Transcript ATRANKINĖS PATIKROS DĖL GIMDOS KAKLELIO …

Cervical cancer screening in
Lithuania 2005
Juozas Kurtinaitis
Institute of Oncology, Vilnius University
[email protected]
Maiori, Italy
2006-06-15
1
Cervical cancer: Incidence and mortality
1,3
Finland
Mortality
Incidence
4,2
2,9
Sweden
9,4
3,4
EC
9,7
3,9
UK
Denmark
9,3
4,1
15,3
4,8
Portugal
14,6
5,4
Latvia
16,6
7,7
Estonia
22,0
8,8
Poland
9,7
Lithuania
0
5
16,1
15,5
10
15
Cases per 100000
20
25
2
Cervical cancer 1978-2005
Rapid increase
of cases at
age 35-49
years
60.0
65-74
50-64
35-49
50.0
40.0
30.0
20.0
Programa
10.0
0.0
19781982
19831987
19881992
19931997
19982000
20012002
2003
2004
3
Cases at 35-64 years are the major
contributors of the rates
66.532
65
60
65
60
55
70
70
70
65
70
50
45
55
65
50
60
70
60
50
65
60
55
45
45
55
50
50
45
40
45
40
rate
40
55
35
35
40
30
40
35
35
35
30
30
30
30
8.07395
1910
1970
cohort
4
Cervical Cancer Screening in Lithuania
Nation - wide screening
started at July 1, 2004
NORWAY
Oslo
Skuodas
Biržai
Joniškis
Mažeikiai Akmenė
Pakruojis
Pasvalys
Rokiškis
Kupiškis
Zarasai
750 000 women at age 30-60
are on the target,
with interval of 3 years
Kretinga Plungė
Plungė
Telšiai
Kelmė
Radviliškis
Šilalė
Raseiniai
Šilutė
Anykščiai
Kėdainiai
Ukmergė
Utena
Molėtai
Ignalina
Švenčionys
Tauragė
Jonava
Jurbarkas
Širvintos
Šakiai
Kaišiadorys
Marijampolė
Vilkaviškis
Prienai
Trakai
Šalčininkai
Alytus
Varėna
Lazdijai
Allocation of resources
STATE PATIENT FUND
Distribution of
resources
REIMBURSEMENT FOR THE SERVICE
(invitation, smear taking, PAP assessment
Invitation system
DECENTRALIZED
5
Cervical cancer screening programme:
women and data management


Methods
Organization:








TREATMENT
BIOPSY
Woman
HEALTH
Invitation
The resources for the cervical cancer
PAP
CARE
N=750.000
PATHOLOGY
screening were allocated at State
Bethesda
CENTERS
LABS
Patient Fund which is responsible to
RESPOND
N>350
N=10
provide the
reimbursement for the
Sharing the list
service. 5 regional State Patient Funds
Woman 30-60
PAP
are responsable to manage contracts
Bethesd
with primary healt centers (PHCC).
Invitations
Request
a
of
The PHCC (more than 350 around the
Future
reimburPopulation-based
development
country) are responsible to join the
sement
REGIONAL
CANCER
screening programme and to implement
STATE
REGISTRY
the screening procedures
PATIENT
N=1
Population
FOUNDS
The visit of the women to PHCC in
registry
N=5
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.
•The nation wide organized cervical
Each GP is supposed to serve 1500-2500
screening was implemented along the
of population.
PAP smears

PRIMARY
COLPOSCOPY
According to the guidelines, the PHCC is
responsible to take the PAP smear.
The GP’s 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.
state insurance based health care
system. It is suggested to be a
reasonable approach for cervical
cancer screening
6
Cervical cancer 2005 – impact of
the programme
Programme
C53
572
600
500
483
C53
504
483
Atv. skaičius
400
300
200
100
0
2002
2003
2004
2005
Metai
7
Cervical cancer 2005 – invasive
and in situ by county
County
Cervical cancer
invasive
Stage I-II
Vilniaus
Kauno
Klaipėdos
Šiaulių
Panevėžio
Alytaus
Marijampolės
Tauragės
Telšių
Utenos
Lithuania, total
125
101
44
57
46
31
31
16
26
27
504
85 ( 68,0%)
59 ( 58,4%)
28 ( 63,6%)
31 ( 54,4%)
28 ( 60,9%)
22 ( 71,0%)
20 ( 64,5%)
6 ( 37,5%)
15 ( 57,7%)
14 ( 51,9%)
308 ( 61,1%)
Cervical
cancer
invasive,
in situ
288
42
11
11
28
43
28
5
5
55
516
Ratio
invasive/in
situ
2,3
0,4
0,3
0,2
0,6
1,4
0,9
0,3
0,2
2,0
1,0
Ratio
invasive/in
situ,
cases before
age 60 years
3,1
0,6
0,3
0,3
0,9
2,3
1,2
0,6
0,3
2,3
1,4
8
Cervical cancer: changes in the target
group (30-60 years)
2005 70%
2004 67%
Atvejų skaičius procentais
80,00
70,00
73,21
65,87
64,99
67,13
65,01
<30 m.
30-60 m.
59,62
>60 m.
60,00
50,00
36,36
40,00
31,87
30,14
31,32
29,90
26,79
30,00
20,00
10,00 4,02
3,99
3,14
3,67
2,97
0,00
0,00
2000
2001
2002
2003
2004
2005
9
Cervical cancer prevention – respond
rate by month
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2006
gu
ž
bi ė
rž
el
is
lie
pa
ru
gp
jū
t
ru is
gs
ėj
is
sp
al
is
la
pk
rit
g r is
uo
di
s
ge
la
nd
is
s
va
ba
ko
sa
va
sa
us
i
s
ris
2005
10
Problem: invitation system

Decentralized

Lacking of IS

Dependent on local activity

Difficult to trace the woman attendance
11
Solution: centralized invitation system

Management from cancer registry in
collaboration with primary health care
center

Independent on local activity

Easy to trace the woman attendance

Possibilities of measurements of
indicators
12
Solution: pilot study

Agreement with one of the municipalities

Installment of IS

Sharing of local activity

The increase of the woman attendance
13
Action and interventions
PAP
Programme
14
Practical implementation
15
Expected results




The increase of attendance rates
Sharing collaboration of PHC
Improvement of the overall performance
% coverage of the programme
16
Thank YOU
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