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Piret Veerus, MD, PhD Department of epidemiology and biostatistics

Women’s reasons for low attendance in the cervical cancer screening programme: experience from Estonia. Piret Veerus, MD, PhD Department of epidemiology and biostatistics National Institute for Health Development Estonia For the EUROCHIP-3 project Ispra, February 27, 2012.

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Piret Veerus, MD, PhD Department of epidemiology and biostatistics

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  1. Women’s reasons for low attendance in the cervical cancer screening programme:experience from Estonia Piret Veerus, MD, PhD Department of epidemiology and biostatistics National Institute for Health Development Estonia For the EUROCHIP-3 project Ispra, February 27, 2012

  2. Cervical cancer in Estonia • Population of Estonia 1,339,681 (2012) • Among the female population, cervical cancer is the 3rd most common cancer site • ASIR(w) 18.1 per 100,000 with 187 new cases in 2007 • ASMR(w) 4.3per 100,000 with 53 deaths in 2007 • In the age-group from 20 to 49 yrs the incidence rates more than doubled in 1980-82 to 2004-2006

  3. Cervical cancer incidence by age groups in Estonia Estonian Cancer Registry

  4. Cervical cancer screening in Estonia • Organised nationwide cervical screening started in 2006, pilot studies in 2003 • Target group women aged 30 to 59 years • Screening interval 5 yrs after a negative result • Women diagnosed with cervical cancer, without health insurance and those having had a Pap-smear in past 12 months excluded from the list of invitees • Trained midwives take Pap-smears at 20 clinics, tests performed at 7 labs • Pathological results handled according to clinical guidelines • Lab quality assurance carried out in 2007

  5. Attendance in the cervical cancer screening programme in Estonia

  6. Aims of the present study To study: • reasons for low attendance in the organised cervical cancer screening programme • women’s wishes for improving the screening programme • the present knowledge about cervical cancer risk factors and screening among the screening target group

  7. Methods • Anonymous postal survey to a random sample of 2,942 women in the screening population together with the invitation to screening and a prepaid return envelope; reminders to 1,600 non-attenders in the screening programme • 21 questions in the Estonian and Russian language - respondent’s background information, general health behaviour, knowledge about cervical cancer and screening, attitude about screening activities and wishes for better organisation of the screening programme

  8. Results: respondents • Response rate 36%, altogether 1054 questionnaires returned (69.1% in Estonian) • Mean age of respondents 43 years • Most respondents married or cohabiting (74.3%), actively working (76.9%), and living in big towns (69.0%) • Mean number of children per respondent 1.8 • Less than half (46.2%) had had a gynaecological check-up in past 12 months; nearly one quarter were regular smokers (22.0%); about half (49.8%) had ever used OC; most (62.4%) had never been diagnosed with a STD; many women (39.9%) had had more than five sexual partners per lifetime

  9. Results: women’s awareness about risk factors of cervical cancer

  10. Results: awareness about cervical cancer screening72.3% of respondents were aware of screening

  11. Results: willingness to attend the screening programme

  12. Results: reasons for non-attendance in the screening programme (N=442)

  13. Results: women’s wishes to improve the screening programme • Most respondents (71%) were satisfied with the current organisation of the programme • Most of them wanted to make the appointment by phone (83.2%) and to have the test taken by a midwife (92.1%) • Women wanted to receive information about the test result by phone (33.9%), by e-mail (34.3%) or by ordinary mail (29%) • Most respondents (74.8%) wanted to recieve information about screening by mail together with the personal invitation

  14. Results: women’s wishes for receiving information about screening

  15. Conclusions • In Estonia, women prefer to be personally and delicately informed about cervical cancer screening • Minorities need more information about the screening programme in their mother langauage • All women need more detailed information about the programme, and encouragement for participation • Better organisation of screening services has to be provided • Opportunistic smears outsied the programme are discouraged

  16. Thank you! • Kivistik A, Lang K, Baili P, Anttila A, Veerus P. Women’s knowledge about cervical cancer risk factors, screening, and reasons for non-participation in cervical cancer screening programme in Estonia. • BMC Women’s Health 2011,11:43.

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