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Cervical cancer screening problems and barriers in Lithuania Presented by Ruta Kurtinaitiene firstname.lastname@example.org Tallin April 2, 2007
Are we going to fight cervical cancer? It’ look’s like a hurdle-race in Lithuania
Cervical cancer Source: Globocan 2002
Cervical cancer in EU 2004 Source: Globocan 2002
Cervical cancer screening in Lithuania:CA in situ and invasive cancer invasive cancer CA in situ
Cervical cancer in Lithuania 2005 Almost 7% of female malignant tumors
THE EUROCHIP-2 IN LITHUANIA • Organisation of the national group • Involvement in the Eurochip pilot studies • Collection of information on available data • Analysis of available data • Production of reports on cancer health planning • Connection with health planners and political makers in order to promote actions
Structure of consumers expenditures Unemployment rate, total and by sex 2002 year: 13.8 both sexes, 14,6 male, 12,9 female.
Biržai Joniškis Akmenė Mažeikiai Pasvalys Skuodas Pa kruojis Rokiškis Kupiškis Zarasai Telšiai Kretinga Plungė Radviliškis Plungė Utena Ignalina Kelmė Anykščiai Šilalė Raseiniai Ukmergė Kėdainiai 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 from July 1, 2004 750 000 woman at age 30-60 are on the target with interval of 3 years
Cervical cancer screening in Lithuania • Distribution of funding – REIMBURSEMENT FOR THE SERVICE (invitation, smear taking, PAP assessment) • Invitation system – DECENTRALIZED • PAP smear taking – DECENTRALIZED • Reimbursement for PAP + LAB = approx 6 Eur
Program problems Better financing – better results? • Program financing 2004 m.- 660 000 Lt (191 000 EUR) 2005 m. - 2 654 000 Lt (768 000 EUR) 2006 m. –2 000 000 Lt (580 000 EUR) ... but ... still no centralised invitation system ... more than 50% committed funds are not used
Survey to identify the screening barriers • Two surveys has been carried out to identify the screening barriers in the country. First survey: • Two municipalities has been selected to test the possibilities of introduction of centralized invitation system • computerized system with centralized call/recall system and distribution of invitations to the woman which does not attended the programme (approx. 3500 woman are on the target)
The invitation to join the programme Municipality B: Invitation mailed to the woman with detailed information on cervical cancer and the major risk factors. The mailing was supported by the information campaign by volunteers Municipality A: Invitation mailed to the woman with information to visit the primary health care center
Survey to identify the screening barriers Next survey: • Questionnaire on attitude on screening programm, the visits to gynecologist, knowledge of risk factors and HPV
Results of survey on invitations • Respond rate in rural municipality on mailed invitation was low (approx. 30%) • Respond rate on distributed invitation by volunteers was reasonable (approx. 60%, the data is pending) The additional information that was provided to the woman was found useful to increase the attendance rates
Results of survey on knowledge • Number of woman – 1075 • Mean age –33 years • Questions: • Do You know about the programme – 80% • How frequently You are visiting gynecologist: • one or twice a year – 34% • never or rare – 65.4% • When the first PAP smear should be taken • when start the sexual life – 53% • since 18 years – 24% • Have You heard about HPV – 64% • have You heard about vaccines – 59% Low frequency of visits to gynecologist and insufficient information on the disease from other sources does not allow the woman to be more active on screening
Summary • Despite of state support of cervical cancer screening, the barriers in implementation of the screening programme still exits • The barriers are: • System related - the lack of centralized invitation system • Patient related – the lack of knowledge on existing prevention programme and risk factors • Active actions should be take to overcome system and patient related barriers in order to reduce mortality rates from cervical cancer in Lithuania