EUROCHIP-2 European Public Health Action on Cervical Cancer Screening GRELL Palma de Majorca Public Health Program EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE - GENERAL Paolo Baili Unità di Epidemiologia Descrittiva e Programmazione Sanitaria Istituto Nazionale per lo Studio e la Cura dei Tumori

INDICATOR A INDICATOR B INDICATOR C. INDICATOR Z INDICATOR A INDICATOR B INDICATOR C. INDICATOR Z

EUROCHIP-2 DISCUSSION PLAN COUNTRY 1COUNTRY 2COUNTRY 3 COUNTRY 30 ACTION1ACTION1 ACTION2ACTION2 ACTION3ACTION3 ACTION3ACTION3 ACTION4ACTION4 ACTION4ACTION4 ACTION5ACTION5 ACTION6ACTION6 ACTION6ACTION6 EUROPEAN PUBLIC HEALTH ACTION – early diagnosis Cervical screening EUROPEAN PUBLIC HEALTH ACTION – care & treatment Pilot studies EUROPEAN PUBLIC HEALTH ACTION - prevention Dietary prevention EU CANCER PLAN EDUCATIONAL ACTIVITY

Uterus cancers ICD 180: Cervical cancer ICD 182: Corpus uteri cancer ICD 179: Uterus cancers, not specified On the basis of overall national death certificates, it is not possible to analyze mortality from cervical cancer in Europe, since 20-65% of deaths from uterine cancer in largest countries are still certified as uterus, unspecified To estimate cervical cancer mortality we used death rates for uterine cancers (ICD 179, 180, 182) in women aged 20-44, since most deaths from uterine cancer below the age of 45 years arise from the cervix Source: Levi et al. European Journal of Cancer 36 (2000);

UTERUS CANCER STANDARDIZED MORTALITY RATE AGE: 20 – 44 (IN THESE AGES MOSTLY CERVICAL CANCER) European standard per 100,000

UTERUS CANCER (age 20-44) AVOIDABLE DEATHS Expected avoidable deaths using following references: NorwayFinlandItaly Bulgaria Latvia 2025 Lithuania 5055 Romania TOTAL EST, HUN, POL, CZE, SLO, SVK

-Analyze the European guidelines to implement/promote/reconstruct cervical cancer screening in countries with increasing mortality trends -Describe the opportunistic/programmed cervical cancer screening in those countries at present time -Find difficulties and problems with specific assessment studies in these Eastern European countries -Connect all the previous points with other European networks ( EUNICE, European Cancer Screening networks) EUROCHIP-2 ACTIVITY: TO ORGANISE A TASK FORCE ON CERVICAL CANCER SCREENING EMERGENCY MILESTONES

For countries without programs: ASSESSMENT STUDIES servicesUnderstand how services for cervical cancer screening and treatment currently are, or could potentially be, organized and delivered key organizationsIdentify the key organizations involved in delivering these services, including potential leaders, coordinators, or area supervisors level of available resourcesDefine the level of available resources and assess how services could be financed systemDocument the system for requesting and purchasing equipment and supplies, and for improving infrastructure

ASSESSMENT PHASES: COLLECTION OF INFO ON Use of Policies, Guidelines, and Norms Program Management Issues Health Services Information and Education Activities Community Perspectives Laboratory Information Systems ROMANIA

Screening prices VS treatment prices In Bulgaria the mean value of programme screening for 1 person is around 5 € Target population: 1.8 million (age 25-60) Screening interval: 3 years 5 € * 0.6 million = 3 million € per year V. Zlatkov - Bulgaria (2006) BULGARIA Cervical cancer stages Number of cases in Bulgaria (2001) Prices according to EU data (Andrae Bengt ) Per itemTotal St. III – IV € € St. I – II € € CIS € € Total € BULGARIAN ESTIMATES

LATVIA CURRENT SITUATION I. Viberga - Latvia (2006) Prevention examination program ( ): –Age 20-35: PAP smear has to be done one time per year initially and, if the results of examination are without the pathological findings, every 3 years –Age 35-70: PAP smear has to be done one time per year Health care reform aims at driving health care to GPs BUT: 76% of women felt that they could not trust their GP to perform a PAP Smear (Source: Survey Reproductive health of the population) ORGANIZATION OF A GROUP OF PRESSURE PRACTICAL PROPOSAL TO DEVELOP A SCREENING PROGRAM

LITHUANIA FIRST RESULTS OF THE NEW ACTIVATED CERVICAL SCREENING PROGRAM CANCERS IN SITU J. Kurtinaitis - Lithuania (2006) EUROCHIP-2 will help the centralization of the invitation system

ESTONIA PROBLEMS OF THE ORGANISED SCREENING PROGRAM P. Veerus - Estonia (2006) Low participation: Only 21.7% of the 12,960 invited women attended the screening No funds for screening registry No invitation of women without insurance (~5% of population) To use experience from other countries to produce successful campaigns Group of pressure for invitation of women without insurance Money for starting the organization of screening registry

-To create relations with groups of pressure with national health ministries and with European Parliament -To share information with other networks -For countries without cervical screening programs: to study specific problems for implementation of screening programs and to find solutions to these problems -For countries with cervical screening programs: to help specific activities that at the moment are not subsidize (ex: screening registry, centralisation of the invitation system) EUROCHIP-2 TASK FORCE ON CERVICAL CANCER SCREENING EMERGENCY AIMS