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

2. 2 Cervical cancer: Incidence and mortality 15,5 16,1 22,0 16,6 14,6 15,3 9,3 9,7 9,4 4,2 9,7 8,8 7,7 5,4 4,8 4,1 3,9 3,4 2,9 1,3 0510152025 Lithuania Poland Estonia Latvia Portugal Denmark UK ECEC Sweden Finland Cases per 100000 Mortality Incidence

3. 3 Cervical cancer 1978-2005 Rapid increase of cases at age 35-49 years 0.0 10.0 20.0 30.0 40.0 50.0 60.0 1978- 1982 1983- 1987 1988- 1992 1993- 1997 1998- 2000 2001- 2002 20032004 65-74 50-64 35-49 Programa

4. 4 Cases at 35-64 years are the major contributors of the rates

5. 5 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 Allocation of resourcesSTATE PATIENT FUND Distribution of resources REIMBURSEMENT FOR THE SERVICE (invitation, smear taking, PAP assessment Invitation system DECENTRALIZED PAP smear takingDECENTRALIZED

6. 6 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. Cervical cancer screening programme: women and data management REGIONAL STATE PATIENT FOUNDS N=5 Population-based CANCER REGISTRY N=1 PRIMARY HEALTH CARE CENTERS N>350 Sharing the list Woman 30-60 Request of reimbur- sement Woman N=750.000 Invitation RESPOND PATHOLOGY LABS N=10 PAP Bethesda COLPOS- COPY BIOPSY Invitations Future development TREATMENT Population registry 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. 7 Cervical cancer 2005 – impact of the programme Programme

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

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

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

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

12. 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. 13 Solution: pilot study Agreement with one of the municipalities Installment of IS Sharing of local activity The increase of the woman attendance

14. 14 Action and interventions Programme PAP

15. 15 Practical implementation

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

17. 17 Thank YOU