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

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 to

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

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

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

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

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

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 and for increasing the proportion of primarily diagnosed cervical cancer cases in early stages

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 and numbers of primarily detected cervical cancer cases before and after introducing the organized screening programme before and after introducing the organized screening programme

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

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

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

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