Cervical cancer screening in Lithuania 2005

1. Cervical cancer screening in Lithuania 2005 Juozas Kurtinaitis Institute of Oncology, Vilnius University kancerreg@is.lt Maiori, Italy 2006-06-15

2. 1,3 Finland Mortality 4,2 2,9 Sweden Incidence 9,4 3,4 EC 9,7 3,9 UK 9,3 4,1 Denmark 15,3 4,8 Portugal 14,6 5,4 Latvia 16,6 7,7 Estonia 22,0 8,8 Poland 16,1 9,7 Lithuania 15,5 0 5 10 15 20 25 Cases per 100000 Cervical cancer: Incidence and mortality

3. 60.0 65-74 50-64 35-49 50.0 40.0 30.0 20.0 Programa 10.0 0.0 1983- 1988- 1993- 1998- 2001- 2003 2004 1978- 1982 1987 1992 1997 2000 2002 Cervical cancer 1978-2005 Rapid increaseof cases at age 35-49 years

4. Casesat 35-64 yearsare the major contributors of the rates

5. Biržai Joniškis Akmenė Mažeikiai Pasvalys Skuodas Pa kruojis Rokiškis Kupiškis Zarasai Telšiai Kretinga Plungė NORWAY Radviliškis Plungė Utena Ignalina Kelmė Anykščiai Šilalė Raseiniai Kėdainiai Ukmergė Oslo Molėtai Švenčionys Tauragė Šilutė Jonava Jurbarkas Širvintos Šakiai Kaišiadorys Trakai Prienai Marijampolė Vilkaviškis Šalčininkai Alytus Varėna Lazdijai Cervical Cancer Screening in Lithuania Nation - wide screening started at July 1, 2004 750 000 women at age 30-60 are on the target,with interval of 3 years

6. Cervical cancer screening programme:women and data management COLPOS-COPY TREATMENT WomanN=750.000 PRIMARYHEALTHCARECENTERS N>350 BIOPSY Invitation PATHOLOGYLABS N=10 PAP Bethesda • Methods • Organization: • The resources for the cervical cancer screening were allocated at State Patient Fund which is responsible to provide the reimbursement for the service. 5 regional State Patient Funds are responsable to manage contracts with primary healt centers (PHCC). • The PHCC (more than 350 around the country) are responsible to join the screening programme and to implement the screening procedures • The visit of the women to PHCC in Lithuania is free of charge if she is registered with the PHCC. • The system is followed by the help of State Patient Found and does not allow simultaneous registrations of a women at different centers. • Each GP is supposed to serve 1500-2500 of population. • PAP smears • According to the guidelines, the PHCC is responsible to take the PAP smear. • The GP’s provides information to the woman about the screening programme during visits to center or at home. • 10 pathology laboratories around the country are certified to assess the PAP smears. RESPOND Sharing the list Woman 30-60 PAPBethesda Invitations Future development Request of reimbur-sement Population-based CANCERREGISTRYN=1 REGIONAL STATEPATIENTFOUNDS N=5 Populationregistry • The nation wide organized cervical screening was implemented along the state insurance based health care system. It is suggested to be a reasonable approach for cervical cancer screening

7. Cervical cancer 2005 – impact of the programme Programme

8. Cervical cancer 2005 – invasive and in situ by county

9. Cervical cancer: changes in the target group (30-60 years) 2005 70% 2004 67%

10. Cervical cancer prevention – respond rate by month 2006 2005

11. Problem: invitation system • Decentralized • Lacking of IS • Dependent on local activity • Difficult to trace the woman attendance

12. Solution: centralized invitation system • Management from cancer registry in collaboration with primary health care center • Independent on local activity • Easy to trace the woman attendance • Possibilities of measurements of indicators

13. Solution: pilot study • Agreement with one of the municipalities • Installment of IS • Sharing of local activity • The increase of the woman attendance

14. Action and interventions PAP Programme

15. Practical implementation

16. Expected results • The increase of attendance rates • Sharing collaboration of PHC • Improvement of the overall performance • % coverage of the programme

17. Thank YOU