the population coverage by Pap-tests population coverage by Pap-tests

and for increasing the proportion of primarily and for increasing the proportion of primarily diagnosed cervical cancer cases in early diagnosed cervical cancer cases in early stagesstages

Planned action in the framework of Planned action in the framework of Eurochip-2 Eurochip-2

Comparative study on coverage of the Comparative study on coverage of the female population by Pap-tests female population by Pap-tests

and numbers of primarily detected cervical and numbers of primarily detected cervical cancer cases cancer cases

before and after introducing the organized before and after introducing the organized screening programmescreening programme

Problems with possible solutions Problems with possible solutions Population coverage by cervical screening very Population coverage by cervical screening very

low - awareness campaigns planned, funding low - awareness campaigns planned, funding provided from 2007 to 2010provided from 2007 to 2010

No screening registry – vision of the IT solution No screening registry – vision of the IT solution prepared, funding from 2008 prepared, funding from 2008

No reference laboratory – planned to be No reference laboratory – planned to be established in 2008, quality assurance in the established in 2008, quality assurance in the labs in 2007labs in 2007

Non-insured women not included – amendment Non-insured women not included – amendment to the legislation being prepared by the Ministry to the legislation being prepared by the Ministry of Social Affairsof Social Affairs

Barriers to be overcomeBarriers to be overcome Clear underfunding of all parts of the Clear underfunding of all parts of the

screening programme – additional funding screening programme – additional funding neededneeded

Funding needed for informing the Funding needed for informing the participants about the test results participants about the test results

The reasons for unattendance-survey?The reasons for unattendance-survey? Screening registry – legislation neededScreening registry – legislation needed Assessment of adherence to cervical Assessment of adherence to cervical

pathology guidelines neededpathology guidelines needed

ESTONIA DISCUSSIONESTONIA DISCUSSION

It is necessary to implement relation It is necessary to implement relation between screening activity and between screening activity and gynecologistsgynecologists

All the screening activities are completely All the screening activities are completely freefree

Thank You!