1. PROJECT “THINK ABOUT YOURSELF – ONLY THE EARLY DISCOVERED BREAST CANCER MAY BE MEDICALLY TREATED WITH SUCCESS”
Association “Education against breast cancer” from Zagreb County ran this project from 2007/2009. Basic information about the Association:
- Founded on May 22nd, 2001
- Primary activity: education of women of all ages in correct and regular self breast examination and raising consciousness about personal health with the primary goal: health through prevention

2. Project “THINK ABOUT YOURSELF
In 2007 the Association won CARDS 2004 contest with the project “THINK ABOUT YOURSELF”
We are the only association from Zagreb County with a project financed by this contest
Zagreb County recognized this project and got involved as the partner
Total project budget is 219, EUR:
81% financed by CARDS 2004
19% financed by Zagreb County (160, HRK) and the Association (152, HRK)
The Association geathered funds through humanitary actions
charity concerts
and donations

3. Project goals
Expanding the National program of breast cancer prevention in the Republic of Croatia (age years)
Expanding the network of trained personnel for education of early breast cancer detection
Promotion of self breast examination for breast cancer prevention through organized workshops, media coverage and public forums

4. Target groups and expected results
Women years – education in correct self breast examination
Women years – free breast ultrasound
Women years – free mammography
13 trainers for education of correct self breast examination

5. Results of the Project (Jun 27th, 2007 – Jun 16th, 2009)

6. Results of ultrasound and mammography
Results of assessments and clinical findings:
- 13 trained educators
women educated in breast self examination
- 931 breast ultrasounds (30-39 years)
mammographies (40-49 years)

7. Results of ultrasound examinations (30 – 39 years)
NORMAL FINDINGS
FIBROUS CHANGES-mastopathy
SEVERE FIBROCYSTIC DYSPLASIA
BENIGN-LOOKING NODES
DEFINITE SIGNS OF MALIGNANCY
TOTAL

8. Results of mammography findings (40 - 49 years)
LEGEND:
R1 – NORMAL FINDINGS
R2 – BENIGN CHARACTERISTICS
R3 – INDETERMINATE FINDINGS
R4 – SUSPICIOUS FINDINGS
R5 – MALIGNANT CHANGES
8 WOMEN OPERATED !

9. Recommendations according to mammography results (40 – 49 years)
LEGEND:
1 – CONTROL EXAM IN 2 YEARS
2 – REFERRED TO FAMILY PHYSICIAN + ULTRASOUND
3 – REFERRED TO THE BREAST DISEASE CENTER (ULTRASOUND, ADDITIONAL MAMMOGRAPHIES, CYTOLOGY)‏
Total: 3,985 recommendations

10. Association “Edication against breast cancer” from Zagreb County
In parallel to the project THINK ABOUT YOURSELF, the Association coducted education, ultrasound and mammography examinations also for the:
age group years, since 2003 (“County program”)
age group years, since 2007 (“National program”)
Statistics, findings and medical recommendations for all projects were analyzed separately

11. Contacts: 1) Gorana Rabatić, Zagreb County Phone: +385 1 6009 475
Fax:
2) Joško Zekan, MD, MSc
Phone:
WWW:
3) Mario Kopljar, MD, PhD
Phone:

12. Reproductive health care Croatian perspective
Mario Kopljar, Joško Zekan

13. Public health impact of STD
Sexually transmitted diseases have a sigificant influence on the pupulation reproductive health
Infertility 12%
Healthcare burden
Reductio of working abillities (hepatitis B, sick leave)

14. Incidence of STD in Croatia per 100000
Chlamydia
Gonococcal infections
Hepatitis B
HIV
HPV

15. Reduction of STD incidence HIV incidence under control
education,
promotion of anonymous testing,
legal purchase of sterile needles in pharmacies
Growing problem is HPV

16. HPV infection represents a major health problem because of its relation to cervical cancer
HPV Summit 1999: there is no cervical cancer without HPV infection
Cervical cancer is a preventable disease

17. Cervical cancer – incidence
Latin America / women
Croatia / women
Israel, Finland 3-4 / women

18. SMOKING – LUNG CANCER:
ODD RATIO =17
HPV INFECTION – CERVICAL CANCER:
ODD RATIO =

19. High risk population Sexarche before the age of 17 Promisquity
Early pregnancy
High-risk HPV infection
Low socioeconomical status
Immunodeficient conditions
Smoking
Nutritional deficit
Oral contraception
High-risk partners
Non-existance of national screening programme

20. Situation in Croatia 597 gyneacologists 142 pathologists
115 cytologists
112 cytoscreeners
Opportunistic screening (OR 0.57): ~ PAP-smears/year
Organized screening (OR 0.25):
women (25-65 years)

21. Croatia has enough resources for opportunistic screening (patients seeking medical attention, PAP-smear/year)
The goal of Womens Health Initiative: doctors activelly addressing people (organized screening) with anticipated reduction in STD incidence by 50%

22. Target group for prevention – adolescents
Adolescent behavior and knowledge
More than 50% of adolescents is under influence of alcohol or drugs before intercourse
Only 6% tested for STD
Insufficient knowledge regarding contraception and prevention of STD
However … over 60% seek relevant education

23. Cervical cancer prevention modalities
Education
Insitutional (schools)
Extra-institutional
Public schools
Courses
Media
Screening
Vaccination

25. Figure reproduced from: Quinn M, Babb P, Jones J, Allen E
Figure reproduced from: Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999; 318: 904. Reproduced with permission from the BMJ Publishing Group.

26. Impact of vaccination strategies diagnosed HPV 16/18-related cervical cancer incidence, females (12+y), lifelong duration
This figure show number of cases of cancer relative to the pre-vaccination cases by different strategies. Vaccinating both females and males and using a catch up program is the most effective strategy. By year 50, cancer cases will be 88% lower. Females-only vaccination does well. Quicker and greater reductions are achieved through catch up vaccination.

27. Reproductive health care
Results of campagne:
⇓ Pelvic Inflammatory Disease
⇓Ectopic pregnancy
⇓ Sterility
⇓ Impact on state budget for health

28. Womens Health Initiative continues to promote reproductive health through organizing european conferences
Croatia accepted modern guidelines for protection of reproductive health and significantly improved reproductive health