Transcript Document

EUROCHIP-2 ACTIVITY
ON CERVICAL CANCER
SCREENING
BULGARIA
Incidence and mortality of cervix uteri cancer in Bulgaria
1970 - 2003
Year
Num of ASR (W)
new cases incidence
Num of
deaths
ASR (W)
mortality
1970
514
9.8
164
3.0
1980
542
11.6
179
2.8
1985
745
10.1
256
3.7
1990
710
12.3
260
3.9
2000
985
17.1
340
5.2
2003
1096
19.3
356
5.5
SDR, cancer of the cervix, 0-64, per 100000
7
6
5
Bulgaria
Netherlands
United Kingdom
European Region
EU
4
3
2
1
1970
1975
1980
1985
1990
1995
2000
2005
HFA-DB, WHO/Europe, June 2005
Cervical cancer screening in Bulgaria
 Prophylactic gynecological examinations have been
conducted in Bulgaria since 1956
 In 1970 K. Tzanev and D. Nikolova introduced
cytological screening as a routine test in the practice:
• The screening involves all female population over 30
years and was performed once per two years;
• It was conducted by district gynecologists and
nurses from all over the country;
• Diagnostic cytological tests were performed in 14
labs (13 Regional Oncological Dispensaries and the
National Oncological Centre in Sofia);
• According to that screening program, 1.5 mill.
women were subject to examination.
 The screening program gradually stop working at the
end of the 80’ies without administrative order or any
other decision from the government
Some reasons for cervical cancer screening program failure
 Faults in organization of the program:
• No team for management
• No screening registry
• Lack of call and recall system
• No unified system for diagnostics of signalized women
• No quality control on all levels
 Faults in screening tests:
• No monitoring quality of cervical smears
• No unified system (guidelines) for preparation and
storage of the smears
• No good synchronization between labs and physicians
• No registration in the screening registry
 Faults in interpretation of the results:
• No unified cytological classification
• No internal and external quality control at the labs
• No continuous training and education of the staff
involved
What’s the situation now?
1. A National Strategy for Prophylactic Oncological
Screening in Republic of Bulgaria for the period
2001-2006 was created. It includes breast cancer,
cancer of the cervix uteri and prostate cancer.
2. The National Oncological Strategy was accepted by
the Council of Ministers on 23rd of April 2001. That
Strategy was not realized in practice.
3. Now, there isn't
organized population based
screening program in Bulgaria.
ACTIVITIES UNDER EUROCHIP-2 PROJECT
IN BULGARIA
Two meetings were organized in Sofia, Bulgaria:
The first one was on February 17th 2006 with experts from
Italy, Bulgaria and Romania. The subject of the meeting
was “Cervical cancer Screening in Bulgaria – past, present
and future”. Official representatives from the Government,
Professional and Public Organizations of Bulgaria
participated in the meeting.
MEETING AIMS
•
To underline EUROCHIP aims
•
Bulgarian cervical cancer screening: state of the
organization and difficulties
•
EUROCHIP-2 in Bulgaria
MEETING CONCLUSIONS
•
Second meeting within 2-3 months again in
Sofia with participation of other Eastern
European countries with specific problems
in the diffusion of cervical cancer screening
•
All the costs will be under EUROCHIP
•
EUROCHIP will invite European cervical
cancer screening experts
•
MAIN AIM - what we need for changing
situation?
•
OTHER AIM - to present to European Health
Authorities the problems of the Eastern
European countries on cancer screening
After the meeting the Bulgarian group of experts
prepared proposal for action with AIM:
ANALYSIS
AND
EVALUATION
OF
THE
SITUATION OF CERVICAL CANCER SECONDARY
PREVENTION
IN
BULGARIA
AND
RECOMMENDATIONS
FOR
THE
FUTURE
DEVELOPMENT
MAIN TASKS
I. STUDY OF:
1. Available information for secondary prevention of
cervical cancer (CC).
2. The law acts in the field of CC secondary prevention.
3. Epidemiology of CC.
4. The health-care affiliations incurred in CC secondary
prevention.
5. Availability and equipment of cytology labs for
completing cervical screening (qualitative and
quantitative assessment).
II. MAIKING of a report with an in-dept evaluation
and recommendations
The second meeting was on 22nd May
2006 in Sofia, Bulgaria. Experts from Milan,
Torino, Helsinki, Bulgaria, Romania, Latvia,
Lithuania and Estonia were invited and
participated in the meeting.
The subject of the meeting was
“EUROCHIP Task Force on Cervical Cancer
Screening Emergency”
DISCUSSIONS AND DECISIONS OF THE MEETING
BULGARIA: STATE OF THE ART
Is organised screening present in the past? YES (up to 1989)
Does this program have problems? YES (mortality did not decrease)
Is organised screening present at the moment? NO
At the moment are we in the position to reorganize the
screening program? NO
What is mainly necessary at the beginning? Which is the
major problem at the moment?
a. Political interest
Steps to follow:
a. MAJOR PROBLEM: To find groups of pressure
(Groups like EuropaDonna, Medical Associations…)
within the country and at international level
b. To find practical proposals necessary to start the
reorganization and also to solve problems in the past
c. To start with Pilot Program: define the team that
could promote and organize the Pilot
TASK FORCE ACTIVITIES (1)
1. Groups of pressures. Ex: ONDA => European Parliament
• Meeting with women of the European Parliament (to
organize probably in September 2006)
• Public opinion. Articles on newspapers and women
magazines with a local vision
2. Information for local medical associations. EUROCHIP WT
Task: Prepare a letter to send to local medical associations
3. Specific recommendations to Health Authorities at
national level and at international level. EUROCHIP WT Task:
paper for Network of Health Authorities. In the PAPER we will
also invite the Health Ministries to inform the EC about the
cervical cancer screening programs activated (info on
structure, organization, results)
WT: Working Team
TASK FORCE ACTIVITIES (2)
4. Participation in the chapter on cancer in the EC Health Book
5. Meeting devoted to the discussion of technical aspects
Probably period: before the end of 2006.
Main tasks: Is our work compatible with European guidelines?
Study of the possibility to develop a centralized information
system (invitation, recall, monitor) in each country
6. To Share information. All information, all presentations will
be available at the web-site www.tumori.net/eurochip
7. To change information with EUNICE in order to have
standardize collection of data from new screening programs (it
is really important to know the activities of the other European
projects on this matter in order to avoid duplications)
WT: Working Team
The recent decision (from this week) of the
Bulgarian Ministry of Health is to form a
National group of experts to develop a new
National Screening Program