Cervical cancer screening in Estonia: present situation

1. Cervical cancer screening in Estonia: present situation Piret Veerus Department of Epidemiology and Biostatistics National Institute for Health Development Tallinn, Estonia

2. Cervical cancer in Estonia • ASIR (W) of cervical cancer 14.1 per 100,000 women yrs in 2003 • In 2003, 143 new cervical cancer cases detected • Among the female population, the 6th most common cancer site • In the age-group from 20 to 49 yrs the incidence rates almost doubled from 1980-82 to 1998-2000

3. Age-specific incidence of cervical cancer in Estonia, 1980-2000 Estonian Cancer Registry 2003

4. Mortality from cervical cancer in Northern Europe in 2000 Ferlay et al. GLOBOCAN 2002

5. Cervical cancer screening in Estonia • Around 140,000 Pap-tests performed yearly during daily medical practice in Estonia • Opportunistic cervical cancer screening started in 2003 in three regions • The Estonian Health Insurance Fund mailed invitations to a random sample of female population aged 30 to 40 yrs • Only 21.7% of the 12,960 invited women attended the screening, in 7% the results was abnormal

6. Cervical cancer screening in Estonia • Since 2004, all Estonian regions were included • Target group in 2004 and 2005 women aged 35 to 40 years and being insured • Women invited to cervical cancer screening tests via media • In 2004, 5264 women attended, 6% abnormal test • In 2005, 6552 women attended, 6% abnormal results

7. New Cancer Strategy • Presented to the Ministry of Social Affairs in 2005 • Includes the needs, structure, methodology and budget forecast for cancer screening programmes in Estonia • Inludes the need for establishment of a screening registry and reference laboratory • Screening should cover the whole population, not only insured persons

8. Cervical cancer screening in Estonia since 2006 • Target group for cervical cancer screening women aged 30 to 59 yrs • Screening interval 5 yrs after a negative result • Pathological results handled according to clinical guidelines • Funding for the screening registry, reference laboratory and non-insured women needed

9. Cervical cancer screening in Estonia since 2006 • In 2006, personal invitations mailed to birth cohorts 1951, 1956, 1961, 1966, 1971 • Trained midwives take Pap-smears at 19 clinics, tests performed at 7 labs • In the first 3 months of 2006, 57% (n=2305) of the invited women participated in cervical cancer screening

10. Planned action in the framework of Eurochip-2 • Comparative study on coverage of the female population by Pap-tests and numbers of primarily detected cervical cancer cases before and after introducing the nationwide screening programme • Primary outcome measure: proportion of the female population covered by Pap-tests in 5-year age groups in different regions • Secondary outcome measure: proportion of primarily detected cervical cancer cases in different cancer stages

11. Data collection • Data about numbers of women in different age groups in each region from the Estonian Population Registry • Data about performed Pap-tests from the Estonian Health Insurance Fund • Data about results of Pap-tests from the screening programme • Data about primarily detected cervical cancer cases from the Estonian Cancer Registry

12. Thank You!