1. EUROCHIP-2 results in Lithuania Varenna October 18, 2007 Presented by Ruta Kurtinaitiene Ruta.Kurtinaitiene@takas.lt

2. Cervical cancer screening program indicators Early detection goals and objectives Year established Indicator status PresentDesired At least one Pap smear in last 3 year 2004 30% Screening of 80% by 2007 Assisting organizations 1 NGO in 2003No goals specified National cervical cancer screening programme 2004Since 2004continue

3. Cervical cancer screening in Lithuania year 2007 The most important year in cervical cancer control in LITHUANIA: –The first ever three year population based screening round almost has been finished! Nation wide screening program July 1, 2004 2004 -07-01 2005 2006 2007 Target population 750 000 woman at age 30-60 Almost 400 000 (53%) woman has been informed during first three years about the programme 330 000 (44%) PAP smears has been taken RESULTS:

4. 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

5. 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

6. National screening programme strength and weakness The implementation of nation wide organized cervical screening along the state insurance based health care system was the new and reasonable approach to setup the cervical cancer screening in the country having low health economy resources. Strength is ability to reach and provide the health service for entire population (almost 100%) Weakness – decentralized system of invitations (they are substituted by information only) and tolerance the opportunistic view on screening

7. Western Europe: -INVITATIONS ARE NECESSARY PART OF THE SCREENING PROGRAM Eastern Europe – NO INVITATION (prevailing opinion) –THEY ARE EXPENSIVE and INEFFECTIVE, - DOCTOR INFORMATION ONLY National screening programme PROBLEM: INVITATIONS to break this opinion in Lithuania OUR MISSION in EUROCHIP:

8. The actions and interventions of national group 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 Female student knowledge on cervical cancer screening and HPV Action 1 Action 2 Action 3

9. The actions and interventions of national EUROCHIP group Action 2 Pakruojis (B) Action 1 Širvintos (A) Vilnius Action 3 Vilnius (student survey)

10. Pakruojis municipality Number of woman at age 30-60 years – 5300. PAP smears are taken in one center Municipality has one town and 9 health points (ambulancies) allocated in rural area Action started in February –woman who not participated in the program since June 2004 were on the target –Pakruojis town were invited by mail (N= 560) –Woman residing in rural area were invited by the help of local nurses (N=286 )

11. Results of action in Pakruojis municipality

12. Action to help discover more cervical pathology Action YesNo action Norma109 (93.2)358 (95.5) ASCUS5 (4.3)13 (3.5) HSIL3 (2.6)4 (1.1) Total117375 Results in selected patient groups by action Note. 10 woman having no insurance – 2 cases ASCUS !

13. Summary There is organized cervical cancer screening in Lithuania since 2004. By the end of 2007 almost 400 000 (53%) woman has been informed about the programme and 330 000 (44%) PAP smears has been taken. The estimates of the knowledge on HPV and cervical cancer screening can be considered as satisfactory – more than 75% of woman knew about the running cervical cancer screening. Relatively low attendance rates at the reasonably high knowledge on cervical cancer risk factors is a challenge to find a barriers in cervical cancer screening program. The EUROCHIP study group suggested the lack of centralized invitation system would be a barrier to reached the higher attendance rates in the program.

14. Summary The pilot study using the centralized invitation system was carried out in one the municipalities in Lithuania. More than 800 of invitation were distributed by mail and help of nurses in February – March, 2007. Matched to the results of the year 2006, the number of the woman attending the program has increased almost twice (362 compare to 614). The findings in selected series show the higher pathology rates (ASCUS, HSIL) among the invited woman compared to self referral. Eurochip-2 was helpful to enhance the effect of cervical cancer screening in Lithuania in one of the municipalities, providing the evidence and the benefits to centralized invitation system.

15. The meeting in primary health care center, October, 2007