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Cervical cancer screening in Lithuania2005Maiori, Italy 2006-06-15Juozas Kurtinaitis Institute of Oncology, Vilnius [email protected]
Cervical cancer: Incidence and mortality
Cervical cancer 1978-2005Rapid increase of cases at age 35-49 years
Cases at 35-64 years are the major contributors of the rates
Cervical Cancer Screening in LithuaniaNation - 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 FUNDDistribution of resourcesREIMBURSEMENT FOR THE SERVICE (invitation, smear taking, PAP assessmentInvitation systemDECENTRALIZEDPAP smear takingDECENTRALIZED
MethodsOrganization: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 smearsAccording to the guidelines, the PHCC is responsible to take the PAP smear. The GPs 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 managementREGIONALSTATE PATIENT FOUNDS N=5Population-basedCANCER REGISTRY N=1PRIMARY HEALTH CARE CENTERSN>350Sharing the listWoman 30-60Request of reimbur-sementWoman N=750.000InvitationRESPONDPATHOLOGY LABSN=10PAP BethesdaPAP BethesdaCOLPOS- COPY BIOPSYInvitations
Future developmentTREATMENTPopulation registryThe 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
Cervical cancer 2005 impact of the programmeProgramme
Chart3
483
483
572
504
C53
Metai
Atv. skaiius
Sheet1
IM30-6060+iki 30Visoproc_30-60
2004Stadija20002831721947459.7
amz_skrynIIIIIIIVVisoproc.20013301512050165.9
30-6024140841181838467.120023101531547864.9
6.336.521.930.74.720033011431746165.3
60+133041622517129.920043841711757267.1
7.617.524.036.314.620051335218571.9
iki 30152173.02006
2007
I viso5722008
2009
2005Stadija2010
amz_skrynIIIIIIIVVisoproc.2011
30-602215767692233770.52012
6.546.619.920.56.52013
60+152530492214129.52014
10.617.721.334.815.6
iki 302126
I viso478
amz_skryn1234
30-6022157676922
60+1525304922
iki 302126
Nera
dgn2002200320042005
C53613167
D0672376156
Grand Total133692163
LVR
tlk10a2002200320042005
C53477470575489
D0677102198356
is viso
2002200320042005
C53483483572504
D0684125274517
Sheet1
00
00
00
00
2004
2005
Stadija
Atv. skaiius, proc.
Sheet2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
proc_30-60
Sheet3
00
00
00
00
C53
D06
Metai
Atv. skaiius
Cervical cancer 2005 invasive and in situ by county
County
Cervical cancer invasive
Stage I-II
Cervical cancer invasive, in situ
Ratio invasive/in situ
Ratio invasive/in situ,
cases before age 60 years
Vilniaus
125
85 ( 68,0%)
288
2,3
3,1
Kauno
101
59 ( 58,4%)
42
0,4
0,6
Klaipdos
44
28 ( 63,6%)
11
0,3
0,3
iauli
57
31 ( 54,4%)
11
0,2
0,3
Panevio
46
28 ( 60,9%)
28
0,6
0,9
Alytaus
31
22 ( 71,0%)
43
1,4
2,3
Marijampols
31
20 ( 64,5%)
28
0,9
1,2
Taurags
16
6 ( 37,5%)
5
0,3
0,6
Teli
26
15 ( 57,7%)
5
0,2
0,3
Utenos
27
14 ( 51,9%)
55
2,0
2,3
Lithuania, total
504
308 ( 61,1%)
516
1,0
1,4
Cervical cancer: changes in the target group (30-60 years) 2005 70% 2004 67%
Chart10
4.016913319259.619450317136.3636363636
3.992015968165.868263473130.1397205589
3.144654088164.989517819731.8658280922
3.671706263565.010799136131.3174946004
2.97202797267.132867132929.8951048951
073.205741626826.7942583732
60 m.
Atvej skaiius procentais
Sheet1
Sergamumas gimdos kaklelio viu 2000-2005 m.
200020012002200320042005
Carcinoma in citu586177100200137
I stadija8811312414418581
II stadija1821511139912443
328325314343509261
Carcinoma in citu17.718.824.529.239.352.5
I stadija26.834.839.542.036.331.0
II stadija55.546.536.028.924.416.5
Lokalizacija200320042005200320042005
Gimdos kaklelio vys463572209
601451715631.3229.9026.79
Lokalizacija200020012002200320042005
Gimdos kaklelio vys473501477463572209
6017215115214517156
Amius200020012002200320042005
60 m.36.3630.1431.8731.3229.9026.79
Sheet1
Carcinoma in citu
Sheet2
Carcinoma in citu
Atvej skaiius procentais
Sheet3
I stadija
Atvej skaiius procentais
II stadija
Atvej skaiius procentais
60
Atvej skaiius procentais
60 m.
Atvej skaiius procentais
MBD00078A3F.xls
Chart1
17.6829268293
26.8292682927
55.487804878
2000
2000 m.
II stadija 55,5 %
I stadija 26,8 %
Carci-noma in citu 17,7 %
Sheet1
Sergamumas gimdos kaklelio viu 2000-2005 m.
200020012002200320042005
Carcinoma in citu586177100200137
I stadija8811312414418581
II stadija1821511139912443
328325314343509261
Carcinoma in citu17.718.824.529.239.352.5
I stadija26.834.839.542.036.331.0
II stadija55.546.536.028.924.416.5
Sheet1
0
0
0
0
0
0
Carcinoma in citu
Sheet2
0
0
0
2000
Sheet3
0
0
0
2001
0
0
0
2002
0
0
0
2003
0
0
0
2004
0
0
0
2005
Cervical cancer prevention respond rate by month20052006
Problem: invitation systemDecentralized Lacking of ISDependent on local activityDifficult to trace the woman attendance
Solution: centralized invitation systemManagement from cancer registry in collaboration with primary health care centerIndependent on local activityEasy to trace the woman attendancePossibilities of measurements of indicators
Solution: pilot studyAgreement with one of the municipalitiesInstallment of ISSharing of local activityThe increase of the woman attendance
Action and interventionsProgrammePAP
Practical implementation
Expected resultsThe increase of attendance rates Sharing collaboration of PHCImprovement of the overall performance % coverage of the programme
Thank YOU