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Breast and Cervical Cancer Screening Program

Breast and Cervical Cancer Screening Program. Professor Rema Gvamichava Director of the National Screening Center September 10-11, 2009 Batumi, Georgia. Epidemiology. Breast Cancer and Cervical Cancer are the increasing Public Health Problems in Georgia

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Breast and Cervical Cancer Screening Program

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  1. Breast and Cervical Cancer Screening Program Professor RemaGvamichava Director of the National Screening Center September 10-11, 2009 Batumi, Georgia

  2. Epidemiology • Breast Cancer and Cervical Cancer are the increasing Public Health Problems in Georgia • According to the data of the Department of Statistics of Georgia the Breast Cancer incidence rate was 52.6 per 100,000 females (27.9 per 100,000 population), and incidence of the Cervical Cancer was 13.5 per 100,000 females (7.1 per 100,000 population) in 2008 • During the same year 51% of newly detected Breast Cancer cases and 49% of newly detected Cervical Cancer cases were on stages III and IV

  3. EpidemiologyBreast and Cervical Cancer Incidence Rates per 100,000 Females in Georgia (27.9) (27.2) (21.7)

  4. EpidemiologyBreast and Cervical Cancer Stage Distribution in Georgia Cervical Cancer Stages (%) Breast Cancer Stages (%)

  5. National Efforts for Reproductive Tract Cancer Prevention • UNFPA CO in Georgia with the co-funding from the Municipality of Tbilisi has been implementing the Reproductive Tract Cancer Prevention and Early Detection Project since 2006. • Based on the analyses of the data and accumulated experience, at the beginning of 2008 under patronage of the First Lady of Georgia, the project has been redesigned to focus on breast and cervical cancer screening for the targeted population of Tbilisi. 

  6. Breast and Cervical Cancer Screening Program in Tbilisi • National Council of Reproductive Health chaired by the First Lady of Georgia, played significant role in initiating the breast and cervical cancer screening programme in Georgia. The Council brings together the representatives of the Ministry of Heath, Health Committee of the Georgian Parliament, major health institutions of the country and international Organizations, among them the UN Population Fund (UNFPA ) plays the most important role.

  7. Breast and Cervical Cancer Screening Program in TbilisiObjectives • To reduce mortality from breast and cervical cancer through early detection of these diseases; • To maximise early detection of breast and cervical cancers in the target population; • To ensure equitable access for women of target ages to the breast and cervical cancer screening; • To achieve high standards of program management, service delivery, monitoring and evaluation and accountability; • National capacity building for breast and cervical cancer screening and control; • IEC and BCC campaign targeted at the general public to raise awareness of the population on cancer prevention and early detection and about benefits of breast and cervical cancer screening programme.

  8. Building Partnerships Government: • Tbilisi Municipality set up special organization NATIONAL SCREENING CENTER for the Screening project, provided sufficient funding and relevant space and infrastructure; • The Federal Government (MoLHSA) provided with the modern medical technology and equipment. UNFPA: • Responsible for Project management • Supports National Capacity building for high quality policies, standards, programmes and services; • Information/communication and behaviour change communication targeted at the general public

  9. National Capacity Building for Breast and Cervical Cancer Prevention& Early Detection • National guideline on Pap test was developed in 2006; • National guidelines were developed on breast and cervical cancer screening and diagnosis based on: • European guidelines for quality assurance in breast cancer screening and diagnosis Guidelines • European guidelines for quality assurance in Cervical cancer screening • The trainings and workshops were conducted (2006-2008): • ESO Cervical cancer screening seminar (2005) • Training for pathologists (2007-2008); • Ensuring quality of services: • Screening management information system was set upCall center was installed for managing effectively incoming calls and subscription into the program • Client satisfaction survey is being implemented on a permanent basisFollow up of women who have been screened

  10. Capacity building of Primary health care providers on RT cancer screening and control • Involvement of Primary Health Care (PHC) managers and service providers in Breast and Cervical Cancer Screening Program • Training of PHC doctors and nurses in educating general population about breast and cervical cancer screening program • Elaboration of a special scheme on referring women to the screening center by PHC sector • Involvement of PHC sector in follow up of screened women • Special guidelines was developed for primary health care professionals on breast and cervical cancer prevention and screening

  11. Breast and Cervical Cancer Screening Program in Tbilisi • The Screening Program consists of a Central Unit – • National Screening Centre and • 3 sub-contracted medical centers: • Tbilisi Cancer Center, D. Tatishvili Medical Center and O. Gudushauri Medical Center • Screening and diagnostic services offered to enrolled females are free of charge

  12. Breast and Cervical Cancer Screening Program in Tbilisi Inclusion Criteria • Females, whose place of residence is Tbilisi city • Agegroup of 40-70 yearsforBreastCancerscreening (n=~214,905) in everytwoyears; • Agegroup of 25-60earsfor Cervical Cancerscreening (n=~280,000) in everythreeyears.

