eurochip-2 european public health action on cervical cancer screening grell 2006 - palma de majorca...
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EUROCHIP-2 EUROCHIP-2 European Public Health Action European Public Health Action on Cervical Cancer Screening on Cervical Cancer Screening
GRELL 2006 - Palma de Majorca GRELL 2006 - Palma de Majorca
Public Health ProgramEUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE - GENERAL
www.tumori.net/eurochip
Paolo BailiUnità di Epidemiologia Descrittiva e Programmazione Sanitaria
Istituto Nazionale per lo Studio e la Cura dei Tumori
INDICATOR AINDICATOR BINDICATOR C...INDICATOR Z
INDICATOR AINDICATOR BINDICATOR C...INDICATOR Z
EUROCHIP-2 DISCUSSION PLANEUROCHIP-2 DISCUSSION PLAN
COUNTRY 1 COUNTRY 2 COUNTRY 3 COUNTRY 30
ACTION 1
ACTION 2
ACTION 3
ACTION 3
ACTION 4
ACTION 4
ACTION 5
ACTION 6
ACTION 6
EUROPEAN PUBLIC HEALTH ACTION –
early diagnosis
Cervical screening
EUROPEAN PUBLIC HEALTH ACTION –
care & treatment
Pilot studies
EUROPEAN PUBLIC HEALTH ACTION -
prevention
Dietary prevention
EU CANCER PLAN
EDUCATIONAL ACTIVITY
Uterus cancers
• ICD 180: Cervical cancer
• ICD 182: Corpus uteri cancer
• ICD 179: Uterus cancers, not specified
• On the basis of overall national death certificates, it is not possible to analyze mortality from cervical cancer in Europe, since 20-65% of deaths from uterine cancer in largest countries are still certified as uterus, unspecified
• To estimate cervical cancer mortality we used death rates for uterine cancers (ICD 179, 180, 182) in women aged 20-44, since most deaths from uterine cancer below the age of 45 years arise from the cervix
Source: Levi et al. European Journal of Cancer 36 (2000); 2266-2271
UTERUS CANCER STANDARDIZED MORTALITY RATEAGE: 20 – 44 (IN THESE AGES MOSTLY CERVICAL CANCER)
European standard per 100,000
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UTERUS CANCER (age 20-44) AVOIDABLE DEATHS. 2000
Expected avoidable deaths using following references:
Norway Finland Italy
Bulgaria 75 85 90
Latvia 20 25 25
Lithuania 50 55 55
Romania 370 410 415
TOTAL 515 575 585
+ EST, HUN, POL, CZE, SLO, SVK 810 980 1020
- Analyze the European guidelines to implement/promote/reconstruct cervical cancer screening in countries with increasing mortality trends
- Describe the opportunistic/programmed cervical cancer screening in those countries at present time
- Find difficulties and problems with specific assessment studies in these Eastern European countries
- Connect all the previous points with other European networks (EUNICE, European Cancer Screening networks)
EUROCHIP-2 ACTIVITY:TO ORGANISE A TASK FORCE ON
CERVICAL CANCER SCREENING EMERGENCY
MILESTONES
For countries without programs:For countries without programs:ASSESSMENT STUDIESASSESSMENT STUDIES
• Understand how servicesservices for cervical cancer screening and treatment currently are, or could potentially be, organized and delivered
• Identify the key organizationskey organizations involved in delivering these services, including potential leaders, coordinators, or area supervisors
• Define the level of available resourceslevel of available resources and assess how services could be financed
• Document the systemsystem for requesting and purchasing equipment and supplies, and for improving infrastructure
ASSESSMENT PHASES: ASSESSMENT PHASES: COLLECTION OF INFO ONCOLLECTION OF INFO ON
• Use of Policies, Guidelines, and Norms
• Program Management Issues
• Health Services
• Information and Education Activities
• Community Perspectives
• Laboratory
• Information Systems
ROMANIA
ROMANIA
Screening prices Screening prices VS VS
treatment pricestreatment prices• In Bulgaria the mean value of programme screening for 1
person is around 5 €
• Target population: 1.8 million (age 25-60)
• Screening interval: 3 years
• 5 € * 0.6 million = 3 million € per year
V.
Zla
tko
v -
Bu
lgar
ia (
2006
)
BULGARIA
BULGARIA
Cervical cancerstages
Number of cases in Bulgaria (2001)
Prices according to EU data(Andrae Bengt - 2004)
Per item Total
St. III – IV 347 30 000 € 10 410 000 €
St. I – II 670 9 000 € 6 030 000 €
CIS 275 300 € 83 500 €
Total 1292 - 16 522 500 €
BULGARIAN BULGARIAN ESTIMATESESTIMATES
LATVIA
LATVIA CURRENT SITUATIONCURRENT SITUATION
I. Viberga - Latvia (2006)
• Prevention examination program (12.2004):
– Age 20-35: PAP smear has to be done one time per year initially and, if the results of examination are without the pathological findings, every 3 years
– Age 35-70: PAP smear has to be done one time per year• Health care reform aims at driving health care to GPs• BUT: 76% of women felt that they could not trust their GP to
perform a PAP Smear (Source: Survey Reproductive health of the population)
• ORGANIZATION OF A GROUP OF PRESSURE
• PRACTICAL PROPOSAL TO DEVELOP A SCREENING PROGRAM
LITHUANIA
LITHUANIA FIRST RESULTS OF THE NEW ACTIVATEDFIRST RESULTS OF THE NEW ACTIVATED
CERVICAL SCREENING PROGRAMCERVICAL SCREENING PROGRAM
CANCERS IN SITUCANCERS IN SITU
J. Kurtinaitis - Lithuania (2006)
EUROCHIP-2 will help the EUROCHIP-2 will help the centralization of the invitation systemcentralization of the invitation system
ESTONIA
ESTONIA PROBLEMS OF THE ORGANISED PROBLEMS OF THE ORGANISED SCREENING PROGRAMSCREENING PROGRAM
P. Veerus - Estonia (2006)
• Low participation: Only 21.7% of the 12,960 invited women attended the screening
• No funds for screening registry
• No invitation of women without insurance (~5% of population)
• To use experience from other countries to produce successful campaigns
• Group of pressure for invitation of women without insurance
• Money for starting the organization of screening registry
- To create relations with groups of pressure with national health ministries and with European Parliament
- To share information with other networks
- For countries without cervical screening programs: to study specific problems for implementation of screening programs and to find solutions to these problems
- For countries with cervical screening programs: to help specific activities that at the moment are not subsidize (ex: screening registry, centralisation of the invitation system)
EUROCHIP-2 TASK FORCE ON CERVICAL CANCER SCREENING EMERGENCY
AIMS