Cervical cancer screening: problems and barriers in Estonia

1. Cervical cancer screening: problems and barriers in Estonia Piret Veerus Department of Epidemiology and Biostatistics National Institute for Health Development Tallinn, 02.04.2007

2. Cervical cancer in Estonia • ASIR (w) of cervical cancer 15.6 per 100,000 women yrs in 2004 • In 2004, 181 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 1980-1982 to 1998-2000

4. Cervical cancer screening in Estonia in 2003 • 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

5. Cervical cancer screening in Estonia in 2004 and 2005 • 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, invitations mailed in 6 districts • In 2005, 6552 women attended, 7% abnormal results

6. Cervical cancer screening in Estonia since 2006 • Organized cervical cancer screening started in 2006 • Target group for cervical cancer screening women aged 30 to 59 years • Screening interval 5 yrs after a negative result • Trained midwives take Pap-smears at 19 clinics, tests preformed at 7 labs • Pathological results handled according to clinical guidelines

7. Cervical cancer screening in Estonia in 2006 Preliminary results: • Altogether 5559 tests performed, in 6.6% of tests results abnormal • Overall attendance rate very low (18.45 %) • Attendance rates were higher in the countryside, lower in the capital area and Eastern Estonia • The number of Pap-tests outside the screening programme is increasing

8. National Cancer Strategy • National Cancer Strategy launched in 2007 • Funding from the State Budget will be provided for mailing invitations and reminders to women, for education of the personnel, and for quality assurance • The Estonian Health Insurance Fund is funding the performance of tests and additional investigations

9. Objective of the Eurochip-2 Task Force in Estonia • To produce knowledge for improving the population coverage by Pap-tests and for increasing the proportion of primarily diagnosed cervical cancer cases in early stages

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 organized screening programme

11. Problems with possible solutions • Population coverage by cervical screening very low - awareness campaigns planned, funding provided from 2007 to 2010 • No screening registry – vision of the IT solution prepared, funding from 2008 • No reference laboratory – planned to be established in 2008, quality assurance in the labs in 2007 • Non-insured women not included – amendment to the legislation being prepared by the Ministry of Social Affairs

12. Barriers to be overcome • Clear underfunding of all parts of the screening programme – additional funding needed • Funding needed for informing the participants about the test results • The reasons for unattendance-survey? • Screening registry – legislation needed • Assessment of adherence to cervical pathology guidelines needed

13. ESTONIA DISCUSSION • It is necessary to implement relation between screening activity and gynecologists • All the screening activities are completely free

14. Thank You!