  13. Breast and Cervical Cancer Screening Program in TbilisiEnrollment Methods Enrollment of thebeneficiaries in theScreening Programisaccomplished in twomajorways: • BySelf-enrollment (bycalling and registering, orvisitingthe NSC or sub-contractedunits and registering) • By Referral.

  14. Special TV commercial is regularly aired on Breast and cervical Cancer Screening Program on Public Broadcaster

  15. Breast and Cervical Cancer Screening Program in Tbilisi Screening Methods • BreastCancer • Physicalexamof Breasts • Radiographyexamination of Breastbasedonthe BIRAD system • Ultrasoundexamination of Breast as indicated • Cytological test as indicated • Cervical Cancer • PAP smeartest • Colposcopyexamination of Cervix as indicated • Punch Biopsy and morphological test

  16. Breast and Cervical Cancer Screening Program in Tbilisi Accomplished ScreeningsMay 2008 – June 2009

  17. Breast and Cervical Cancer Screening Program in Tbilisi Performed InvestigationsMay 2008 – June 2009

  18. Breast and Cervical Cancer Screening Program in Tbilisi Abnormal PAP smear ResultsMay 2008 – June 2009

  19. Breast and Cervical Cancer Screening Program in Tbilisi Detected Cervical PathologyMay 2008 – June 2009

  20. Breast and Cervical Cancer Screening Program in Tbilisi Breast Cytology ResultsMay 2008 – June 2009

  21. Breast and Cervical Cancer Screening Program in Tbilisi Benign and Malignant forms of Breast CancerMay 2008 – June 2009

  22. Breast and Cervical Cancer Screening Program in Tbilisi After Surgery by Stage Distribution of Breast Cancer CasesMay 2008 – June 2009 (1 Year Period) 77.7% 22.3%

  23. Breast and Cervical Cancer Screening Program in Tbilisi After Surgery by Stage Distribution of Breast Cancer CasesMay 2008 – December 2008 (8 months period) 74.9% 25.1%

  24. Breast and Cervical Cancer Screening Program in Tbilisi After Surgery by Stage Distribution of Breast Cancer CasesJanuary 2009 – June 2009 (6 months period) 81.9% 18.1%

  25. Breast and Cervical Cancer Screening Program in Tbilisi National Statistics VS The Screening Program *Remark: Precancerous Conditions are included in Stage I

  26. Results • 20% of target population in Tbilisi were screened for Cervical Cancer during 1 year • 18% of target population in Tbilisi were screened for Breast Cancer during 1 year • 77.7%of due to screening identified Breast Cancer cases were stages I and II

  27. Awards and Acknowlgment In January 2009, the Georgian National Screening Program was awarded a “Pearl of Wisdom” special award at the Cervical Cancer Prevention Summit, organized by the European Parliament, European Cervical Cancer Association and Politicians for Cervical Cancer Prevention In December 2008, the program was assigned a “Georgian Quality Certificate”

  28. Breast and Cervical Cancer Screening Program in Tbilisi Information, Education, Communication and Bahaviour Change Communication Patient Brochure Self Examination Brochure Flyer • Website: www.gnsc.ge • Special trainingafor journalists; • Special trainings for PHC doctors and managers in educating general population about breast and cervical cancer screening program and its benefits

  29. Achievements • Government commitment and resources allocated for breast and cervical cancer prevention and screening • Behavior change among women • Pilot program in Tbilisi is being replicated in regions of Georgia • Detection at early stages when cancer is curable has increased • Partnership established and strengthened among Government, UN and the private sector

  30. Future Plans and Challenges • To strengthen and expand existing program in other regions of Georgia (currently being launched) • To implement organized screening programme based on call and recall system • To establish close contacts with similar organizations and programs in the EU and neighbouring countries (South Caucasus, Black Sea) to share experience and learn best lessons • To launch HPV vaccination programme

  31. Thank You! National Screening Center 12, Kalaubani str. Tbilisi, Georgia Tel: (995-32) 48-17-27 Email: screening_center@yahoo.com Webpage: www.gnsc.ge

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