“THINK ABOUT YOURSELF – Only The Early Discovered Breast Cancer May Be Medically Treated With Success”

Is the project co-financed by the European Union

PROJECT “THINK ABOUT YOURSELF – ONLY THE PROJECT “THINK ABOUT YOURSELF – ONLY THE EARLY DISCOVERED BREAST CANCER MAY BE EARLY DISCOVERED BREAST CANCER MAY BE MEDICALLY TREATED WITH SUCCESS”MEDICALLY TREATED WITH SUCCESS”

Association “Education against breast cancer” from Zagreb County ran this project from 2007/2009. Basic information about the Association:- Founded on May 22nd, 2001- Primary activity: education of women of all ages in correct and regular self breast examination and raising consciousness about personal health with the primary goal: health through prevention

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Project “THINK ABOUT YOURSELF In 2007 the Association won CARDS 2004 contest with the

project “THINK ABOUT YOURSELF” We are the only association from Zagreb County with a

project financed by this contest Zagreb County recognized this project and got involved as

the partner Total project budget is 219,379.80 EUR:

81% financed by CARDS 2004 19% financed by Zagreb County (160,088.68 HRK)

and the Association (152,187.48 HRK) The Association geathered funds through humanitary

actions

charity concerts

and donations

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Project goals

Expanding the National program of breast cancer

prevention in the Republic of Croatia (age 50-69 years)

Expanding the network of trained personnel for

education of early breast cancer detection

Promotion of self breast examination for breast cancer

prevention through organized workshops, media

coverage and public forums

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Target groups and expected results

Women 18 - 49 years – education in correct self breast examination Women 30 - 39 years – free breast ultrasound Women 40 - 49 years – free mammography 13 trainers for education of correct self breast examination

AgeTarget group

(total number)Education Ultrasound Mammography

18-29 1000

30-39 1000

40-49 4500

50-65 0

6500 6500 1000 4500

Type of serviceProject plan

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Results of the Project(Jun 27th, 2007 – Jun 16th, 2009)

AgeTarget group

(total number)Education Ultrasound Mammography

- 13 trainers 13 100%

18-29 1000 1003 100%

30-39 1000 1000 100%

40-49 4500 4357 97%

50-65 0 0

6500 6500 1000 4500 6360 98%

Achieved result

Type of serviceProject plan Results of the project "Think

About Yourself"

“THINK ABOUT YOURSELF – Only The Early Discovered Breast Cancer May Be Medically Treated With Success”

Is the project co-financed by the European Union

Results of ultrasound and Results of ultrasound and mammography mammography

Results of assessments and clinical findings:- 13 trained educators- 6500 women educated in breast self examination - 931 breast ultrasounds (30-39 years)- 4398 mammographies (40-49 years)

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Results of ultrasound examinations (30 – 39 years)

NORMAL FINDINGS 358 FIBROUS CHANGES-mastopathy 425 SEVERE FIBROCYSTIC DYSPLASIA 91 BENIGN-LOOKING NODES 57 DEFINITE SIGNS OF MALIGNANCY 0 TOTAL 931

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Results of mammography findings (40 - 49 years)

LEGEND: R1 – NORMAL FINDINGS R2 – BENIGN

CHARACTERISTICS R3 – INDETERMINATE

FINDINGS R4 – SUSPICIOUS FINDINGS R5 – MALIGNANT CHANGES

8 WOMEN OPERATED !

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Recommendations according to mammography results (40 – 49 years)

LEGEND: 1 – CONTROL EXAM IN 2

YEARS 2 – REFERRED TO FAMILY

PHYSICIAN + ULTRASOUND 3 – REFERRED TO THE

BREAST DISEASE CENTER

(ULTRASOUND, ADDITIONAL

MAMMOGRAPHIES,

CYTOLOGY)

Total: 3,985

recommendations

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Association “Edication against breast cancer” from Zagreb County

In parallel to the project THINK ABOUT YOURSELF, the Association coducted education, ultrasound and mammography examinations also for the:

age group 50-60 years, since 2003 (“County program”) age group 50-69 years, since 2007 (“National program”)

