Transcript Diapositiva 1

GRELL 2006 - Palma de Majorca
EUROCHIP-2
European Public Health Action
on Cervical Cancer Screening
Paolo Baili
Unità di Epidemiologia Descrittiva e Programmazione Sanitaria
Istituto Nazionale per lo Studio e la Cura dei Tumori
Public Health Program
EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE - GENERAL
www.tumori.net/eurochip
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EUROCHIP-2 DISCUSSION PLAN
COUNTRY 1
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COUNTRY 2
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COUNTRY 3
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COUNTRY 30
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5 EDUCATIONAL
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ACTIVITY
EUROPEAN PUBLIC
HEALTH ACTION –
early diagnosis
EUROPEAN PUBLIC
HEALTH ACTION –
care & treatment
EUROPEAN PUBLIC
HEALTH ACTION prevention
Cervical screening
Pilot studies
Dietary prevention
EU CANCER PLAN
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); 2266-2271
UTERUS CANCER STANDARDIZED MORTALITY RATE
AGE: 20 – 44 (IN THESE AGES MOSTLY CERVICAL CANCER)
http://epicancer.iss.it
European standard per 100,000
UTERUS CANCER (age 20-44) AVOIDABLE DEATHS. 2000
Expected avoidable deaths using
following references:
Norway
Finland
Italy
Bulgaria
75
85
90
Latvia
20
25
25
Lithuania
50
55
55
Romania
370
410
415
TOTAL
515
575
585
+ EST, HUN, POL,
CZE, SLO, SVK
810
980
1020
EUROCHIP-2 ACTIVITY:
TO ORGANISE A TASK FORCE ON
CERVICAL CANCER SCREENING EMERGENCY
MILESTONES
- 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)
For countries without programs:
ASSESSMENT STUDIES
• Understand how services for cervical cancer
screening and treatment currently are, or could
potentially be, organized and delivered
• Identify the key organizations involved in delivering
these
services,
including
potential
leaders,
coordinators, or area supervisors
• Define the level of available resources and assess
how services could be financed
• Document 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
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)
BULGARIAN
ESTIMATES
• Screening interval: 3 years
• 5 € * 0.6 million = 3 million € per year
Number of cases
in Bulgaria (2001)
St. III – IV
Prices according to EU data
(Andrae Bengt - 2004)
Per item
Total
347
30 000 €
10 410 000 €
St. I – II
670
9 000 €
6 030 000 €
CIS
275
300 €
83 500 €
Total
1292
-
16 522 500 €
V. Zlatkov - Bulgaria (2006)
Cervical cancer
stages
CURRENT SITUATION
• Prevention examination program (12.2004):
– 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)
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ORGANIZATION OF A GROUP OF PRESSURE
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PRACTICAL PROPOSAL TO DEVELOP A SCREENING
PROGRAM
I. Viberga - Latvia (2006)
FIRST RESULTS OF THE NEW ACTIVATED
CERVICAL SCREENING PROGRAM
CANCERS IN SITU
EUROCHIP-2 will help the
centralization of the invitation system
J. Kurtinaitis - Lithuania (2006)
PROBLEMS OF THE ORGANISED
SCREENING PROGRAM
• 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)
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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
P. Veerus - Estonia (2006)
EUROCHIP-2 TASK FORCE ON
CERVICAL CANCER SCREENING EMERGENCY
AIMS
- 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)