Cervical cancer screening problems and barriers in Latvia

1. Cervical cancer screening problems and barriers in Latvia Ilze Viberga MD, PhD Ludmila Engele MD, PhD

2. Cervical cancer prevalencein 1990-2005

3. Cervical cancer prevalence in 1999 – 2005

4. Prevalence in according to stages of cervical cancer in 1990 – 2005

5. Cervical cancer incidence and mortality

6. Cervical cancer incidence per 100.000 women in 1990-2005

7. Cervical cancer incidence in according to age in 1990 – 2005

8. Cervical cancer mortality per 100.000 women in 1990-2005

9. Cervical cancer incidence and mortality in age groups in 2005

10. Cervical cancer in Latvia

11. Cervical cancer five years life expectancy /survival– all stages

12. Cervical cancer five years life expectancy – early and late stages

13. Latvian female population in 2005

14. Cervical cancer screening in Latvia • The regulation of Cabinet of Ministers Nr.1046, December 19, 2006 (initially – 2005), with the supplement No.5 ”Programme of the preventive examinations” contains the Paragraph No.2.4 ”Cancer screening” (corrected in according to the proposal after the ”round-table” meeting in September, 2006): • Taking the smear from cervix of uterus as a screening test of cervical cancer in women in age from 25 to 70 years one time per three years

15. Screening results in 2005 and 2006 (two target populations: 20-34; 35-70)

16. Cervical cancer screening problems and barriers in Latvia • Informational • Organizational • Professional • Financial • Geographical

17. Informational • Population doesn’t know: • about this disease (mass media role: radio, regional news papers, TV!) • about the meaning of screening: the test is not treatment or a diagnostic tool if the person is a sick • the regulation and accessibility of the service regarding to this test • Professionals don’t know: • about the meaning of screening test • what to do exactly because no unified methodology and guidelines of action or screening programme • how is the regulation and accessibility and payment of the service regarding to this test (Ministry of Health very often changes terms and conditions)

18. Organizational • No calculations about the professional medical resources/population – geographical disproportion • Cultural-historical situation in female heath care (Ob/Gyn) • Private/public service disproportion (HCISA) (486/34 Ob/Gyn and 1800/1356/30 GP) – accessibility to the screening test service!!! • No data exchange between laboratories and GP about the abnormal smear results • No unified clinical database regarding to the abnormal smear results

19. Professional • No trained nurses and midwives for the taking of smear • No smear taking control • No bordered competencies between GP and Ob/Gyn regarding to the abnormal smear results management • No clinical guidelines for the management of woman with the abnormal smear findings within the screening programme • No unified clinical-laboratory database • No qualification and training criteria (minimal work load) for laboratory staff in the cervical screening programme • Leishman methodology for preparation, coloring and assessment of smear (instead of Papanicolau)

20. Financial • Public/private gynecological service disproportion (historical-cultural background, geographical situation) • Existing financial regulation does not allow to cover expenses of the taking and assessment of smear in screening programme for private gynecology and GP practice • Majority of women have to pay themselves for the smear taking and assessment • Accessibility to the screening programme is limited

21. Geographical • Infrastructure, logistics disproportion (rural population) • Limited professional medical resources (rural regions) • No geographical density assessment of female population to plan financial and human resources for the screening programme implementation

22. Work groups • Cabinet of Ministers (12 persons; March – August) • To work out the coordinated model for collaboration among different sectors to implement the organized screening programme • To realize and find solution of the existing problems and barriers for the implementation of the organized screening programme • To promote accessibility of health care service Ministry of Health • To realize and find solution of the existing problems and barriers for the implementation of the organized screening programme • Practical ways of solution and implementation Mass media and non-governmental organizations - information

23. Eurochip project • Technical report for the organized cervical cancer screening programme implementation in Latvia • Main tasks: • Analysis and evaluation of the current situation of cervical cancer screening in Latvia • Defining the existing obstacles for the implementation of the organized cervical cancer screening in Latvia • Making of the report with in-depth recommendations for a national promotion strategy of the population-based National Screening Programme of cervical cancer • Stage of data collection

24. Thank you for your attention!

25. LATVIA DISCUSSION • Problems of different lab methods