Statistics, findings and medical recommendations for all projects were analyzed separately

Projekt sufinancira Europska unijaProject is co-financed by the European Union

Contacts:

1) Gorana Rabatić, Zagreb CountyPhone: +385 1 6009 475

Fax: +385 1 6009 488E-mail: g.rabatic@zagrebacka-zupanija.hr

2) Joško Zekan, MD, MScPhone: +385 91 6150 555E-mail: josko.zekan@zg.t-com.hrWWW: www.womens-health-initiative.com

3) Mario Kopljar, MD, PhDPhone: +385 91 582 7446E-mail: kopljar@yahoo.com

Reproductive health care Croatian perspective

Mario Kopljar, Joško Zekan

Public health impact of STD

• Sexually transmitted diseases have a sigificant influence on the pupulation reproductive health

• Infertility 12%• Healthcare burden• Reductio of working abillities (hepatitis B, sick

leave)

Incidence of STD in Croatiaper 100000

• Chlamydia 19.9 -12.9

• Gonococcal infections 0.6 - 0.4

• Hepatitis B 4.4 - 3.0

• HIV 0.7 - 1.5

• HPV 22.3 - 38.4

• Reduction of STD incidence

• HIV incidence under control – education, – promotion of anonymous testing, – legal purchase of sterile needles in pharmacies

• Growing problem is HPV

• HPV infection represents a major health problem because of its relation to cervical cancer

• HPV Summit 1999: there is no cervical cancer without HPV infection

• Cervical cancer is a preventable disease

Cervical cancer – incidence

• Latin America 55-72 / 100 000 women

• Croatia 16.8 / 100 000 women

• Israel, Finland 3-4 / 100 000 women

• SMOKING – LUNG CANCER:

ODD RATIO =17

• HPV INFECTION – CERVICAL CANCER:

ODD RATIO =150-250

High risk population• Sexarche before the age of 17• Promisquity• Early pregnancy• High-risk HPV infection• Low socioeconomical status• Immunodeficient conditions• Smoking• Nutritional deficit• Oral contraception• High-risk partners• Non-existance of national screening programme

Situation in Croatia

597 gyneacologists 142 pathologists 115 cytologists 112 cytoscreeners Opportunistic screening (OR

0.57): ~ 400 000 PAP-smears/year

Organized screening (OR 0.25): 1 198 299 women (25-65 years)

• Croatia has enough resources for opportunistic screening (patients seeking medical attention, 400 000 PAP-smear/year)

• The goal of Womens Health Initiative: doctors activelly addressing people (organized screening) with anticipated reduction in STD incidence by 50%

• Target group for prevention – adolescents• Adolescent behavior and knowledge

- More than 50% of adolescents is under influence of alcohol or drugs before intercourse

- Only 6% tested for STD- Insufficient knowledge regarding contraception

and prevention of STD- However … over 60% seek relevant education

Cervical cancer prevention modalities

• Education– Insitutional (schools)– Extra-institutional

• Public schools

• Courses

• Media

• Screening• Vaccination

Figure reproduced from: Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999; 318: 904. Reproduced with permission from the BMJ Publishing Group.

Impact of vaccination strategies diagnosed HPV 16/18-related cervical cancer incidence, females (12+y), lifelong duration

0

1

2

3

4

5

0 10 20 30 40 50 60 70 80 90 100

Time in Years

Inci

denc

e pe

r 100

,000

.

No Vaccination12-yo females12-yo females+females catch up12-yo females&males12-yo females&males+females catch up12-yo females&males+females and males catch up

Reproductive health careResults of campagne:

•⇓ Pelvic Inflammatory Disease

•⇓Ectopic pregnancy

•⇓ Sterility

•⇓ Impact on state budget for health

• Womens Health Initiative continues Womens Health Initiative continues to promote reproductive health to promote reproductive health through organizing european through organizing european conferences conferences

• Croatia accepted modern guidelines for Croatia accepted modern guidelines for protection of reproductive health and protection of reproductive health and significantly improved reproductive health significantly improved reproductive health