Cervical Cancer Screening in Latvia: Present, Problems and Future

1. Cervical Cancer Screening in Latvia: Present, Problems and Future Ilze Viberga, MD, PhD, Ob/Gyn

2. Demographics of the Latvian Population

3. Structure of Cancer Incidence in Latvia 2002 – 2004 (per 100 000 Women)

4. Ca Colli Uteri III-IV 1995 – 2004 (%)

5. Primary Health Care • there are three groups of practitioners in Latvia that are working as primary care practitioners since health care reforms has come into force: Family doctors (GP), Internists and Paediatricians (paid for mostly by HCISA or also only privately) • the outpatient service is provided by Specialists that has private practice (directly paid for by HCISA or only privately) or are working in the outpatient clinics in the contract with GP paid for by HCISA

6. Preventive Examinations for Women (1) • Survey Reproductive health of the population (2003) – 1251 ♀ aged 15 to 49 • 63% of women go for a preventive gynecological examination at least once a year • 18% do the same once every 2-3 years • less frequently, never, no answer – 19% • despite recent health care reforms, the most popular doctor for this kind of examination is a gynecologist • why do women not attend preventive visits to a gynecologist: • I do not have any gynecological complaints: 61% • I do not like gynecological examination: 36% • I do not have time: 17% • Nobody has actively invited me to go for the examination: 16% • The visit to doctor costs too much: 14%

7. Preventive Examinations for Women (2) • Choice of specialist: • despite health care reforms that aim at driving health care to GPs, women still consider the GYN to be the best specialist for preventive gynecological examinations • 76% of women felt that they could not trust their GP to perform a preventive gynecological examination: women with a higher education had the most objections against services rendered by a GP • selection of services paid by HCISA and privately paid services: • 35% of all women who had used the services of a GYN went to a doctor paid for by HCISA, thereby only needing to co-pay services rendered • on the other hand, women are often referred to GYN paid for by HCISA in order to receive a preventive examination or need certificate

8. Preventive examinations of women (3)

9. Preventive examinations of women (4)

10. Cervical Cancer Screening • Preventive examination program December 2004 (corrections November 2005) • the preventive gynecological examination, including breasts examination, and PAP smear examination has to be done one time per year initially and, if the results of examination are without the pathological findings, a repeated preventive examination follows one time per three years in 20 – 35 years age group • in age group 35 – 70 years, the preventive gynecological and PAP smear examination has to be done one time per year

11. Problems • how to implement the announced screening: • who is going to invite woman for the preventive gynecological examination and how • training of GPs in taking of PAP smears • who is going to control the level of examinations and practices of GPs • majority of women consider the GYN to be the best specialist for preventive gynecological examination • the preventive gynecological examination and PAP smear as the screening program is paid for by HCISA: • if woman selects privately paid services, how about registration and data collection from this sector • who is going to treat and monitoring CIN I and CIN II and how – no guidelines!! • if woman selects privately paid services, how about registration and data collection from this sector • !! no good traditions of Colposcopy at all for gynecologists

12. Future • the educational aspect • what is the cervical cancer • what is the screening of cervical cancer • the implementation aspect • who is ’the main’ specialist in the screening • who is responsible for the invitation for the screening • how ‘screening money’ follows the woman • how precise is data collection • the quality aspect • the treatment and monitoring aspect • Colposcopy • guidelines • follow-up